1) Molao-motheo oa endoscopic sclerotherapy (EVS):
Intravascular ente: sclerosing agent e baka ho ruruha ho pota-pota methapo, e thatafatsa methapo ea mali le ho thibela ho phalla ha mali;
Ente ea paravascular: e baka ts'ebetso e sa sebetseng ea ho ruruha methapong ho baka thrombosis.
2) Lipontšo tsa EVS:
(1) Ho phatloha ho hoholo ha EV le ho tsoa mali;
(2) Batho ba nang le histori ea ho phatloha ha EV le ho tsoa mali;(3) Batho ba nang le ho khutla ha EV ka mor'a ho buuoa;(4) Batho ba sa tšoaneleheng bakeng sa phekolo ea ho buuoa.
3) Contraindications tsa EVS:
(1) Ho tšoana le gastroscopy;
(2) Hepatic encephalopathy mohato oa 2 le ka holimo;
(3) Bakuli ba nang le ho se sebetse ho matla ha sebete le liphio, palo e ngata ea ascites, le jaundice e matla.
4) Litlhokomelo tsa ts'ebetso
China, o ka khetha lauromacrol.Bakeng sa methapo e meholo ea mali, khetha ente ea intravascular.Bophahamo ba ente hangata ke 10 ~ 15mL.Bakeng sa methapo e menyenyane ea mali, o ka khetha ente ea paravascular.Leka ho qoba ho enta lintlheng tse 'maloa tse fapaneng sefofaneng se le seng (mohlomong Liso li ka 'na tsa e-ba teng tse lebisang ho thibaneng ha 'metso).Haeba phefumoloho e ameha nakong ea ts'ebetso, sekoahelo se hlakileng se ka kenngoa ho gastroscope.Linaheng tsa linaheng tse ling, hangata balune e kenngoa ho gastroscope.Ke habohlokoa ho ithuta ho.
5) Tsamaiso ea postoperative ea EVS
(1) U se ke ua ja kapa ua noa lihora tse 8 ka mor'a ho buuoa 'me butle-butle u qale ho ja lijo tse metsi;
(2) Sebelisa tekanyo e loketseng ea lithibela-mafu ho thibela tšoaetso;(3) Sebelisa lithethefatsi tse theolang khatello ea portal ha ho loketse.
6) Koetliso ea phekolo ea EVS
Multiple sclerotherapy e hlokahala ho fihlela methapo ea varicose e nyamela kapa ha e le hantle e nyamela, ka nako e ka bang beke e le 'ngoe pakeng tsa phekolo e' ngoe le e 'ngoe;gastroscopy e tla hlahlojoa khoeli e le 'ngoe, likhoeli tse 3, likhoeli tse 6 le selemo se le seng ka mor'a ho fela ha phekolo.
7) Mathata a EVS
(1) Mathata a tloaelehileng: ectopic embolism, esophageal ulcer, joalo-joalo, le
Ho bonolo ho etsa hore mali a phalle kapa a tšolohe ka lesoba la nale ha nalete e ntšoa.
(2) Mathata a sebakeng seo: liso, ho tsoa mali, stenosis, ho se sebetse hantle ha 'metso, odynophagia, maqeba.Mathata a tikoloho a kenyelletsa mediastinitis, perforation, pleural effusion, le portal hypertensive gastropathy e nang le kotsi e eketsehileng ea ho tsoa mali.
(3) Mathata a tsamaiso: sepsis, aspiration pneumonia, hypoxia, spontaneous bacterial peritonitis, le portal vein thrombosis.
Endoscopic varicose vein ligation(EVL)
1) Lipontšo tsa EVL:E tšoana le EVS.
2) Contraindications tsa EVL:
(1) Li-contraindication tse tšoanang le tsa gastroscopy;
(2) EV e tsamaeang le GV e hlakileng;
(3) ho tsamaisana le ho se sebetse ho matla ha sebete le liphio, bongata ba ascites, jaundice
Kalafo ea Gangrene le ea morao-rao ea multiple sclerotherapy kapa methapo e menyenyane ea varicose
Ho nka Leloko la Han e le haufi-duofu ho bolela hore batho ba Hua ba tla khona ho tsamaea ka bolokolohi, kapa li-tendon le li-pulses li tla otlolloa ka bophirimela.
Ka.
3) Mokhoa oa ho sebetsa
Ho kenyelletsa moriri o le mong oa ho kopanya, moriri o mongata oa moriri, le khoele ea nylon.
Molao-motheo: Thibela phallo ea mali ea methapo ea varicose 'me u fane ka hemostasis ea tšohanyetso → venous thrombosis sebakeng sa ligation → tissue necrosis → fibrosis → ho nyamela ha methapo ea varicose.
(2) Litlhokomelo
Bakeng sa methapo e leka-lekaneng ho ea ho e matla ea 'metso, mothapo o mong le o mong oa varicose o hokahantsoe ka mokhoa oa spiral ho ea holimo ho tloha tlase ho ea holimo.Ligator e lokela ho ba haufi ka hohle kamoo ho ka khonehang ho sepheo sa ligation ea mothapo oa varicose, e le hore ntlha e 'ngoe le e' ngoe e be le ligated ka ho feletseng le densely ligated.Leka ho koahela mothapo o mong le o mong oa varicose ka lintlha tse fetang 3.
EVL mehato
Mohloli: Sebui PPT
Ho nka libeke tse 1 ho isa ho tse 2 hore necrosis e oele ka mor'a necrosis ea tlamisa.Beke ka mor'a ho buuoa, liso tsa sebakeng seo li ka 'na tsa tsoa mali a mangata haholo, letlapa la letlalo lea oa,' me ho itšeha ha methapo ea varicose ho tsoa mali, joalo-joalo;
EVL e ka felisa methapo ea varicose ka potlako 'me e na le mathata a fokolang, empa sekhahla sa ho khutla ha methapo ea varicose se phahame;
EVL e ka thibela mats'oafo a mali a mothapo o ka letsohong le letšehali, mothapo oa esophageal le vena cava, empa kamora hore phallo ea mali ea esophageal e koetsoe, mothapo oa pelo le perigastric venous plexus li tla atoloha, phallo ea mali e tla eketseha, 'me lebelo la ho khutla hape. e tla eketseha ha nako e ntse e ea, kahoo hangata E phetoa band ligation e hlokahalang ho kopanya phekolo.Bophara ba methapo ea varicose ha boa lokela ho feta 1.5cm.
4) Mathata a EVL
(1) Ho tsoa mali a mangata haholo ka lebaka la liso tsa sebakeng seo hoo e ka bang beke e le ’ngoe ka mor’a ho buuoa;
(2) Ho tsoa mali ka har'a opereishene, ho lahleheloa ke letlapa la letlalo, le ho tsoa mali ho bakoang ke methapo ea varicose;
(3) Tšoaetso.
5) Tlhahlobo ea postoperative ea EVL
Selemong sa pele ka mor'a EVL, ts'ebetso ea sebete le liphio, B-ultrasound, mokhoa oa mali, ts'ebetso ea coagulation, joalo-joalo e lokela ho hlahlojoa likhoeli tse ling le tse ling tse 3 ho isa ho tse 6.Endoscopy e lokela ho hlahlojoa likhoeli tse ling le tse ling tse 3, ebe likhoeli tse ling le tse ling tse 0 ho isa ho tse 12.6) EVS vs EVL
Ha ho bapisoa le sclerotherapy le ligation, litekanyetso tsa ho shoa le ho khutlela mokhoeng oa bobeli li joalo
Ha ho na phapang e khōlō tekanyong ea mali le ho bakuli ba hlokang phekolo khafetsa, band ligation e atisa ho khothaletsoa.Band ligation le sclerotherapy ka linako tse ling li kopantsoe ho ntlafatsa phello ea kalafo.Linaheng tsa linaheng tse ling, li-stents tsa tšepe tse koahetsoeng ka ho feletseng li boetse li sebelisoa ho emisa ho tsoa mali.
TheNale ea Sclerotherapyho tsoa ho ZRHmed li sebelisetsoa Endoscopic Sclerotherapy (EVS) le Endoscopic varicose vein ligation(EVL).
Nako ea poso: Jan-08-2024