(最后)内镜下食管静脉曲张套扎治疗知情赞成书(国外英文资料).doc

(最后)内镜下食管静脉曲张套扎治疗知情同意书(国外英文资料) Page 2, page 2 Tianjin ninghe county hospital The endoscopic esophageal vein varicose was treated with the knowledge of the consent form The patient name gender age Date of birth Medical record no. : Outpatient number: Advice on disease diagnosis and treatment The reason for the hemorrhage in the upper gastrointestinal tract may be the rupture of the esophagus and/or the gastric vein, the doctor has told him The need for: Conventional gastroscopy; Esophageal varicotomy: the method of varicose veins. [different screening programmes] According to your condition at present, our mainly has the following several kinds of treatment plan: _______________________________________________________________________________ mind surgery and drug treatment Line 【 suggestion is proposed to check the name 】 __________________________________________. The date of the year of the examination is divided 【 refused to check the possible consequences of esophageal gastric varices is usually caused by liver cirrhosis and portal hypertension, serious when can happen stomach esophagus varicosity burst bleeds, is one of serious complication of liver cirrhosis and portal hypertension. If it does not stop the blood or prevent further blood treatment, it will cause anemia, hemorrhagic shock, liver function damage, liver failure and liver disease. It can also induce other heart, cerebrovascular events, or kidney failure and so on. A heavy man is a danger to life. The patients own high risk factors exist 】 _______________________________________________________ ______________________________________________________________________________ intraoperative inspection fee 】 【 might use the high value of out-of-pocket medical consumables: _______________________________________ [surgical potential risk and strategy] The doctor told me the following endoscopic interventional treatment esophageal gastric varices may be some risk, the risk of some unusual there may not be o