Esophageal/gastric varices yog tshwm sim los ntawm kev pheej hmoo ntawm portal hypertension thiab muaj kwv yees li 95% tshwm sim los ntawm cirrhosis ntawm ntau yam ua rau. Varicose leeg los ntshav feem ntau cuam tshuam nrog cov ntshav ntau thiab cov neeg tuag coob, thiab cov neeg mob los ntshav tsis kam ua rau kev phais me ntsis.
Nrog rau kev txhim kho thiab kev siv cov tshuab digestive endoscopic kev kho mob, kev kho mob endoscopic tau dhau los ua ib txoj hauv kev tseem ceeb los kho esophageal / gastric variceal los ntshav. Nws feem ntau suav nrog endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) thiab endoscopic kua nplaum txhaj tshuaj kho (EVHT).
Endoscopic Sclerotherapy (EVS)
ntu 1
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) Yav dhau los keeb kwm ntawm EV rupture thiab los ntshav;
(3) Cov neeg mob rov muaj dua EV tom qab kev phais;
(4) Cov uas tsis haum rau kev kho mob phais.
3) Contraindications ntawm EVS:
(1) Tib contraindications raws li gastroscopy;
(2) Hepatic encephalopathy theem 2 lossis 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 (Sivkoob sclerotherapy). Rau cov hlab ntsha loj, xaiv cov tshuaj intravascular. Qhov kev txhaj tshuaj yog feem ntau 10 mus rau 15 mL. 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 (Ulcers yuav 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 kho mob 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 tshuaj los 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 ua rau cov ntshav spurting los yog gushing ntshav los ntawm lub qhov koob thaum tshem lub koob.
(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, portal vein thrombosis.
Endoscopic varicose leeg ligation (EVL)
Ntu 2
1) Indications rau EVL: Ib yam li EVS.
2) Contraindications ntawm EVL:
(1) Tib contraindications raws li gastroscopy;
(2) EV nrog pom tseeb GV;
(3) Cov neeg mob uas mob siab heev thiab lub raum tsis ua haujlwm, muaj ntau ntawm ascites, jaundice, tsis ntev los no ntau yam kev kho mob sclerotherapy lossis cov leeg varicose me me.
3) Ua haujlwm li cas
Xws li ib leeg plaub hau ligation, ntau cov plaub hau ligation, thiab nylon hlua ligation.
(1) Lub hauv paus ntsiab lus: Thaiv cov ntshav ntws ntawm varicose leeg thiab muab cov hemostasis thaum muaj xwm 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 kab 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.
Nws yuav siv li 1 mus rau 2 lub lis piam rau cov necrosis poob tom qab cov ntaub qhwv necrosis. Ib lub lis piam 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 ntawm varicose leeg los ntshav. EVL tuaj yeem tshem tawm cov kab mob varicose sai sai thiab muaj qee qhov teeb meem, tab sis cov leeg varicose rov tshwm sim. Qhov kev faib ua feem yog nyob rau sab siab;
EVL tuaj yeem thaiv cov hlab ntsha ntawm cov hlab ntsha sab laug, cov hlab ntsha hauv plab, thiab vena cava. Txawm li cas los xij, tom qab esophageal venous ntshav khiav tau raug thaiv, lub plab coronary leeg thiab perigastric venous plexus yuav nthuav dav, cov ntshav ntws yuav nce, thiab tus nqi rov qab yuav nce ntxiv rau lub sijhawm. Yog li ntawd, nws yog feem ntau Repeated band ligation yog yuav tsum tau muab cov kev kho mob. Txoj kab uas hla ntawm varicose leeg ligation yuav tsum tsawg dua 1.5 cm.
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 phais, daim siab thiab lub raum ua haujlwm, B-ultrasound, cov 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) EV vs EV
Piv nrog rau sclerotherapy thiab ligation, tsis muaj qhov sib txawv tseem ceeb hauv kev tuag thiab rov los ntshav ntawm ob. Rau cov neeg mob uas xav tau kev kho mob dua, ligation feem ntau pom zoo. Qee zaum ligation thiab sclerotherapy kuj tau ua ke, uas tuaj yeem txhim kho kev kho mob. nyhuv. Nyob rau hauv txawv teb chaws, tag nrho cov hlau stents kuj tau siv los tiv thaiv los ntshav.
Endoscopic cov ntaub so ntswg kua nplaum kev kho mob (EVHT)
ntu 3
Txoj kev no yog tsim rau gastric varices thiab esophageal variceal los ntshav thaum muaj xwm ceev.
1) Cov teeb meem ntawm EVHT: feem ntau yog pulmonary artery thiab portal vein embolism, tab sis qhov tshwm sim tsawg heev.
2) Qhov zoo ntawm EVHT: varicose veins ploj sai sai, rov los ntshav tsawg, cov teeb meem tsis tshua muaj, qhov taw qhia dav thiab cov cuab yeej siv tau yooj yim.
3) Cov ntsiab lus tseem ceeb:
Hauv kev kho mob endoscopic kua nplaum, qhov kev txhaj tshuaj yuav tsum txaus. Endoscopic ultrasound plays lub luag haujlwm zoo heev hauv kev kho cov leeg varicose thiab tuaj yeem txo qhov kev pheej hmoo ntawm rov los ntshav.
Muaj cov ntawv ceeb toom nyob rau hauv cov ntaub ntawv txawv teb chaws hais tias kev kho mob ntawm gastric varices nrog coils los yog cyanoacrylate nyob rau hauv cov kev taw qhia ntawm endoscopic ultrasound yog zoo rau lub zos gastric varices. Piv nrog rau kev txhaj tshuaj cyanoacrylate, endoscopic ultrasound-guided coiling yuav tsum tau txhaj tshuaj intraluminal tsawg dua thiab cuam tshuam nrog cov xwm txheej tsis zoo.
Peb, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., yog cov chaw tsim khoom hauv Suav teb tshwj xeeb hauv cov khoom siv endoscopic, xws libiopsy forceps, hemoclip, polyp nuv, koob sclerotherapy, tshuaj tsuag catheter, cytology txhuam, phau ntawv qhia, pob zeb retrieval pob tawb, qhov ntswg biliary kua catheteretc. uas yog dav siv nyob rau hauvEMR, ESD, ERCP. Peb cov khoom muaj ntawv pov thawj CE, thiab peb cov nroj tsuag tau 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 cov neeg siv khoom ntawm kev lees paub thiab qhuas!
Post lub sij hawm: Aug-15-2024