Maganin endoscopic na zubar jini a cikin esophagus/ciki

Ciwon hanji/ƙashi sakamakon ci gaba da hawan jini a cikin mahaifa (portal haemorrhage) yana faruwa ne sakamakon cirrhosis na jijiyoyin jini daban-daban, kuma kusan kashi 95% na waɗanda ke kamuwa da cutar suna faruwa ne sakamakon cirrhosis na wasu dalilai daban-daban. Zubar da jinin jijiyoyin jini sau da yawa yana haifar da zubar jini mai yawa da kuma mace-mace mai yawa, kuma marasa lafiya da ke zubar jini ba su da haƙurin yin tiyata.

Tare da ingantawa da amfani da fasahar maganin endoscopic na narkewar abinci, maganin endoscopic ya zama ɗaya daga cikin manyan hanyoyin magance zubar jini a cikin esophagus/ciki. Ya haɗa da maganin endoscopic sclerotherapy (EVS), ligation na endoscopic variceal (EVL) da kuma maganin allurar manne nama na endoscopic (EVHT).

Maganin Ciwon Ƙwayar Ƙarya (EVS)

Kashi na 1

1) Ka'idar maganin endoscopic sclerotherapy (EVS):
Allurar da ke cikin jijiyoyin jini: sinadarin sclerosing yana haifar da kumburi a kusa da jijiyoyin jini, yana taurare jijiyoyin jini kuma yana toshe kwararar jini;
Allurar Paravascular: yana haifar da kumburi mara kyau a cikin jijiyoyin jini wanda ke haifar da thrombosis.
2) Alamomin EVS:
(1) Karyewar EV mai tsanani da zubar jini;
(2) Tarihin fashewar EV da zubar jini a baya;
(3) Marasa lafiya da suka sake kamuwa da cutar EV bayan tiyata;
(4) Waɗanda ba su dace da maganin tiyata ba.
3) Abubuwan da ba su dace ba game da EVS:
(1) Abubuwa iri ɗaya da suka saba wa gastroscopy;
(2) Ciwon hanta na mataki na 2 ko sama da haka;
(3) Marasa lafiya masu fama da matsalar hanta da koda mai tsanani, yawan ascites, da kuma ciwon jaundice mai tsanani.
4) Gargaɗin aiki
A China, zaka iya zaɓar lauromacrol (Yi amfani da shi)allurar sclerotherapy) Ga manyan jijiyoyin jini, zaɓi allurar da ke cikin jijiyoyin jini. Yawan allurar yawanci shine 10 zuwa 15 mL. Ga ƙananan jijiyoyin jini, zaku iya zaɓar allurar paravascular. Yi ƙoƙarin guje wa allurar a wurare daban-daban a kan hanya ɗaya (Ciwon gyambo na iya faruwa wanda zai haifar da tauri a cikin esophagus). Idan numfashi ya shafi yayin aikin tiyata, ana iya ƙara murfi mai haske a cikin gastroscope. A ƙasashen waje, sau da yawa ana ƙara balan-balan a cikin gastroscope. Ya cancanci a koya daga gare shi.
5) Maganin EVS bayan tiyata
(1) Kada a ci ko a sha na tsawon awanni 8 bayan tiyata, sannan a hankali a ci gaba da cin abinci mai ruwa;
(2) Yi amfani da adadin maganin rigakafi masu dacewa don hana kamuwa da cuta;
(3) Yi amfani da magunguna don rage matsin lamba a ƙofar kamar yadda ya dace.
6) Kwas ɗin magani na EVS
Ana buƙatar yin amfani da maganin sclerotherapy sau da yawa har sai jijiyoyin varicose sun ɓace ko kuma sun ɓace, tare da tazara ta kimanin mako 1 tsakanin kowace magani; za a sake duba gastroscopy na wata 1, watanni 3, watanni 6, da shekara 1 bayan ƙarshen aikin magani.
7) Matsalolin EVS
(1) Matsalolin da aka saba fuskanta: embolism na ƙashin ƙugu, ciwon makogwaro, da sauransu, kuma yana da sauƙi a haifar da zubar jini ko zubar jini daga ramin allura yayin cire allurar.
(2) Matsalolin da ke faruwa a yankin: gyambo, zubar jini, toshewar jijiyoyin jini, matsalar motsi a cikin esophagus, odynophagia, lacerations. Matsalolin da ke faruwa a yankuna sun haɗa da mediastinitis, rami, fitar da ruwa daga fata, da kuma ciwon gastropatitis mai hawan jini wanda ke ƙara haɗarin zubar jini.
(3) Matsalolin tsarin jiki: sepsis, ciwon huhu na numfashi, hypoxia, spontaneous bacterial peritonitis, portal venous venous thrombosis.

Lakabin jijiyoyin varicose na endoscopic (EVL)

Kashi na 2

1) Alamomi ga EVL: Kamar EVS.
2) Abubuwan da ba su dace ba na EVL:
(1) Abubuwa iri ɗaya da suka saba wa gastroscopy;
(2) EV tare da GV a bayyane;
(3) Marasa lafiya masu fama da matsalar hanta da koda mai tsanani, yawan ascites, jaundice, da kuma maganin sclerotherapy da aka yi musu kwanan nan ko kuma ƙananan jijiyoyin jini.
3) Yadda ake aiki
Ya haɗa da haɗa gashi ɗaya, haɗa gashi da yawa, da kuma haɗa igiyar nailan.
(1) Ka'ida: Toshe kwararar jini daga jijiyoyin varicose da kuma samar da gaggawar zubar jini → venous thrombosis a wurin da aka haɗa → tissue necrosis → fibrosis → ɓacewar jijiyoyin varicose.
(2) Gargaɗi
Ga masu fama da matsalar ƙashin ƙugu zuwa mai tsanani, kowace jijiyar ƙashin ƙugu tana ɗaurewa ta hanyar karkace daga ƙasa zuwa sama. Ya kamata ligator ɗin ya kasance kusa da wurin da aka nufa na jijiyar ƙashin ƙugu, ta yadda kowane wuri zai kasance cikakke kuma ya yi kauri. Yi ƙoƙarin rufe kowace jijiyar ƙashin ƙugu a sama da maki 3.
Yana ɗaukar kimanin makonni 1 zuwa 2 kafin ƙwayoyin cuta su faɗi bayan an yi musu bandeji. Mako guda bayan an yi musu tiyata, gyambon ciki na iya haifar da zubar jini mai yawa, fatar jiki ta faɗi, kuma ta hanyar injinan yanke jijiyoyin jini na varicose za su yi zubar jini. EVL na iya kawar da jijiyoyin varicose da sauri kuma yana da ƙarancin matsaloli, amma jijiyoyin varicose suna sake dawowa. Adadin yana kan babban ɓangaren;
EVL na iya toshe hanyoyin zubar jini na jijiyoyin ciki na hagu, jijiyoyin esophageal, da vena cava. Duk da haka, bayan an toshe kwararar jinin jijiyoyin esophageal, jijiyoyin zuciya na ciki da kuma plexus na jijiyoyin perigastric za su faɗaɗa, kwararar jini zai ƙaru, kuma yawan sake dawowa zai ƙaru akan lokaci. Saboda haka, sau da yawa ana buƙatar sake maimaita ɗaurewa don ƙarfafa maganin. Diamita na ɗaurewar jijiyoyin varicose ya kamata ya zama ƙasa da 1.5 cm.
4) Matsalolin EVL
(1) Zubar jini mai yawa saboda gyambon da ke cikin gida kimanin mako 1 bayan tiyata;
(2) Zubar jini a lokacin tiyata, asarar madaurin fata, da zubar jini da jijiyoyin jini ke haifarwa;
(3) Kamuwa da cuta.
5) Bitar EVL bayan tiyata
A shekara ta farko bayan tiyatar EVL, aikin hanta da koda, aikin duban dan tayi na B-ultrasound, tsarin jini, aikin coagulation, da sauransu ya kamata a duba su duk bayan watanni 3 zuwa 6. Ya kamata a duba Endoscopy bayan kowane watanni 3, sannan kuma bayan kowane watanni 0 zuwa 12.
6)EVS vs EVL
Idan aka kwatanta da sclerotherapy da ligation, babu wani bambanci mai mahimmanci a cikin mace-mace da kuma yawan sake zubar jini tsakanin su biyun. Ga marasa lafiya da ke buƙatar magani akai-akai, ana ba da shawarar ligation. Wani lokaci ana haɗa ligation da sclerotherapy, wanda zai iya inganta magani. Tasiri. A ƙasashen waje, ana amfani da stent na ƙarfe da aka rufe gaba ɗaya don dakatar da zubar jini.

Maganin allurar manne nama na endoscopic (EVHT)

Kashi na 3

Wannan hanyar ta dace da cututtukan ciki da kuma zubar jini a cikin esophagus a cikin yanayi na gaggawa.
1) Matsalolin EVHT: galibi jijiyoyin huhu da kuma embolism na jijiyoyin portal, amma yawan faruwar hakan ba shi da yawa.
2) Fa'idodin EVHT: jijiyoyin varicose suna ɓacewa da sauri, yawan sake zubar jini yana da ƙasa, rikitarwa kaɗan ne, alamu suna da faɗi kuma fasahar tana da sauƙin fahimta.
3) Abubuwan da ya kamata a lura da su:
A cikin maganin allurar manne na nama na endoscopic, adadin allurar dole ne ya isa. Endoscopic ultrasound yana taka muhimmiyar rawa wajen magance jijiyoyin varicose kuma yana iya rage haɗarin sake zubar jini.
Akwai rahotanni a cikin wallafe-wallafen ƙasashen waje cewa maganin varices na ciki da coils ko cyanoacrylate ƙarƙashin jagorancin endoscopic ultrasound yana da tasiri ga varices na ciki na gida. Idan aka kwatanta da allurar cyanoacrylate, coiling mai jagora ta endoscopic ultrasound yana buƙatar ƙarancin allurar ciki kuma yana da alaƙa da ƙarancin abubuwan da suka faru marasa kyau.

Mu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., kamfani ne da ke kera kayayyaki a China wanda ya ƙware a fannin amfani da endoscopic, kamar suƙarfin biops, hemoclip, tarkon polyp, allurar sclerotherapy, feshi catheter, gogewar cytology, waya mai jagora, Kwandon ɗaukar dutse, catheter na magudanar ruwa ta hancida sauransu waɗanda ake amfani da su sosai a cikinEMR, ESD, ERCPKayayyakinmu an ba su takardar shaidar CE, kuma masana'antunmu an ba su takardar shaidar ISO. An fitar da kayayyakinmu zuwa Turai, Arewacin Amurka, Gabas ta Tsakiya da wani ɓangare na Asiya, kuma yana sa abokin ciniki ya yaba da kuma yaba masa sosai!