Kuvura amaraso ava mu mitsi yo mu gifu hakoreshejwe endoscope

Indwara zo mu nda cyangwa mu gifu ziterwa n’ingaruka zihoraho z’umuvuduko ukabije w’amaraso mu muyoboro w’amaraso kandi zigera kuri 95% ziterwa na cirrhose y’impamvu zitandukanye. Guva amaraso mu mitsi ya varicose akenshi bitera kuva amaraso menshi n’impfu nyinshi, kandi abarwayi bava amaraso ntibakunze kubagwa.

Bitewe no kunoza no gukoresha ikoranabuhanga ryo kuvura indwara zo mu gifu, uburyo bwo kuvura indwara zo mu gifu bwabaye bumwe mu buryo bw’ingenzi bwo kuvura kuva amaraso mu gifu no mu muhogo. Bukubiyemo cyane cyane uburyo bwo kuvura indwara zo mu gifu no mu muhogo (EVS), uburyo bwo kuvura indwara zo mu gifu no kuzitera (EVL) hamwe n’uburyo bwo kuvura indwara zo mu gifu no mu muhogo (EVHT).

Ubuvuzi bwa Endoscopic Sclerotherapy (EVS)

Igice cya 1

1) Ihame ryo kuvura indwara ya sclerotherapy hakoreshejwe endoscopic (EVS):
Gutera imitsi mu mitsi: umuti utera ububabare ku mitsi, ugatuma imitsi y'amaraso ikomera kandi ugahagarika gutembera kw'amaraso;
Gutera imitsi yo mu mitsi: gutera indwara y’imitsi idafite uburibwe mu mitsi bigatuma habaho thrombosis.
2) Ibimenyetso bya EVS:
(1) Guturika cyane kwa EV no kuva amaraso;
(2) Amateka yabanje yo guturika no kuva amaraso mu mashini zitwara imizigo;
(3) Abarwayi basubira kurwara indwara ya EV nyuma yo kubagwa;
(4) Abatabereye kuvurwa no kubagwa.
3) Ibibujijwe ku bijyanye na EVS:
(1) Ibinyuranye n'ibyo gupima indwara nk'uko byakozwe na gastroscopy;
(2) Indwara y'umwijima yo mu cyiciro cya 2 cyangwa hejuru yayo;
(3) Abarwayi bafite ikibazo gikomeye cy'umwijima n'impyiko, ascites nyinshi, n'indwara ikomeye y'umuhondo.
4) Ingamba zo kwirinda imikorere
Mu Bushinwa, ushobora guhitamo lauromacrol (Ikoreshwaurushinge rwo kuvura sclerotherapy). Ku mitsi minini y'amaraso, hitamo guterwa inshinge mu mitsi. Ubusanzwe ingano y'inshinge ni hagati ya mL 10 na 15. Ku mitsi mito y'amaraso, ushobora guhitamo guterwa inshinge mu mitsi. Gerageza kwirinda guterwa inshinge ahantu hatandukanye mu nzira imwe (Ibisebe bishobora kubaho bigatera guhagarara k'umuyoboro w'amaraso). Iyo guhumeka bigize ingaruka mu gihe cyo kubagwa, umupfundikizo ugaragara ushobora kongerwa kuri gastroscope. Mu bihugu by'amahanga, agapira k'inyuma gakunze kongerwa kuri gastroscope. Ni byiza kwigiraho.
5) Kuvura EVS nyuma yo kubagwa
(1) Ntukarye cyangwa ngo unywe mu masaha 8 nyuma yo kubagwa, kandi buhoro buhoro wongere urye ibiryo by'amazi;
(2) Koresha ingano ikwiye ya antibiyotike kugira ngo wirinde kwandura;
(3) Koresha imiti kugira ngo ugabanye umuvuduko w'amaraso mu mwanya w'umubiri uko bikwiye.
6) Inzira yo kuvura indwara ya EVS
Gukoresha sclerotherapy nyinshi birakenewe kugeza igihe imitsi ya varicose igiye gucika cyangwa ikabura, hagakurikiraho icyumweru kimwe hagati ya buri buryo bwo kuvurwa; isuzuma rya gastroscopy rizakorwa nyuma y'ukwezi kumwe, amezi atatu, amezi atandatu, n'umwaka umwe nyuma y'uko uburyo bwo kuvurwa burangiye.
7) Ingorane za EVS
(1) Ingorane zikunze kugaragara: gucika kw'amaraso mu nda, igisebe cyo mu muhogo, nibindi, kandi byoroshye gutuma amaraso asohoka cyangwa ava mu mwenge w'urushinge iyo ukuyemo urushinge.
(2) Ingorane zo mu gace: ibisebe, kuva amaraso, stenosis, kudakora neza k'umuyoboro w'amaraso, odynophagie, gucika kw'imitsi. Ingorane zo mu gace zirimo mediastinitis, gutobora, pleural effusion, na portal hypertension gastropathy hamwe n'ibyago byo kuva amaraso byiyongera.
(3) Ingorane z’umubiri: sepsis, umusonga wo mu bihaha, kubura umwuka uhagije, peritonitisi ya bagiteri yibasira, thrombosis y’imitsi yo mu muyoboro w’amaraso.

Gufunga imitsi yo mu bwonko hakoreshejwe endoscopic (EVL)

Igice cya 2

1) Ibimenyetso bya EVL: Kimwe na EVS.
2) Ibibujijwe kuri EVL:
(1) Ibinyuranye n'ibyo gupima indwara nk'uko byakozwe na gastroscopy;
(2) EV iherekejwe na GV igaragara;
(3) Abarwayi bafite ikibazo gikomeye cy’umwijima n’impyiko, ascites nyinshi, jaundice, ubuvuzi buherutse gukorwa bwa sclerotherapy nyinshi cyangwa imitsi mito itera kuribwa mu maraso.
3) Uburyo bwo gukora
Harimo gufunga umusatsi umwe, gufunga umusatsi mwinshi, no gufunga umugozi wa nylon.
(1) Ihame: Kubuza amaraso gutembera mu mitsi itera uburibwe no gutanga hemostasis yihutirwa → thrombosis y'imitsi aho ihambiriye → necrosis y'imitsi → fibrosis → ibura ry'imitsi itera uburibwe.
(2) Amabwiriza yo kwirinda
Ku ndwara zo mu muhogo zifata imitsi iri hagati kugeza ku ikomeye, buri mutsi ufata imitsi ugenda uzamuka uva hasi ugana hejuru. Umutsi ufata imitsi ugomba kuba wegereye cyane aho umutsi ufata imitsi, ku buryo buri ngingo iba yuzuye kandi ifatanye cyane. Gerageza gupfuka buri mutsi ufata imitsi ku manota arenga 3.
Bifata icyumweru kimwe kugeza kuri bibiri kugira ngo necrosis igwe nyuma yo gupfuka. Nyuma y'icyumweru kimwe cyo kubagwa, ibisebe byo mu gace bishobora gutera kuva amaraso menshi, umukandara w'uruhu ukagwa, kandi gukata imitsi yo mu bwoko bwa varicose bikava amaraso mu buryo bw'ikoranabuhanga. EVL ishobora kurandura imitsi yo mu bwoko bwa varicose vuba kandi nta ngorane nyinshi igira, ariko imitsi yo mu bwoko bwa varicose iragaruka. Igipimo kiri hejuru;
EVL ishobora kuziba amaraso aturuka mu mitsi y'igifu y'ibumoso, imitsi yo mu gifu, na vena cava. Ariko, nyuma yo kuziba kw'amaraso yo mu gifu, imitsi yo mu gifu n'imitsi yo mu gifu iragenda yiyongera, amaraso agakomeza kwiyongera, kandi umuvuduko wo kongera kwiyongera ugakomeza kwiyongera uko igihe kigenda gihita. Kubwibyo, akenshi birakenewe ko habaho gufunga imitsi kugira ngo hakorwe neza ubuvuzi. Ingano y'umurambararo w'imitsi yo mu gifu igomba kuba munsi ya cm 1.5.
4) Ingorane za EVL
(1) Kuva amaraso menshi bitewe n'ibisebe byo mu gace runaka nyuma y'icyumweru kimwe nyuma yo kubagwa;
(2) Kuva amaraso mu gihe cyo kubagwa, gutakaza umukanda w'uruhu, no kuva amaraso guterwa n'imitsi itera uburibwe;
(3) Kwandura indwara.
5) Isuzuma rya EVL nyuma yo kubagwa
Mu mwaka wa mbere nyuma yo kubagwa kwa EVL, imikorere y'umwijima n'impyiko, B-ultrasound, gahunda y'amaraso, imikorere yo gufungana kw'amaraso, n'ibindi bigomba gusuzumwa buri mezi 3 kugeza kuri 6. Endoscopiyo igomba gusuzumwa buri mezi 3, hanyuma buri mezi 0 kugeza kuri 12.
6) EVS vs EVL
Ugereranyije na sclerotherapy na ligation, nta tandukaniro rigaragara mu rupfu no kongera kuva amaraso hagati y’ibi byombi. Ku barwayi bakeneye kuvurwa kenshi, ligation ni yo ikunze kugirwa inama. Hari igihe ligation na sclerotherapy nabyo bihuzwa, bishobora kunoza ubuvuzi. Ingaruka. Mu bihugu by’amahanga, stent z’icyuma zipfutse neza nazo zikoreshwa mu guhagarika kuva amaraso.

Uburyo bwo gutera ubwoko bwa kole mu mubiri (EVHT)

Igice cya 3

Ubu buryo bukwiriye ku ndwara zo mu gifu no kuva amaraso mu muhogo mu bihe byihutirwa.
1) Ingorane za EVHT: ahanini imitsi y'ibihaha n'imitsi yo mu muyoboro w'amaraso, ariko indwara ni nke cyane.
2) Ibyiza bya EVHT: imitsi igenda icika vuba, kongera kuva amaraso ni bike, ingorane ni nke, ibimenyetso ni byinshi kandi ikoranabuhanga ryoroshye kurimenya.
3) Ibintu byo kwitaho:
Mu kuvura hakoreshejwe kole yo mu bwoko bwa endoscopic tissue, ingano y'inshinge igomba kuba ihagije. Ultrasound ya endoscopic igira uruhare runini mu kuvura imitsi iterwa n'imitsi kandi ishobora kugabanya ibyago byo kongera kuva amaraso.
Hari raporo mu nyandiko zo mu mahanga zivuga ko kuvura varice zo mu gifu hakoreshejwe coils cyangwa cyanoacrylate hifashishijwe endoscopic ultrasound ari ingirakamaro ku varice zo mu gifu zo mu gace runaka. Ugereranije no gutera cyanoacrylate, endoscopic ultrasound-guided ultrasound coiling isaba inshinge nke zo mu gifu kandi ijyana n’ingaruka mbi nke.

Twebwe, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ni uruganda rukora ibikoresho byo mu Bushinwa byihariye mu gukoresha ibikoresho byo mu nda, nkaforceps za biopsy, hemoklip, umutego wa polyp, urushinge rwo kuvura sclerotherapy, katheteri itera umuti, uburoso bwa cytology, insinga y'ubuyobozi, agasanduku ko gukurura amabuye, katheteri itwara amazi mu mazurun'ibindi bikoreshwa cyane muriEMR, ESD, ERCPIbicuruzwa byacu bifite icyemezo cya CE, naho inganda zacu zifite icyemezo cya ISO. Ibicuruzwa byacu byoherejwe mu Burayi, Amerika ya Ruguru, Uburasirazuba bwo Hagati no mu gice kimwe cya Aziya, kandi birushaho kumenyekana no gushimwa n'abakiriya!