Esophageal / gastric varices nigisubizo cyingaruka ziterwa na hypertension portal kandi hafi 95% biterwa na cirrhose yibintu bitandukanye. Kuva amaraso kwa Varicose akenshi bikubiyemo amaraso menshi ndetse nimpfu nyinshi, kandi abarwayi bafite amaraso ntibihanganira bike kubagwa.
Hamwe nogutezimbere no gukoresha ikoreshwa rya tekinoroji yo kuvura endoskopique, kuvura endoskopique byabaye bumwe muburyo bwingenzi bwo kuvura amaraso ya Esophageal / gastric variceal. Harimo cyane cyane endoskopi sclerotherapie (EVS), endoskopique variceal ligation (EVL) hamwe nubuvuzi bwa endoskopique tissue glue inshinge (EVHT).
Endoscopic Sclerotherapy (EVS)
igice 1
1) Ihame rya endoskopi sclerotherapie (EVS):
Gutera imitsi y'amaraso: imiti ya sclerose itera uburibwe mu mitsi, igakomera imiyoboro y'amaraso ikabuza gutembera kw'amaraso;
Gutera paravaskulaire: gutera sterile inflammatory reaction mumitsi itera trombose.
2) Ibimenyetso bya EVS:
(1) Guturika gukabije kwa EV no kuva amaraso;
(2) Amateka yabanjirije guturika no kuva amaraso;
(3) Abarwayi bafite ibibazo bya EV nyuma yo kubagwa;
(4) Abadakwiriye kuvurwa.
3) Kurwanya EVS:
(1) Kurwanya kimwe na gastroscopi;
(2) Hepatic encephalopathie icyiciro cya 2 cyangwa hejuru;
(3) Abarwayi bafite umwijima mwinshi nimpyiko zidakora neza, asitite nyinshi, na jaundice ikabije.
4) Ibikorwa byo kwirinda
Mubushinwa, urashobora guhitamo lauromacrol (Koreshainshinge). Ku miyoboro minini y'amaraso, hitamo inshinge. Ingano yo gutera inshinge muri rusange ni 10 kugeza kuri 15 mL. Ku mitsi mito y'amaraso, urashobora guhitamo inshinge za paravascular. Gerageza kwirinda gutera inshinge ahantu hatandukanye ku ndege imwe (Ulcers irashobora kubaho biganisha kuri esophageal stiffure). Niba guhumeka bigira ingaruka mugihe cyo kubaga, capa ibonerana irashobora kongerwaho gastroscope. Mu bihugu by'amahanga, ballon ikunze kongerwa muri gastroscope. Birakwiye ko twigiraho.
5) Kuvura nyuma yubuvuzi bwa EVS
(1) Ntukarye cyangwa unywe amasaha 8 nyuma yo kubagwa, hanyuma buhoro buhoro usubukure ibiryo byamazi;
(2) Koresha antibiyotike ikwiye kugirango wirinde kwandura;
(3) Koresha ibiyobyabwenge kugirango ugabanye umuvuduko wurubuga uko bikwiye.
6) Amasomo yo kuvura EVS
Sclerotherapie nyinshi irakenewe kugeza igihe imitsi ya varicose ibuze cyangwa ahanini ikabura, hamwe nigihe kingana nicyumweru 1 hagati yubuvuzi; gastroscopy izasubirwamo ukwezi 1, amezi 3, amezi 6, numwaka 1 nyuma yamasomo yo kuvura.
7) Ingorane za EVS
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. Ingorane zo mu karere zirimo mediastinitis, perforasi, pleural effusion, hamwe na portal hypertensive gastropathie ifite ibyago byinshi byo kuva amaraso.
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Endoscopic varicose vein ligation (EVL)
Igice cya 2
1) Ibyerekana kuri EVL: Kimwe na EVS.
2) Kurwanya EVL:
(1) Kurwanya kimwe na gastroscopi;
(2) EV iherekejwe na GV igaragara;
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3) Uburyo bwo gukora
Harimo guhuza umusatsi umwe, guhuza imisatsi myinshi, hamwe na nylon umugozi.
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(2) Kwirinda
Kuburyo butandukanye kandi bukabije Esophageal varices, buri mitsi ya varicose ihujwe muburyo buzunguruka hejuru kuva hejuru kugeza hejuru. Ligator igomba kuba yegeranye hashoboka kugera kuntego yo guhuza imiyoboro ya varicose, kugirango buri ngingo ihuze neza kandi ihujwe cyane. Gerageza gupfuka imitsi ya varicose kurenza ingingo 3.
Bifata ibyumweru 1 kugeza kuri 2 kugirango nérosose igwe nyuma ya bande ya nérosose. Icyumweru kimwe nyuma yo kubagwa, ibisebe byaho bishobora gutera kuva amaraso menshi, uruhu rwuruhu ruragwa, no gukata imashini ya varicose. EVL irashobora kurandura imitsi ya varicose vuba kandi ifite ibibazo bike, ariko imitsi ya varicose irongera. Umubare uri kuruhande rwo hejuru;
EVL irashobora guhagarika amaraso ava mumitsi yibumoso, imitsi ya esophageal, na vena cava. Nyamara, nyuma yo gutembera kw'amaraso y'amaraso ya Esophageal ahagaritswe, imitsi ya gastric coronary veine na perigastric venous plexus izaguka, umuvuduko w'amaraso uziyongera, kandi umuvuduko wo kwisubiramo uziyongera mugihe runaka. Kubwibyo, bikunze gusubirwamo bande isabwa kugirango ihuze imiti. Diameter ya varicose vein ligation igomba kuba munsi ya cm 1.5.
4) Ingorane za EVL
(1) Kuva amaraso menshi kubera ibisebe byaho nyuma yicyumweru 1 nyuma yo kubagwa;
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(3) Kwandura.
5) Isubiramo rya nyuma ya EVL
Mu mwaka wa mbere nyuma yo kubagwa kwa EVL, imikorere yumwijima nimpyiko, B-ultrasound, gahunda yamaraso, imikorere ya coagulation, nibindi bigomba gusubirwamo buri mezi 3 kugeza kuri 6. Endoscopi igomba gusubirwamo buri mezi 3, hanyuma buri mezi 0 kugeza 12.
6) EVS vs EVL
Ugereranije na sclerotherapie na ligation, nta tandukaniro rikomeye riri hagati yimfu nigipimo cyo kugabanuka hagati yibi byombi. Ku barwayi bakeneye kuvurwa inshuro nyinshi, birasabwa cyane. Rimwe na rimwe, ligation na sclerotherapie nabyo birahujwe, bishobora kunoza imiti. Ingaruka. Mu mahanga, ibyuma bitwikiriye byuzuye nabyo bikoreshwa muguhagarika kuva amaraso.
Endoscopic tissue glue inshinge (EVHT)
igice cya 3
Ubu buryo bukwiranye na varices gastrica na esophageal variceal ava mugihe cyihutirwa.
1) Ingorane za EVHT: cyane cyane imiyoboro yimpyiko na portal vein embolism, ariko indwara ni nke cyane.
2) Ibyiza bya EVHT: imitsi ya varicose irashira vuba, igipimo cyo kongera kuva amaraso ni gito, ingorane ni nke, ibimenyetso ni binini kandi ikoranabuhanga ryoroshye kumenya.
3) Ibintu ugomba kumenya:
Mu kuvura endoskopi tissue glue inshinge, ingano yo guterwa igomba kuba ihagije. Endrascopic ultrasound igira uruhare runini mukuvura imitsi ya varicose kandi irashobora kugabanya ibyago byo kongera kuva amaraso.
Hari amakuru mu bitabo by’amahanga avuga ko kuvura varisi zo mu gifu hamwe na coil cyangwa cyanoacrylate iyobowe na ultrasound ya endoscopique ifite akamaro kanini kuri gastrica. Ugereranije no guterwa na cyanoacrylate, endoscopic ultrasound-iyobowe na coiling bisaba inshinge nke zo mu nda kandi bifitanye isano nibintu bike bibi.
Twebwe, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., Ni uruganda mu Bushinwa ruzobereye mu gukoresha endoskopi, nkabiopsy imbaraga, hemoclip, umutego, inshinge, spray catheter, cytology, kuyobora, igitebo cyo kugarura amabuye, izuru rya biliary drainage catheternibindi bikoreshwa cyane muriEMR, ESD, ERCP. Ibicuruzwa byacu byemewe na CE, kandi ibihingwa byacu byemewe na ISO. Ibicuruzwa byacu byoherejwe mu Burayi, Amerika y'Amajyaruguru, Uburasirazuba bwo hagati ndetse no muri Aziya, kandi bigera ku bakiriya bamenyekana kandi bashimwe!
Igihe cyo kohereza: Kanama-15-2024