Kev kho mob endoscopic ntawm cov ntshav tawm hauv esophageal / gastric

Cov hlab ntsha varices ntawm txoj hlab pas/gastric yog qhov tshwm sim ntawm cov teebmeem ntawm kev mob ntshav siab thiab kwv yees li 95% yog tshwm sim los ntawm cirrhosis ntawm ntau yam ua rau. Kev los ntshav ntawm cov leeg ntshav varicose feem ntau muaj kev los ntshav ntau thiab kev tuag ntau, thiab cov neeg mob uas los ntshav tsis kam phais.

Nrog kev txhim kho thiab kev siv cov thev naus laus zis kho mob plab zom mov endoscopic, kev kho mob endoscopic tau dhau los ua ib txoj hauv kev tseem ceeb los kho cov ntshav tawm ntawm esophageal/gastric variceal. Nws feem ntau suav nrog endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) thiab endoscopic tissue glue injection therapy (EVHT).

Kev kho mob endoscopic sclerotherapy (EVS)

ntu 1

1) Lub hauv paus ntsiab lus ntawm kev kho mob endoscopic sclerotherapy (EVS):
Kev txhaj tshuaj rau hauv cov hlab ntsha: tus neeg sawv cev sclerosing ua rau o ntawm cov hlab ntsha, ua rau cov hlab ntsha tawv thiab thaiv cov ntshav ntws;
Kev txhaj tshuaj paravascular: ua rau muaj kev o ntawm cov leeg ntshav kom ua rau muaj kev ntshav txhaws.
2) Cov cim qhia ntawm EVS:
(1) EV tawg thiab los ntshav sai heev;
(2) Keeb kwm yav dhau los ntawm EV tawg thiab los ntshav;
(3) Cov neeg mob uas rov qab muaj EV tom qab phais;
(4) Cov neeg uas tsis haum rau kev phais mob.
3) Cov Kev Txwv Tsis Pub Siv EVS:
(1) Cov kev tsis pom zoo ib yam li gastroscopy;
(2) Kab mob hlwb siab theem 2 lossis siab dua;
(3) Cov neeg mob uas muaj teeb meem siab thiab raum loj heev, muaj cov kua qaub ntau ntau, thiab mob daj ntseg heev.
4) Kev ceev faj ua haujlwm
Hauv Suav teb, koj tuaj yeem xaiv lauromacrol (Sivkoob txhaj tshuaj sclerotherapy). Rau cov hlab ntsha loj dua, xaiv kev txhaj tshuaj rau hauv cov hlab ntsha. Feem ntau qhov ntim txhaj tshuaj yog 10 txog 15 mL. Rau cov hlab ntsha me dua, koj tuaj yeem xaiv kev txhaj tshuaj paravascular. Sim tsis txhob txhaj tshuaj rau ntau qhov sib txawv ntawm tib lub dav hlau (Tej zaum yuav muaj qhov txhab ua rau esophageal nruj). Yog tias ua pa tsis zoo thaum lub sijhawm phais, lub hau pob tshab tuaj yeem ntxiv rau hauv lub gastroscope. Hauv cov tebchaws txawv tebchaws, lub npas feem ntau ntxiv rau hauv lub gastroscope. Nws tsim nyog kawm los ntawm.
5) Kev kho mob tom qab phais ntawm EVS
(1) Tsis txhob noj lossis haus dej li 8 teev tom qab phais, thiab maj mam rov qab noj cov kua dej;
(2) Siv cov tshuaj tua kab mob kom txaus los tiv thaiv kev kis kab mob;
(3) Siv cov tshuaj kom txo qhov siab ntawm lub qhov rooj raws li qhov tsim nyog.
6) Kev kho mob EVS
Yuav tsum tau siv ntau yam kev kho mob sclerotherapy kom txog thaum cov leeg ntshav ploj mus lossis ploj mus tas li, nrog rau lub sijhawm li 1 lub lis piam ntawm txhua qhov kev kho mob; gastroscopy yuav raug tshuaj xyuas 1 hlis, 3 hlis, 6 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 yooj yim ua rau ntshav ntws los yog ntws ntshav los ntawm lub qhov koob thaum tshem lub koob.
(2) Cov teeb meem hauv cheeb tsam: mob qog, los ntshav, stenosis, esophageal motility tsis zoo, odynophagia, lacerations. Cov teeb meem hauv cheeb tsam suav nrog mediastinitis, perforation, pleural effusion, thiab portal hypertensive gastropathy nrog rau kev pheej hmoo ntawm kev los ntshav ntau dua.
(3) Cov teeb meem hauv lub cev: sepsis, aspiration pneumonia, hypoxia, spontaneous bacterial peritonitis, portal vein thrombosis.

Kev khi cov hlab ntsha varicose endoscopic (EVL)

Tshooj 2

1) Cov cim qhia rau EVL: Ib yam li EVS.
2) Cov Kev Txwv Tsis Pub Siv EVL:
(1) Cov kev tsis pom zoo ib yam li gastroscopy;
(2) EV nrog rau GV pom tseeb;
(3) Cov neeg mob uas muaj teeb meem siab thiab raum hnyav, muaj cov kua tsib ntau, mob daj ntseg, tsis ntev los no tau kho ntau yam sclerotherapy lossis cov leeg ntshav me me.
3) Yuav ua li cas khiav lag luam
Xws li kev khi plaub hau ib zaug, kev khi ntau plaub hau, thiab kev khi hlua nylon.
(1) Lub Ntsiab Cai: Thaiv cov ntshav ntws ntawm cov leeg ntshav thiab muab kev hemostasis thaum muaj xwm txheej ceev → venous thrombosis ntawm qhov chaw ligation → cov ntaub so ntswg necrosis → fibrosis → ploj ntawm cov leeg ntshav.
(2) Kev Ceev Faj
Rau cov kab mob varicose esophageal uas muaj qhov nruab nrab mus rau qhov hnyav, txhua txoj hlab ntsha varicose yuav tsum khi ua ib lub voj voog los ntawm hauv qab mus rau saum toj. Lub ligator yuav tsum nyob ze li sai tau rau qhov chaw khi ntawm cov hlab ntsha varicose, kom txhua qhov chaw khi tag nrho thiab khi nruj nreem. Sim npog txhua txoj hlab ntsha varicose ntau dua 3 qhov.
Yuav siv sijhawm li 1 txog 2 lub lis piam rau qhov necrosis kom poob tom qab bandage necrosis. Ib lub lis piam tom qab phais, cov qhov txhab hauv zos yuav ua rau los ntshav ntau heev, daim tawv nqaij poob tawm, thiab kev txiav cov leeg ntshav varicose los ntshav. EVL tuaj yeem tshem tawm cov leeg ntshav varicose sai sai thiab muaj ob peb qhov teeb meem, tab sis cov leeg ntshav varicose rov tshwm sim dua. Qhov feem pua ​​​​​​yog nyob rau sab siab;
EVL tuaj yeem thaiv cov hlab ntsha sab laug ntawm lub plab, cov hlab ntsha esophageal, thiab cov hlab ntsha vena cava. Txawm li cas los xij, tom qab cov ntshav ntws ntawm cov hlab ntsha esophageal raug thaiv, cov hlab ntsha gastric coronary thiab cov hlab ntsha perigastric yuav nthuav dav, cov ntshav ntws yuav nce ntxiv, thiab qhov rov tshwm sim yuav nce ntxiv raws sijhawm. Yog li ntawd, feem ntau yuav tsum tau rov ua dua cov hlua khi kom ruaj khov kho. Lub txoj kab uas hla ntawm cov hlab ntsha varicose ligation yuav tsum tsawg dua 1.5 cm.
4) Cov Teeb Meem ntawm EVL
(1) Los ntshav ntau heev vim yog cov qhov txhab hauv zos li ntawm 1 lub lim tiam tom qab phais;
(2) Kev los ntshav thaum phais, poob txoj siv tawv, thiab kev los ntshav los ntawm cov leeg ntshav varicose;
(3) Kev kis kab mob.
5) Kev tshuaj xyuas tom qab phais mob ntawm EVL
Xyoo thawj zaug tom qab phais EVL, yuav tsum tau saib xyuas lub siab thiab lub raum ua haujlwm li cas, B-ultrasound, kev kuaj ntshav, kev ua haujlwm ntawm cov ntshav coagulation, thiab lwm yam txhua 3 txog 6 lub hlis. Yuav tsum tau saib xyuas Endoscopy txhua 3 lub hlis, thiab tom qab ntawd txhua 0 txog 12 lub hlis.
6) EVS vs EVL
Piv nrog rau kev kho mob sclerotherapy thiab ligation, tsis muaj qhov sib txawv tseem ceeb hauv kev tuag thiab kev rov los ntshav ntawm ob qho no. Rau cov neeg mob uas xav tau kev kho mob ntau zaus, ligation feem ntau pom zoo. Qee zaum ligation thiab sclerotherapy kuj tseem ua ke, uas tuaj yeem txhim kho kev kho mob. Cov txiaj ntsig. Hauv cov tebchaws txawv teb chaws, cov hlau stents uas npog tag nrho kuj tseem siv los tiv thaiv kev los ntshav.

Kev kho mob siv koob txhaj kua nplaum rau hauv cov ntaub so ntswg (EVHT)

ntu 3

Txoj kev no yog qhov tsim nyog rau kev mob gastric varices thiab esophageal variceal los ntshav thaum muaj xwm txheej ceev.
1) Cov teeb meem ntawm EVHT: feem ntau yog cov hlab ntsha hauv lub ntsws thiab cov hlab ntsha portal embolism, tab sis qhov tshwm sim tsawg heev.
2) Cov txiaj ntsig ntawm EVHT: cov leeg ntshav ploj sai, qhov rov los ntshav tsawg, cov teeb meem tsawg, cov cim qhia dav dav thiab cov thev naus laus zis yooj yim rau kev paub.
3) Tej yam yuav tsum nco ntsoov:
Hauv kev kho mob siv tshuaj txhaj kua nplaum los ntawm kev siv lub koob yees duab endoscopic, yuav tsum txhaj kom txaus. Kev siv lub tshuab ultrasound los ntawm kev siv lub koob yees duab endoscopic ua lub luag haujlwm zoo heev hauv kev kho cov leeg ntshav varicose thiab txo tau qhov kev pheej hmoo ntawm kev rov los ntshav dua.
Muaj cov ntawv ceeb toom hauv cov ntaub ntawv txawv teb chaws hais tias kev kho mob ntawm cov hlab ntsha hauv plab nrog cov kauj lossis cyanoacrylate nyob rau hauv kev coj ntawm endoscopic ultrasound muaj txiaj ntsig zoo rau cov hlab ntsha hauv plab hauv zos. Piv nrog rau kev txhaj tshuaj cyanoacrylate, endoscopic ultrasound-guided coiling xav tau tsawg dua cov tshuaj txhaj rau hauv lub luminal thiab cuam tshuam nrog tsawg dua cov xwm txheej tsis zoo.

Peb, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., yog lub chaw tsim khoom hauv Suav teb tshwj xeeb hauv cov khoom siv endoscopic, xws licov forceps biopsy, hemoclip, polyp snare, koob txhaj tshuaj sclerotherapy, tshuaj tsuag catheter, cov txhuam cytology, txoj hlua qhia, pob zeb rov qab tau pob zeb, lub raj xa dej ntawm lub qhov ntswgthiab lwm yam uas siv dav hauvEMR, ESD, ERCPPeb cov khoom muaj daim ntawv pov thawj CE, thiab peb cov nroj tsuag muaj daim ntawv pov thawj ISO. Peb cov khoom tau raug xa tawm mus rau Tebchaws Europe, North America, Middle East thiab ib feem ntawm Asia, thiab tau txais kev lees paub thiab qhuas los ntawm cov neeg siv khoom!