Treat the esophagus - variceal bleeding _'s treatment of fundus of stomach by the gastroscope

Treat the esophagus - variceal bleeding _'s treatment of fundus of stomach by the gastroscope
The esophagus - fundus of stomach is variceal to break to bleed for the main complications of liver cirrhosis, portal vein with common hyperbarism. Get up worried person who bleed great disease and case fatality rate high, account for upper second that digestive tract bleed. The mortality with first bleeding of person who damages liver function is up to more than 50%, recur the incidence of bleeding is about 80%. The medicine that adopted in the past arrested blood and oppressed therapeutic method with three of tubes, the case fatality rate was still up to about 35%. Treat esophagus to be variceal to break, bleed behind the this new technology under the mirror in not adopting, the case fatality rate has already dropped to about 10%. At present, treat variceal to break, bleed, have two kinds of main methods esophagus inner mirror that recommend in the world: Pass variceal ligature skill (endoscopic variceal ligation, EVL) of the gastroscope esophagus ; Pass the variceal sclerosis pharmaceutical treatment (endoscopic variceal sclerotherapy, EVS) of gastroscope esophagus .
First, pass variceal ligature skill of the gastroscope esophagus
(1) Basic principle
Esophagus variceal ligature whether less than the intersection of pile and elastic rubber surround the intersection of ligature and arresting blood and preventing the therapeutic method that bled based on the principle under the inner mirror, it is safe and effective, the method is easy. Clinical research indicates, light watch ulcer happens in the therapeutic position of variceal ligature of esophagus, 12- 16d reexamines gastroscope ulcer to heal, the vein of one of song is variable and detailed or disappears after 1- 2 treatments. Little light than complication of EVS, inject the intersection of needle and hole, bleed with intravenous wall tearing, injuring etc. dangerously. EVL encloses a vein of ligature song with the little elasticity rubber, make its ischemic, necrosis achieve the goal of arresting blood and reducing to bleed again. At present, EVL that adopt have single times of ligature and continuous ligature Two kinds.
(2) Adapt to card and taboo card
1.The esophagus is variceal to break to bleed through the persons who will still bleed again in the near future after the medicine and three of tube oppression;
2.Too variceal to bleed one, with obstacle, ascites, jaundice of serious liver function person of esophagus;
3.It is unsuitable to do shunting, persons who bleed to bleed repeatedly again after blanking operation or operation.
(3) Working technique
1.The apparatus is prepared
Adopt the fibrous gastroscope or electronic gastroscope of the normal form, do the electricity of the skill centre of a patient well to guard the work at the same time.
( 1) Single second-class ligature device
Furnished with passway tooth cushion of the heavy-calibre, silicon oil, aspirator and an intravenous ligature device of oesophageal song. Ligature device is made up of 4 parts: The tube of overcoat: Generally used as gastroscope of 11- 13mm external diameter. One end of the tube of overcoat is enclosed for the rubbery column, make it connect with front of gastroscope closely, difficult slip; Unless enclose another end to plasticses hard, make collets internal and external not met closely,is it getting getting easier very to be more pull into more line in there last overcoat tube is collet, rubber on the collet enclose and carry out the ligature blood vessel make. Inner collet: The inside telescopic external diameter is generally the same with internal diameter of the tube of overcoat, there are small grooves inside, it is a junction of pulling the line front brief summary. When pulling and pulling the line, the inner telescopic retraction gets in the tube of overcoat, the rubber on the collet is enclosed and carried out in making, intravenous blood vessel of ligature. Pull the line: Through examine hole, send the intersection of gastroscope and front to while being living, emerge brief summary of pulling in front of the line, link with telescopic groove in ligature device. The ligature rubber is enclosed: " O" It is that one kind has very strong and elastic and nonpoisonous rubbery products that the shape rubber is enclosed, internal diameter 2mm, and can pull to the diameter 15mm.
( 2) Continuous ligature device
American department ahead of Company (Microvasive) by U.S.A. Newest introduction, are used in set pitching and treating the esophagus variceally. It features one can suit pitch Fifth Ring Road or 8 rings, need overcoats in charge of under the mirror; A set of piece of it is a transparent material, do not influence visual field and tape to pour into the conduit; The performance of one set of circles is good, the manual controlling part is easy to operate and effective, patients have few agony. Every set of intact packaging includes: A set of piece of Fifth Ring Road or eight rings a set of piece, manual controlling part, pouring into one respectively conduit.
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