Kalafo ea Endoscopic ea ho tsoa mali ha 'metso / gastric venous

Esophageal / gastric varices ke litholoana tsa litlamorao tse sa khaotseng tsa portal hypertension mme li ka ba 95% tse bakoang ke ho thatafala ha lisosa tse fapaneng. Hangata mali a tsoa mali a methapo ea varicose e ama mali a mangata haholo le ho shoa ho hoholo, 'me bakuli ba tsoang mali ba na le mamello e fokolang ea ho buuoa.

Ka ntlafatso le ts'ebeliso ea thekenoloji ea kalafo ea tšilo ea lijo, kalafo ea endoscopic e fetohile e 'ngoe ea mekhoa ea mantlha ea ho phekola ho tsoa mali ha 'metso / gastric variceal. Haholo-holo e kenyelletsa endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) le endoscopic tissue glue injection therapy (EVHT).

Endoscopic Sclerotherapy (EVS)

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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;
Paravascular injection: ho baka ts'oaetso e sa sebetseng ea ho ruruha methapong ho baka thrombosis.
2) Matšoao a EVS:
(1) Ho phatloha ho hoholo ha EV le ho tsoa mali;
(2) Histori e fetileng ea ho phatloha ha EV le ho tsoa mali;
(3) Bakuli ba nang le ho khutla ha EV ka mor'a ho buuoa;
(4) Ba sa tšoaneleheng bakeng sa phekolo ea ho buuoa.
3) Contraindications tsa EVS:
(1) Li-contraindication tse tšoanang le tsa gastroscopy;
(2) Hepatic encephalopathy sethaleng sa 2 kapa 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(Sebelisasclerotherapy nale). Bakeng sa methapo e meholo ea mali, khetha ente ea intravascular. Bophahamo ba ente hangata ke 10 ho isa ho 15 ml. 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 ( Liso li ka 'na tsa hlaha tse lebisang ho thipa 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) Kalafo ea morao-rao 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 ho theola 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
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(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, portal vein thrombosis.

Endoscopic varicose vein ligation (EVL)

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1) Lipontšo tsa EVL: Ho tšoana le EVS.
2) Contraindications tsa EVL:
(1) Li-contraindication tse tšoanang le tsa gastroscopy;
(2) EV e tsamaeang le GV e hlakileng;
(3) Bakuli ba nang le ho se sebetse ho matla ha sebete le liphio, boholo ba ascites, jaundice, phekolo ea morao tjena ea multiple sclerotherapy kapa methapo e nyenyane ea varicose.
3) Mokhoa oa ho sebetsa
Ho kenyelletsa moriri o le mong oa ho kopanya, moriri o mongata oa moriri, le khoele ea nylon.
(1) Molao-motheo: Thibela phallo ea mali ea methapo ea varicose le ho fana 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.
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 methapo ea varicose e tsoa mali. EVL e ka felisa methapo ea varicose kapele mme e na le mathata a fokolang, empa methapo ea varicose e ipheta hape. Karolo e ka lehlakoreng le phahameng;
EVL e ka thibela ho tsoa mali ho tsoa mothapong o ka letsohong le letšehali, mothapo oa esophageal le vena cava. Leha ho le joalo, ka mor'a 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 sekhahla sa ho khutla se tla eketseha ha nako e ntse e feta. Ka hona, hangata E phetoa band ligation ho hlokahala ho kopanya kalafo. Bophara ba methapo ea varicose e lokela ho ba tlase ho 1.5 cm.
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 ho buuoa ka EVL, sebete le liphio, B-ultrasound, mokhoa oa mali, ts'ebetso ea coagulation, joalo-joalo e lokela ho hlahlojoa likhoeli 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, ha ho na phapang e khōlō ho batho ba shoang le ho tsoa mali hape pakeng tsa tse peli. Bakeng sa bakuli ba hlokang phekolo khafetsa, ligation e khothalletsoa hangata. Ka linako tse ling ligation le sclerotherapy li boetse li kopantsoe, tse ka ntlafatsang phekolo. Phello. Linaheng tsa linaheng tse ling, li-stents tsa tšepe tse koahetsoeng ka ho feletseng li boetse li sebelisoa ho emisa ho tsoa mali.

Endoscopic tissue glue injection therapy (EVHT)

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Mokhoa ona o loketse bakeng sa varices gastric le esophageal variceal mali maemong a tšohanyetso.
1) Mathata a EVHT: haholo-holo pulmonary artery le portal vein embolism, empa ketsahalo e tlase haholo.
2) Melemo ea EVHT: methapo ea varicose e nyamela kapele, sekhahla sa ho tsoa mali hape se tlase, mathata a batla a fokola, matšoao a pharalletse mme theknoloji e bonolo ho e tseba.
3) Lintho tseo u lokelang ho li ela hloko:
Phekolo ea endoscopic glue ente, palo ea ente e tlameha ho lekana. Endoscopic ultrasound e bapala karolo e ntle haholo kalafong ea methapo ea varicose mme e ka fokotsa kotsi ea ho tsoa mali hape.
Ho na le litlaleho libukeng tse tsoang linaheng tse ling hore phekolo ea li-varices tsa gastric tse nang le li-coil kapa cyanoacrylate tlas'a tataiso ea endoscopic ultrasound e sebetsa hantle bakeng sa li-gastric varices tsa sebakeng seo. Ha ho bapisoa le liente tsa cyanoacrylate, endoscopic ultrasound-guided coiling e hloka liente tse fokolang tsa intraluminal 'me e amahanngoa le liketsahalo tse fokolang tse fokolang.

We, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ke moetsi oa China ea sebetsanang le lisebelisoa tsa endoscopic, joalo kabiopsy forceps, hemoclips, polyp leraba, sclerotherapy nale, fafatsa catheter, borashe ba cytology, guidewire, seroto sa ho khutlisa lejoe, nasal biliary drainage catheterjoalo-joalo tse sebelisoang haholo hoEMR, ESD, ERCP. Lihlahisoa tsa rona li netefalitsoe ke CE, 'me limela tsa rona li netefalitsoe ke ISO. Thepa ea rona e rometsoe Europe, Amerika Leboea, Bochabela bo Hare le karolo ea Asia, 'me e fumana ho pharaletseng moreki oa kananelo le thoriso!