Te maimoatanga endoscopic o te toto uaua esophageal/puku

Ko ngā varicose esophageal/gastric veins te hua o ngā pānga pumau o te toto toto tiketike portal, ā, tata ki te 95% e puta mai ana i te cirrhosis o ngā take maha. He maha ngā wā ka nui te toto e puta mai ana i te toto o te uaua varicose, ā, he iti noa te manawanui o ngā tūroro e toto ana ki te pokanga.

Nā te whakapainga me te whakamahinga o te hangarau maimoatanga endoscopic nakunaku, kua noho te maimoatanga endoscopic hei tētahi o ngā huarahi matua ki te rongoā i te toto varicose o te esophagus/puku. Kei roto i tēnei ko te endoscopic sclerotherapy (EVS), te endoscopic variceal ligation (EVL) me te endoscopic tissue glue injection therapy (EVHT).

Te Whakaora Hiko Endoscopic (EVS)

wāhanga 1

1) Te mātāpono o te endoscopic sclerotherapy (EVS):
Werohanga ā-roto: ka puta te mumura huri noa i ngā uaua mā te kaihoko whakapūkara, ka whakapakeke i ngā oko toto, ka aukati hoki i te rere o te toto;
Werohanga paravascular: ka puta he tauhohenga mumura koretake i roto i ngā uaua ka puta ai te thrombosis.
2) Ngā tohu mō ngā EVS:
(1) Te pakaru tere o te EV me te toto;
(2) He hītori o mua mō te pakaru me te toto o te EV;
(3) Ngā tūroro e hoki anō ana te mate EV i muri i te pokanga;
(4) Te hunga kāore e tika ana mō te maimoatanga pokanga.
3) Ngā ārai mō te whakamahi i te EVS:
(1) He rite tonu ngā ārai ki te gastroscopy;
(2) Te mate pukupuku ate wāhanga 2, neke atu rānei;
(3) Ngā tūroro e pāngia ana e te ngoikore nui o te ate me te whatukuhu, te nui o te ascites, me te jaundice kino.
4) Ngā whakatūpato whakahaere
I Haina, ka taea e koe te whiriwhiri i te lauromacrol (Whakamahiangira whakaora kiriuhi). Mō ngā oko toto nui ake, whiriwhiria te werohanga ā-roto. Ko te nui o te werohanga he 10 ki te 15 mL te nuinga. Mō ngā oko toto iti ake, ka taea e koe te whiriwhiri i te werohanga paravascular. Ngāna kia kaua e werohanga i ngā wāhi rerekē i runga i te papa kotahi (tērā pea ka puta he mate pukupuku ka arahi ki te whakawhāiti i te korokoro). Mena ka pāngia te manawa i te wā o te pokanga, ka taea te tāpiri i tētahi taupoki mārama ki te gastroscope. I ngā whenua ke, he maha ngā wā ka tāpirihia he poihau ki te gastroscope. He mea tika kia akohia tēnei.
5) Te maimoatanga o te EVS i muri i te pokanga
(1) Kaua e kai, kaua e inu mō ngā haora e 8 i muri i te pokanga, ā, me tīmata mārire te kai wai;
(2) Whakamahia ngā rahinga tika o ngā paturopi hei ārai i te mate;
(3) Whakamahia ngā rongoā hei whakaiti i te pēhanga o te tomokanga ina tika.
6) Akoranga maimoatanga EVS
Me whakahaere te maha o ngā sclerotherapy kia ngaro ra ano ngā uaua varicose, kia ngaro rawa rānei, me te wā okiokinga mō te 1 wiki i waenga i ia maimoatanga; ka arotakehia te gastroscopy i muri i te 1 marama, 3 marama, 6 marama, me te 1 tau i muri i te mutunga o te maimoatanga.
7) Ngā raruraru o te EVS
(1) Ngā raruraru noa: te embolism ectopic, te mate pukupuku esophageal, me ētahi atu, ā, he ngāwari te pupuhi toto, te totohu rānei mai i te kōhao ngira i te wā e tangohia ai te ngira.
(2) Ngā raruraru ā-rohe: ngā mate pukupuku, te toto, te stenosis, te ngoikore o te nekehanga o te korokoro, te odynophagia, ngā motumotu. Ko ngā raruraru ā-rohe ko te mediastinitis, te perforation, te pleural effusion, me te portal hypertensive gastropathy me te mōrearea nui ake o te toto.
(3) Ngā raruraru pūnaha: te sepsis, te niumōnia manawa, te hypoxia, te peritonitis huakita ohorere, te thrombosis uaua portal.

Te herenga uaua varicose endoscopic (EVL)

Wāhanga 2

1) Ngā tohu mō te EVL: Pērā i te EVS.
2) Ngā ārai o te EVL:
(1) He rite tonu ngā ārai ki te gastroscopy;
(2) EV e haere tahi ana me te GV mārama;
(3) Ngā tūroro e pāngia ana e te ngoikore nui o te ate me te whatukuhu, he nui te ascites, te jaundice, ngā maimoatanga sclerotherapy maha tata nei, ngā uaua varicose iti rānei.
3) Me pēhea te whakahaere
Tae atu ki te herenga makawe kotahi, te herenga makawe maha, me te herenga taura nairona.
(1) Mātāpono: Āraia te rere o te toto o ngā uaua varicose, ā, whakaratohia he hemostasis ohorere → te totohu o te uaua i te wāhi here → te pirau o te kiko → te fibrosis → te ngaronga o ngā uaua varicose.
(2) Ngā Whakatūpato
Mō ngā varicose esophageal ngawari ki te kino, ka herea ia uaua varicose ki runga i te ara porowhita mai i raro ki runga. Me tata te here ki te pūwāhi herenga o te uaua varicose, kia tino herea ia pūwāhi, kia kikī hoki. Ngāna kia taupokina ia uaua varicose i ngā pūwāhi neke atu i te 3.
E tata ana ki te 1 ki te 2 wiki ka ngaro te kiriuhi i muri i te takai. Kotahi wiki i muri i te pokanga, ka nui te toto ka puta mai i ngā mate pukupuku o te rohe, ka ngaro te whitiki kiri, ā, ka toto te toto i te tapahi ā-ringa o ngā uaua varicose. Ka taea e te EVL te whakakore wawe i ngā uaua varicose, ā, he iti noa ngā raruraru, engari ka hoki mai anō ngā uaua varicose. He nui te ōwehenga;
Ka taea e te EVL te aukati i ngā toto toto o te uaua puku maui, te uaua esophageal, me te vena cava. Heoi, i muri i te aukati i te rere o te toto uaua esophageal, ka whānui te uaua coronary gastric me te perigastric venous plexus, ka piki ake te rere o te toto, ā, ka piki ake te tere o te hokinga mai i roto i te wā. Nō reira, he maha ngā wā ka hiahiatia te herea anō i te whitiki hei whakaū i te maimoatanga. Me iti iho i te 1.5 cm te whānui o te herea o te uaua varicose.
4) Ngā raruraru o te EVL
(1) Te toto nui nā ngā mate pukupuku o te rohe i te wiki kotahi i muri i te pokanga;
(2) Te toto i te wā o te pokanga, te ngaronga o te whitiki hiako, me te toto i puta mai i ngā uaua varicose;
(3) Te mate urutā.
5) Arotake i muri i te pokanga o te EVL
I te tau tuatahi i muri i te pokanga EVL, me arotake te mahi ate me te whatukuhu, te ultrasound-B, te mahinga toto, te mahi toto totoka, me ētahi atu i ia 3 ki te 6 marama. Me arotake te endoscopy i ia 3 marama, kātahi i ia 0 ki te 12 marama.
6) EVS me EVL
Ki te whakatauritea ki te sclerotherapy me te herenga, kāore he rerekētanga nui o te mate me te reiti toto anō i waenga i ngā mea e rua. Mō ngā tūroro e hiahia ana ki ngā maimoatanga maha, he mea nui ake te herenga. I ētahi wā ka whakakotahihia te herenga me te sclerotherapy, ka taea ai te whakapai ake i te maimoatanga. Ngā Pānga. I ngā whenua ke, ka whakamahia hoki ngā stent whakarewa kua hipokina katoatia hei whakamutu i te toto.

Te werohanga kāpia kiko endoscopic (EVHT)

wāhanga 3

He pai tēnei tikanga mō ngā varicose puku me te toto varicose esophageal i ngā wā ohorere.
1) Ngā raruraru o te EVHT: ko te nuinga o te wā ko te embolism o te uaua pūkahukahu me te uaua portal, engari he tino iti te auau.
2) Ngā Painga o te EVHT: ka tere te ngaro atu o ngā uaua varicose, he iti te tere o te toto anō, he iti noa ngā raruraru, he whānui ngā tohu, ā, he ngāwari te hangarau ki te mōhio.
3) Ngā mea hei mōhio:
I roto i te werohanga kāpia kiko endoscopic, me rawaka te nui o te werohanga. He tino pai te mahi a te ultrasound endoscopic i roto i te rongoā i ngā uaua varicose, ā, ka taea te whakaiti i te tūponotanga o te toto anō.
He pūrongo kei roto i ngā tuhinga o tāwāhi e kī ana he whai hua te maimoatanga o ngā varices puku mā te whakamahi i ngā coils, i te cyanoacrylate rānei i raro i te arataki o te ultrasound endoscopic mō ngā varices puku ā-rohe. Ki te whakaritea ki ngā werohanga cyanoacrylate, he iti ake ngā werohanga intraluminal e hiahiatia ana mā te coiling e arahina ana e te ultrasound endoscopic, ā, he iti ake ngā pānga kino e pā ana ki tēnei.

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