Ciwon ciki/masu ciwon ciki sune sakamakon dagewar tasirin hauhawar jini na portal kuma kusan kashi 95% ne ke haifar da cirrhosis na dalilai daban-daban. Zubar da jini na varicose sau da yawa yakan haɗa da yawan zubar jini da yawan mace-mace, kuma marasa lafiya masu zubar da jini ba su da ɗan jure wa tiyata.
Tare da haɓakawa da aikace-aikacen fasahar jiyya na endoscopic narkewa, maganin endoscopic ya zama ɗaya daga cikin manyan hanyoyin da za a bi da zubar da jini na esophageal / ciki. Ya ƙunshi endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) da endoscopic tissue glue injection far (EVHT).
Endoscopic Sclerotherapy (EVS)
part 1
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: haifar da rashin lafiyan kumburi a cikin jijiyoyi don haifar da thrombosis.
2) Alamun EVS:
(1) Mummunan fashewar EV da zubar jini;
(2) Tarihin baya na fashewar EV da zubar jini;
(3) Marasa lafiya tare da sake dawowa na EV bayan tiyata;
(4) Wadanda basu dace da aikin tiyata ba.
3) Contraindications na EVS:
(1) Irin contraindications kamar gastroscopy;
(2) Hepatic encephalopathy mataki na 2 ko 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 zaɓar lauromacrol (Amfaniallurar sclerotherapy). Don manyan hanyoyin jini, zaɓi allurar cikin jini. Yawan allurar gabaɗaya shine 10 zuwa 15 ml. Don ƙananan tasoshin jini, zaku iya zaɓar allurar paravascular. Yi ƙoƙarin guje wa yin allura a wurare daban-daban a kan jirgin sama guda (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) Maganin EVS bayan tiyata
(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 kwayoyi don rage matsa lamba ta hanyar da ta 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) Matsalolin gama gari: ectopic embolism, esophageal ulcer, da dai sauransu, kuma yana da sauƙin haifar da zubar jini ko zubar jini daga ramin allura lokacin cire allura.
(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, ciwon huhu, hypoxia, peritonitis na kwayan cuta na kwatsam, thrombosis portal vein.
Endoscopic varicose vein ligation (EVL)
Kashi na 2
1) Alamomi ga EVL: Daidai da EVS.
2) Contraindications na EVL:
(1) Irin contraindications kamar gastroscopy;
(2) EV tare da bayyane GV;
(3) Marasa lafiya tare da hanta mai tsanani da rashin aiki na koda, yawan adadin ascites, jaundice, kwanan nan da yawa sclerotherapy jiyya ko ƙananan varicose veins.
3) Yadda ake aiki
Ciki har da ligation na gashi guda ɗaya, ligation ɗin gashi da yawa, da igiya na nylon.
(1) Ka'ida: Toshe magudanar jini na varicose veins da samar da hemostasis na gaggawa → venous thrombosis a wurin ligation → tissue necrosis → fibrosis → bacewar veins varicose.
(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.
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 varicose veins na inji. EVL na iya kawar da varicose veins da sauri kuma yana da 'yan rikitarwa, amma varicose veins ya sake dawowa. Matsakaicin yana kan babban gefen;
EVL na iya toshe ɓangarorin zub da jini na jijiyar ciki na hagu, jijiyar esophageal, da cava vena. Duk da haka, bayan an toshe kwararar jini na jijiyoyi na esophageal, jijiya na ciki da na perigastric venous plexus za su fadada, jinin zai karu, kuma yawan sake dawowa zai karu a kan lokaci. Saboda haka, sau da yawa ana buƙatar maimaita bandeji don ƙarfafa maganin. Diamita na varicose vein ligation ya kamata ya zama ƙasa da 1.5 cm.
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 aikin EVL, aikin hanta da koda, B-ultrasound, aikin jini na yau da kullum, aikin coagulation, da dai sauransu ya kamata a sake duba 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, babu wani gagarumin bambanci a cikin mace-mace da yawan zubar jini tsakanin su biyun. Ga marasa lafiya waɗanda ke buƙatar maimaita jiyya, an fi ba da shawarar ligation. Wani lokaci ligation da sclerotherapy suna haɗuwa, wanda zai iya inganta jiyya. Tasiri. A cikin kasashen waje, ana kuma amfani da tarkacen karfe da aka rufe sosai don dakatar da zubar jini.
Endoscopic tissue glue injection far (EVHT)
part 3
Wannan hanya ta dace da varices na ciki da kuma zubar da jini na esophageal a cikin yanayin gaggawa.
1) Matsalolin EVHT: galibin jijiya na huhu da bugun jini na portal, amma abin ya ragu sosai.
2) Amfanin EVHT: varicose veins yana ɓacewa da sauri, sake zubar da jini ya ragu, rikitarwa ba su da yawa, alamu suna da fadi kuma fasaha yana da sauƙin ganewa.
3) Abubuwan lura:
A cikin endoscopic tissue manne far allura, adadin allura dole ne ya isa. Endoscopic duban dan tayi yana taka rawar gani sosai a cikin maganin varicose veins kuma yana iya rage haɗarin sake zubar jini.
Akwai rahotanni a cikin wallafe-wallafen kasashen waje cewa maganin cututtuka na ciki tare da coils ko cyanoacrylate a karkashin jagorancin endoscopic duban dan tayi yana da tasiri ga varices na ciki na gida. Idan aka kwatanta da alluran cyanoacrylate, endoscopic duban dan tayi jagorar dunƙulewa yana buƙatar ƙarancin alluran intraluminal kuma yana da alaƙa da ƙarancin abubuwan da suka faru.
Mu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., wani manufacturer ne a kasar Sin ƙware a cikin endoscopic consumables, kamarbiopsy forceps, hemoclip, polyp tarko, allurar sclerotherapy, fesa catheter, cytology goge, jagora, kwandon dawo da dutse, hanci biliary drainage catheterda sauransu wadanda ake amfani da su sosai a cikiEMR, ESD, ERCP. Samfuran mu suna da takardar shedar CE, kuma tsire-tsire namu suna da takaddun ISO. An fitar da kayanmu zuwa Turai, Arewacin Amurka, Gabas ta Tsakiya da wani yanki na Asiya, kuma suna samun abokin ciniki yabo da yabo!
Lokacin aikawa: Agusta-15-2024