上消化道出血的内镜治疗.pptVIP

2021/2/6 * 2021/2/6 * 内镜治疗技术－食管静脉曲张组织粘合剂栓塞治疗术 组织粘合剂(Histoacryl)—N-丁基-2-氰基丙稀酸酯(N-butyl-2-cyanoacrylate),具有止血和抑制细菌生长作用,遇血立即发生固化,起到闭塞血管、控制曲张静脉破裂出血的效果 限量应用将其直接注入曲张静脉内一般不会发生系统栓塞。Histoacryl在空气中迅速凝固,须用脂溶性碘剂（Lipiodol）稀释,以延缓Histoacryl过快凝固,并便于X线下监视以避免或减轻异位栓塞 2021/2/6 * 2021/2/6 * 2021/2/6 * 结肠镜检查适应症 1.原因不明的下消化道出血（黑便、血便）或便潜血阳性者 2.慢性腹泻原因未明者 3.低位肠梗阻或原因不明的腹部肿块,不能排除肠道病变者。 4.原因不明的中下腹疼痛 5.结直肠癌病人,为了解肿瘤的类型、病变的范围,在手术前需做肠镜检查,以利决定手术方案。 * The current indications for endoscopic treatment of bleeding ulceration are listed. Here is the endoscopic stigmata that we will identify; the photographs are there. The clean-based ulcer patient who does not have any stigmata and is hemodynamically stable can probably be discharged without even being admitted to hospital. If you do that evaluation in the emergency room. The flat spot is the ulcer that should be left alone. The adherent clot, we are going to talk about it because that is a controversial watershed area. The visible vessel or active bleeder gets our blood pressures up. They need some kind of intervention. * * * * * * * How would you treat patients with bleeding ulcers? Are oral PPIs appropriate? The majority of your patients who are clinically stable and on upper endoscopy, having an ulcer with a clean base or a flat pigmented spot do not need IVs. * * * * * * * Duodenal angiodysplasia can be a source of chronic gastrointestinal tract blood loss and anemia. If only a single lesion or only a few lesions are present, bipolar electrocoagulation can be effective treatment. Image A shows a typical duodenal angiodysplasia. Image B depicts application of the bipolar probe with enough force to create a slight bow in the device. Image C shows the result of successful electrocoagulation * * * * * * * Blood loss from unresectable gastrointestinal tract hollow organ tumors represents a major pallative challange to the endoscopic oncologist. Image A depicts an adenocarcinoma of the duodenum complicated by chronic blood loss. Repeated attempts to c