1) Lub hauv paus ntsiab lus ntawm endoscopic sclerotherapy (EVS):
Kev txhaj tshuaj intravascular: sclerosing tus neeg sawv cev ua rau o nyob ib ncig ntawm cov leeg, ua rau cov hlab ntsha tawv thiab thaiv cov ntshav ntws;
Kev txhaj tshuaj Paravascular: ua rau muaj kev tsis haum tshuaj tiv thaiv kab mob hauv cov leeg ua rau thrombosis.2) Indications ntawm EVS:
(1) Mob EV rupture thiab los ntshav;
(2) Cov neeg muaj keeb kwm ntawm EV rupture thiab los ntshav;(3) Cov neeg uas rov muaj dua EV tom qab phais;(4) Cov neeg tsis haum rau kev kho mob phais.
3) Contraindications ntawm EVS:
(1) Ib yam li gastroscopy;
(2) Hepatic encephalopathy theem 2 thiab siab dua;
(3) Cov neeg mob uas mob siab heev thiab lub raum tsis ua haujlwm, muaj ntau qhov ascites, thiab mob daj ntseg loj.
4) Kev ceev faj ua haujlwm
Hauv Suav teb, koj tuaj yeem xaiv lauromacrol.Rau cov hlab ntsha loj, xaiv cov tshuaj intravascular.Kev txhaj tshuaj yog feem ntau 10 ~ 15mL.Rau cov hlab ntsha me, koj tuaj yeem xaiv kev txhaj tshuaj paravascular.Sim kom tsis txhob txhaj tshuaj ntawm ob peb lub ntsiab lus sib txawv ntawm tib lub dav hlau (tej zaum Ulcers tuaj yeem tshwm sim ua rau txoj hlab pas txhaws).Yog tias ua pa cuam tshuam rau lub sijhawm ua haujlwm, lub hau pob tshab tuaj yeem muab ntxiv rau hauv gastroscope.Nyob rau hauv txawv teb chaws, ib tug balloon feem ntau yog ntxiv rau lub gastroscope.Nws yog tsim nyog kawm los ntawm.
5) Kev tswj xyuas tom qab EVS
(1) Tsis txhob noj lossis haus dej li 8 teev tom qab kev phais thiab maj mam rov ua cov zaub mov ua kua;
(2) Siv cov tshuaj tua kab mob kom tsim nyog los tiv thaiv kev kis kab mob;(3) Siv cov tshuaj uas txo qhov siab ntawm lub portal raws li qhov tsim nyog.
6) EVS kev kho mob
Kev kho ntau yam sclerotherapy yuav tsum tau kom txog thaum cov hlab ntsha varicose ploj los yog qhov pib ploj, nrog lub sijhawm li ntawm 1 lub lis piam ntawm txhua qhov kev kho mob;gastroscopy yuav raug tshuaj xyuas 1 lub hlis, 3 hlis, 6 lub hlis, thiab 1 xyoos tom qab qhov kawg ntawm kev kho mob.
7) Cov teeb meem ntawm EVS
(1) Cov teeb meem tshwm sim: ectopic embolism, esophageal ulcer, thiab lwm yam, thiab
Nws yog ib qho yooj yim uas yuav ua rau cov ntshav spurting los yog gushing ntshav los ntawm lub qhov koob thaum lub koob yog rub tawm.
(2) Cov teeb meem hauv zos: ulcers, los ntshav, stenosis, esophageal motility dysfunction, odynophagia, lacerations.Cov teeb meem hauv cheeb tsam muaj xws li mediastinitis, perforation, pleural effusion, thiab portal hypertensive gastropathy nrog kev pheej hmoo los ntshav.
(3) Cov teeb meem hauv lub cev: sepsis, aspiration pneumonia, hypoxia, spontaneous bacterial peritonitis, thiab portal vein thrombosis.
Endoscopic varicose leeg ligation (EVL)
(1) Cov Lus Qhia rau EVL: Ib yam li EVS.
(2) Contraindications ntawm EVL:
(1) Tib contraindications raws li gastroscopy;
(2) EV nrog pom tseeb GV;
(3) nrog rau lub siab thiab lub raum tsis ua haujlwm hnyav, ntau qhov ascites, jaundice
Gangrene thiab tsis ntev los no ntau yam kev kho mob sclerotherapy lossis varicose leeg me me
Noj Han Dynasty ua ib qho ze-duofu txhais tau hais tias cov neeg Hua yuav txav tau yooj yim, lossis cov leeg thiab cov pulses yuav ncab mus rau sab hnub poob.
Los ntawm.
3) Ua haujlwm li cas
Xws li ib leeg plaub hau ligation, ntau cov plaub hau ligation, thiab nylon hlua ligation.
Lub hauv paus ntsiab lus: Thaiv cov ntshav khiav ntawm varicose leeg thiab muab cov hemostasis thaum muaj xwm txheej ceev → venous thrombosis ntawm qhov chaw ligation → cov ntaub so ntswg necrosis → fibrosis → ploj ntawm varicose leeg.
(2) Kev ceev faj
Rau nruab nrab mus rau qhov loj heev varices esophageal varices, txhua lub varicose leeg yog ligated nyob rau hauv ib tug kauv upward yam los ntawm hauv qab mus rau sab saum toj.Lub ligator yuav tsum nyob ze li sai tau rau lub hom phiaj ligation point ntawm varicose leeg, kom txhua qhov taw tes yog tag nrho ligated thiab densely ligated.Sim npog txhua qhov varicose leeg ntawm ntau tshaj 3 ntsiab lus.
EVL cov kauj ruam
Tau qhov twg los: Speaker PPT
Nws yuav siv li 1 mus rau 2 lub lis piam rau cov necrosis poob tom qab cov ntaub qhwv necrosis.Ib lub lim tiam tom qab kev ua haujlwm, cov kab mob hauv zos tuaj yeem ua rau los ntshav loj, daim tawv nqaij poob tawm, thiab cov neeg kho tshuab txiav cov leeg varicose los ntshav, thiab lwm yam;
EVL tuaj yeem tshem tawm cov kab mob varicose sai sai thiab muaj qee yam teeb meem, tab sis qhov rov tshwm sim ntawm varicose leeg yog siab;
EVL tuaj yeem thaiv cov hlab ntsha ntawm cov hlab ntsha sab laug, cov hlab ntsha hauv plab, thiab vena cava, tab sis tom qab cov hlab ntsha hauv cov hlab ntsha raug thaiv, cov hlab ntsha hauv plab thiab cov hlab ntsha perigastric venous plexus yuav nthuav dav, cov ntshav ntws yuav nce ntxiv, thiab qhov rov tshwm sim dua. yuav nce ntxiv rau lub sij hawm, yog li nws yog feem ntau Rov qab band ligation yuav tsum tau sib sau ua ke cov kev kho mob.Txoj kab uas hla ntawm varicose leeg ligation yuav tsum tsawg dua 1.5cm.
4) Cov teeb meem ntawm EVL
(1) Los ntshav loj heev vim muaj kab mob hauv zos li 1 lub lis piam tom qab kev phais;
(2) Intraoperative los ntshav, poob ntawm daim tawv nqaij, thiab los ntshav los ntawm varicose leeg;
(3) Kab mob.
5) Kev tshuaj xyuas tom qab EVL
Hauv thawj xyoo tom qab EVL, daim siab thiab lub raum ua haujlwm, B-ultrasound, ntshav niaj hnub, coagulation muaj nuj nqi, thiab lwm yam yuav tsum tau tshuaj xyuas txhua 3 mus rau 6 lub hlis.Endoscopy yuav tsum tau tshuaj xyuas txhua 3 lub hlis, thiab tom qab ntawd txhua txhua 0 mus rau 12 lub hlis.6) TSI vs EVL
Piv nrog rau kev kho mob sclerotherapy thiab ligation, qhov kev tuag thiab rov qab los ntawm ob yog
Tsis muaj qhov sib txawv loj ntawm cov ntshav thiab rau cov neeg mob uas xav tau kev kho mob rov qab, band ligation feem ntau pom zoo.Band ligation thiab sclerotherapy qee zaum ua ke los txhim kho kev kho mob.Nyob rau hauv txawv teb chaws, tag nrho cov hlau stents tseem siv los tiv thaiv los ntshav.
CovSclerotherapy kooblos ntawm ZRHmed yog siv rau Endoscopic Sclerotherapy (EVS) thiab Endoscopic varicose leeg ligation (EVL).
Post lub sij hawm: Jan-08-2024