ERCP Zvishandiso-Stone Extraction Basket
Dengu rekudzoreredza dombo ndiro rinowanzo shandiswa mubatsiri wekudzorera matombo muERCP accessories.Kune vanachiremba vazhinji vari vatsva kuERCP, tswanda yematombo inogona kunge ichiri kungogumira kune pfungwa ye "zvishandiso zvekunhonga matombo", uye hazvina kukwana kutarisana neyakaoma ERCP mamiriro.Nhasi, ndichapfupikisa nekudzidza ruzivo rwakakodzera rweERCP mabhasikiti ematombo zvichienderana neruzivo rwakakodzera rwandabvunza.
General classification
Tswanda yekudzosa matombo yakakamurwa kuita bhasikiti rinotungamira waya, bhasikiti rinotungamirwa newaya risiri kutungamira, uye tswanda yakasanganiswa yematombo.Pakati pavo, mabhasikiti akabatanidzwa ekudzoreredza-kupwanya mabhasikiti akajairwa-kupwanya mabhasikiti anomiririrwa neMicro-Tech uye iyo Rapid Exchange (RX) yekudzosa-crush matengu anomiririrwa neBoston Sayenzi.Nekuda kwekuti bhasikiti rekutsvagisa-crush-crush uye bhasiketi rekuchinja-chinja zvinodhura zvakanyanya kupfuura mabhasikiti akajairwa, mamwe mayuniti uye vanachiremba vanoshanda vanogona kuderedza kushandiswa kwavo nekuda kwemitengo.Nekudaro, zvisinei nemutengo wekungoisiya, vanachiremba vazhinji vanoshanda vanonyanya kuda kushandisa tswanda (ine dhairekitori waya) kupatsanurwa, kunyanya kune yakakura zvishoma bile duct matombo.
Zvinoenderana nechimiro chebhasikiti, inogona kukamurwa kuita "hexagonal", "dhaimondi" uye "spiral", kureva diamond, Dormia uye spiral, pakati peiyo mabhasikiti eDormia anonyanya kushandiswa.Mabhasikiti ari pamusoro ane zvakanakira nezvaanokanganisa, uye anofanirwa kusarudzwa zviri nyore zvichienderana nemamiriro chaiwo uye maitiro ekushandisa ega.
Nekuti dengu rakaita sedhaimani nedengu reDormia ibhasiketi rinochinjika rine "rakatambanudzwa kumucheto uye kupera kwakaderedzwa", zvinogona kuita kuti zvive nyore kuti tswanda itore matombo.Kana dombo racho risingakwanisi kubudiswa mushure mekuvharirwa nokuti dombo rakakura zvikuru, tswanda inogona kusunungurwa zvakanaka, kuitira kudzivirira njodzi dzinonyadzisa.
Ordinary "diamond" tswanda
Nguva dzose "hexagon-rhombus" mabhasikiti anoshandiswa zvishoma, kana chete mumabhasikiti ematombo anopwanya.Nekuda kwenzvimbo yakakura ye "diamond" bhasiketi, zviri nyore kuti matombo madiki atize kubva mudengu.Dengu rakaita spiral rine maitiro ekuti "nyore kupfeka asi zvisiri nyore kusunungura".Kushandiswa kwebhasikiti rakaita spiral kunoda kunzwisiswa kwakazara kwedombo uye kufungidzirwa kushanda kuti dombo rirege kunamira zvakanyanya sezvinobvira.
Spiral basket
Bhasikiti rinokurumidza-kuchinjana rakabatanidzwa nekupwanya nekupwanya rinoshandiswa panguva yekuchera matombo makuru, anogona kupfupisa nguva yekushanda uye kuvandudza kubudirira kwekupwanya.Mukuwedzera, kana tswanda ichida kushandiswa pamifananidzo, mumiririri wekusiyanisa anogona kunge afanoputirwa uye apera simba risati rapinda mu bile duct.
Chechipiri, nzira yekugadzira
Chimiro chikuru chebhasikiti yematombo inoumbwa nekasi yebhasikiti, sheath yekunze uye mubato.Tsvimbo yebhasiketi inoumbwa newaya yebhasiketi (titanium-nickel alloy) uye waya yekudhonza (304 yekurapa simbi isina tsvina).Tsvimbo yebhasiketi ndeye alloy yakarukwa chimiro, yakafanana neyakarukwa chimiro chemusungo, iyo inobatsira kubata chinongedzo, kudzivirira kutsvedza, uye kuchengetedza tension yakakwira uye haisi nyore kuputsika.Waya yekudhonza iwaya yakakosha yekurapa ine simba rakasimba rekumanikidza uye kuomarara, saka ini handisi kuzopinda muhuwandu pano.
Chinhu chinokosha chekutaura pamusoro pacho chimiro chewelding pakati pewaya yekudhonza newaya yebhasiketi, waya yebhasiki uye musoro wesimbi webhasiketi.Kunyanya, iyo welding point pakati pekudhonza wire uye bhasiketi waya inonyanya kukosha.Kubva pakugadzirwa kwakadaro, zvinodiwa zvekugadzirisa welding zvakakwirira zvikuru.Tswanda ine hutsika husina kunaka haingotadzi kupwanya dombo chete asi kuti inogona kukonzera kuti panoperera wire iri pakati pewaya yekudhonza newaya yedengu ityoke panguva yekupwanywa kwedombo mushure mekunge dombo rabviswa zvoita kuti tswanda uye dombo rinosara mubile duct, uye kubviswa kwakatevera.Kuomerwa (kazhinji kunogona kudzoserwa nedengu rechipiri) uye kungatoda kuvhiyiwa.
Kusakwana kwehupfu hwewaya uye musoro wesimbi wetswanda dzakawanda zvinogona kuita kuti tswanda ive nyore.Nekudaro, tswanda dzeBoston Sayenzi dzakaedza zvakanyanya mune izvi uye dzakagadzira nzira yekudzivirira kuchengetedza.Izvi zvinoreva kuti kana matombo achiri kusakwanisa kuputswa nematombo ekupwanya ane simba guru, tswanda inoomesa matombo inogona kudzivirira musoro wesimbi kumucheto wepamberi webhasiki kuti uve nechokwadi chekubatanidzwa kwetambo yebhasiki uye tambo yekudhonza.Kuvimbika, nokudaro kudzivirira mabhasikiti nematombo akasiiwa mune bile duct.
Ini handisi kuzoenda mune zvakadzama nezve yekunze sheath chubhu uye mubato.Uye zvakare, vakasiyana siyana vanogadzira matombo vanopwanya vachave neakasiyana ematombo anopwanya, uye ini ndichave nemukana wekudzidza zvimwe gare gare.
Kushandisa sei
Kubviswa kwedombo kwakasungwa chinhu chinonetsa.Izvi zvinogona kunge zviri kutarisisa kweanoshanda mamiriro emurwere uye zvishongedzo, kana inogona kunge iri chimiro cheiyo bile duct matombo ivo pachavo.Chero zvazvingava, tinofanira kutanga taziva nzira yekudzivisa kusungwa, uye tinofanira kuziva zvekuita kana kusungwa kukaitika.
Kuti udzivise kusungwa kwebhasikiti, bharumu re columnar rinofanirwa kushandiswa kukwenenzvera kuvhura zamu risati rabviswa dombo.Dzimwe nzira dzinogona kushandiswa kubvisa bhasikiti rakavharirwa dzinosanganisira: kushandiswa kwebhasikiti rechipiri (basket-to-basket) uye kubviswa kwekuvhiya, uye chinyorwa chemazuva ano chakashumawo kuti hafu (2 kana 3) yewaya inogona kupiswa uchishandisa. APC.putsa, uye usunungure tswanda yakasungwa.
Chechina, kurapwa kwekusungwa kwedengu rematombo
Kushandiswa kwebhasikiti kunonyanya kusanganisira: kusarudzwa kwebhasikiti uye zvinyorwa zviviri zvebhasikiti kutora dombo.Panyaya yekusarudzwa kwebhasiketi, zvinonyanya kuenderana nechimiro chebhasiketi, dhayamita yebhasiketi, uye kana kushandisa kana kuchengetedza emergency lithotripsy (kazhinji, iyo endoscopy centre inogarogadzirirwa).
Parizvino, dengu "dhaimondi" rinoshandiswa nguva dzose, kureva, Dormia tswanda.Mugwaro reERCP, rudzi urwu rwetswanda runotaurwa zvakajeka muchikamu chekubviswa kwematombo kune akajairika bile duct matombo.Iine kubudirira kwepamusoro kwekutora dombo uye iri nyore kubvisa.Ndiyo yekutanga-mutsara sarudzo yezvizhinji zvekutorwa kwematombo.Nokuda kwehupamhi hwebhasikiti, bhasikiti rinoenderana rinofanira kusarudzwa maererano nehukuru hwebwe.Hazvina kunaka kutaura zvakawanda nezve kusarudzwa kwebhasikiti mhando, ndapota sarudza zvinoenderana nemaitiro ako ega.
Unyanzvi hwekubvisa dombo: Dengu rinoiswa pamusoro pedombo, uye dombo rinoedzwa pasi pekutariswa kweangiographic.Zvechokwadi, EST kana EPBD inofanira kuitwa maererano nekukura kwebwe risati ratora dombo.Kana iyo bile duct yakakuvara kana kutetepa, panogona kunge pasina nzvimbo yakakwana yekuvhura dengu.Inofanira kutorwa maererano nemamiriro chaiwo.Iyo inotova sarudzo yekutsvaga nzira yekutumira ibwe kune yakapamhama bile duct kuti itore.Kune hilar bile duct matombo, zvinofanirwa kucherechedzwa kuti matombo anosundirwa muchiropa uye haagone kudzoserwa kana tswanda yabviswa mubhasiki kana bvunzo yaitwa.
Pane mamiriro maviri ekutora matombo kubva mudengu rematombo: imwe ndeyokuti pane nzvimbo yakakwana pamusoro pebwe kana padivi pedombo kuti bhasikiti rizaruke;imwe yacho ndeyekudzivisa kutora matombo makuru, kunyange kana tswanda yakazarurwa zvachose, haigoni kubviswa.Isu takasanganawo nematombo matatu masendimita akabviswa mushure me endoscopic lithotripsy, izvo zvese zvinofanirwa kuve lithotripsy.Zvisinei, mamiriro ezvinhu aya achiri nengozi uye anoda chiremba ane ruzivo kuti ashande.
Nguva yekutumira: May-13-2022