1) Ka'idar endoscopic sclerotherapy (EVS):
Allurar intravascular: wakili na sclerosing yana haifar da kumburi a kusa da veins, yana taurare hanyoyin jini kuma yana toshe kwararar jini;
Paravascular allura: yana haifar da kumburi mai kumburi a cikin jijiyoyi don haifar da thrombosis.
2) Alamun EVS:
(1) Mummunan fashewar EV da zubar jini;
(2) Mutanen da ke da tarihin fashewar EV da zubar jini;(3) Mutanen da ke da maimaitawar EV bayan tiyata;(4) Mutanen da basu dace da aikin tiyata ba.
3) Contraindications na EVS:
(1) Daidai da gastroscopy;
(2) Hepatic encephalopathy mataki na 2 da sama;
(3) Marasa lafiya masu fama da ciwon hanta da koda, yawan ciwon ascites, da jaundice mai tsanani.
4) Kariyar aiki
A kasar Sin, zaku iya zabar lauromacrol.Don manyan hanyoyin jini, zaɓi allurar cikin jini.Yawan allurar gabaɗaya shine 10 ~ 15ml.Don ƙananan tasoshin jini, zaku iya zaɓar allurar paravascular.Yi ƙoƙarin guje wa yin allura a wurare daban-daban a kan jirgin sama ɗaya (wataƙila Ulcers na iya faruwa wanda zai haifar da takurawar esophageal).Idan numfashi ya shafi yayin aikin, ana iya ƙara hular haske a cikin gastroscope.A cikin ƙasashen waje, ana ƙara balloon a cikin gastroscope.Yana da daraja koyo daga.
5) Gudanar da aikin EVS bayan aiki
(1) Kada ku ci ko sha na tsawon sa'o'i 8 bayan tiyata kuma a hankali ci gaba da abinci mai ruwa;
(2) Yi amfani da adadin da ya dace na maganin rigakafi don hana kamuwa da cuta;(3) Yi amfani da magungunan da ke rage matsa lamba kamar yadda ya dace.
6) EVS magani hanya
Ana buƙatar sclerotherapy da yawa har sai veins na varicose ya ɓace ko kuma ya ɓace, tare da tazara na kusan mako 1 tsakanin kowane magani;Gastroscopy za a sake nazarin wata 1, watanni 3, watanni 6, da shekara 1 bayan ƙarshen aikin jiyya.
7) Matsalolin EVS
(1) Rikice-rikice na yau da kullun: ectopic embolism, ulcer na esophageal, da sauransu, da
Yana da sauƙi don haifar da zubar jini ko zubar jini daga ramin allura lokacin da aka ciro allurar.
(2) Rikicin gida: ulcers, zub da jini, stenosis, rashin aikin motsa jiki na esophageal, odynophagia, lacerations.Rikita-rikitar yanki sun haɗa da mediastinitis, perforation, pleural effusion, da hypertensive gastropathy na portal tare da ƙara haɗarin zubar jini.
(3) Matsalolin tsarin: sepsis, buri ciwon huhu, hypoxia, kwatsam na kwayan cuta peritonitis, da portal vein thrombosis.
Endoscopic varicose vein ligation (EVL)
1) Alamun EVL:Daidai da EVS.
2) Contraindications na EVL:
(1) Irin contraindications kamar gastroscopy;
(2) EV tare da bayyane GV;
(3) tare da hanta mai tsanani da rashin aikin koda, yawan adadin ascites, jaundice
Gangrene da magungunan sclerotherapy da yawa na baya-bayan nan ko ƙananan jijiyoyin varicose
Ɗaukar daular Han a matsayin kusa-duofu yana nufin cewa mutanen Hua za su iya motsawa cikin 'yanci, ko kuma a shimfiɗa jijiyoyi da bugun jini zuwa yamma.
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3) Yadda ake aiki
Ciki har da ligation na gashi guda ɗaya, ligation ɗin gashi da yawa, da igiya na nylon.
Ka'ida: Toshe magudanar jini na varicose veins da samar da hemostasis gaggawa → venous thrombosis a ligation site → tissue necrosis → fibrosis → bacewar varicose veins.
(2) Hattara
Don matsakaita zuwa matsananciyar variceal na esophageal, kowace jijiyar varicose an haɗa shi a karkace zuwa sama daga ƙasa zuwa sama.ligator ya kamata ya kasance kusa da maƙasudin ligation na jijiyar varicose, ta yadda kowane batu ya kasance cikakke kuma yana da yawa.Yi ƙoƙarin rufe kowace jijiyar varicose fiye da maki 3.
Hanyoyin ciniki na EVL
Source: Kakakin PPT
Yana ɗaukar kimanin makonni 1 zuwa 2 don necrosis ya fadi bayan bandeji necrosis.Mako guda bayan tiyatar, gyambon gida na iya haifar da zub da jini mai yawa, bandejin fata ya fado, da yankan jini na varicose veins, da dai sauransu;
EVL na iya kawar da varicose veins da sauri kuma yana da 'yan rikitarwa, amma yawan sake dawowa na varicose veins yana da yawa;
EVL na iya toshe ɓangarorin zubar da jini na jijiyar ciki na hagu, jijiya, da vena cava, amma bayan an toshe magudanar jini na jijiyar jijiyar, jijiya na jijiyoyin ciki da jijiyoyin jini na perigastric za su faɗaɗa, kwararar jini zai ƙaru, kuma yawan sake dawowa. zai ƙaru akan lokaci, don haka sau da yawa ana buƙatar maimaita band ligation don ƙarfafa maganin.Diamita na varicose vein ligation ya kamata ya zama ƙasa da 1.5cm.
4) Matsalolin EVL
(1) Zubar da jini mai yawa saboda gyambon gida kamar mako 1 bayan tiyata;
(2) Zubar da jini a ciki, da asarar bandejin fata, da zub da jini wanda varicose veins ke haifarwa;
(3) Kamuwa da cuta.
5) Binciken EVL bayan tiyata
A cikin shekara ta farko bayan EVL, aikin hanta da koda, B-ultrasound, aikin jini na yau da kullum, aikin coagulation, da dai sauransu ya kamata a sake nazarin kowane watanni 3 zuwa 6.Ya kamata a sake duba endoscopy kowane watanni 3, sannan kowane watanni 0 zuwa 12.6) EVS vs EVL
Idan aka kwatanta da sclerotherapy da ligation, yawan mace-mace da koma bayan biyun sun kasance.
Babu wani gagarumin bambanci a cikin adadin jini kuma ga marasa lafiya waɗanda ke buƙatar maimaita jiyya, an fi ba da shawarar bandeji.Band ligation da sclerotherapy wani lokaci ana haɗa su don inganta tasirin jiyya.A cikin kasashen waje, ana kuma amfani da tarkacen karfe da aka rufe sosai don dakatar da zubar jini.
TheAllurar SclerotherapyAna amfani da ZRHmed don Endoscopic Sclerotherapy (EVS) da Endoscopic varicose vein ligation (EVL).
Lokacin aikawa: Janairu-08-2024