ERCP Inopinda Munguva Itsva Yekuvhiyiwa Kwemarobhoti

Vanachiremba vekuLatin America vanofara kutiERCPyapinda munguva itsva yekuvhiyiwa kwemarobhoti uye iri kuparadzira nhau idzi kure nekure.

Munguva pfupi yapfuura yekukurukurirana navanachiremba vekuLatin America, ndakataura nezveERCProbhoti rekuvhiya kubva kuAusway Endoscopy, iyo iri kuyedzwa pari zvino. Pavakadzidza kuti sisitimu iyi inogona kuita basa rekushandisa robhotiERCP, vachidzora endoscope inochinjika nezvishandiso vachishandisa ruoko rwerobhoti kuti vapedzise maitiro akadai sekuiswa kwe biliary stent pasina kupfeka maapuroni e lead uye nekuratidzwa nemwaranzi yakaderera zvakanyanya, mhepo yakabva yatanga kushanda. Vanachiremba vazhinji vakafara zvekuti vakanga vava kuparadzira nhau idzi.

 

Munguva yangu yekuzorora, ndakazvibvunza kuti: sei vaifara kudaro?

Ndichifunga nezvemubvunzo uyu, ndakaongororazve mabhuku nedata rakakodzera, uye pandaiverenga zvakawanda, zvaiwedzera kujeka—ERCPMarobhoti ekuvhiya zvechokwadi anobatsira zvikuru kune vanoongorora masero emuviri, kunyangwe tekinoroji inochinja hupenyu.

Pazasi, ndinoda kugoverana nemi: Muurayi Akanyarara muEndoscopy: Dambudziko reMwaranzi Rava Pedyo Kupfuura Zvamunofunga! Munhu Wese Ari KuitaERCPUnofanira Kuverenga Izvi

Chinhu chinonyanya kufuratirwa muimba yekuvhiyira haisi matambudziko, asi chiedza chiri kuungana chinyararire.

Nyanzvi dzakawanda dze endoscopist dzinoziva izvozvoERCPinoshandisa fluoroscopy, asi ungasaziva—Maitiro aya akanyorwa neFDA seongororo ine njodzi huru iyo "inogona kukonzera kukuvara kukuru kwemwaranzi."

Tiri kubatikana nekurapa matombo emunduru nematombo emudumbu, asi tinowanzo kanganwa chimwe chinhu chinotyisa kupfuura izvi:

Mwaranzi iri kukuvadza varwere chinyararire, uye inokuvadza munhu wese akamira padivi peC-arm.

Nhasi, nenzira iri nyore kunzwisisa, ndichatsanangura nhungamiro dzepasi rose neruzivo rwechokwadi rwekutsvagisa:

Une tsika dzakaita sei chaizvo? Ndedzipi tsika dziri "kuba" hutano hwako? Ungava sei nechokwadi chekuti wakachengeteka zvechokwadi?

I. Nei zvakadaroERCPinoonekwa senzira ine njodzi huru inosanganisira mwaranzi?

NekutiERCPinosangana nemamiriro ese ezvinhu ekuti "upihwe mushonga wakanyanya"

● Inoda fluoroscopy

● Maitiro akaomarara

● Kuva pedyo nachiremba

● Nguva refu

● Maitiro ekudzokorora

Nhamba dzechokwadi dzinotyisa sei?

Chiyero chemwaranzi cheimweERCPnzira iyi inenge yakaenzana ne312 chest X-rays (avhareji).

—Chidzidzo kubva kuERCPchirongwa chekuyera mwaranzi muUruguay

Chinonyanya kukosha: Unowana makumi, mazana, kana kutopfuura pagore.

II. Chii chinokonzerwa nemwaranzi pauri?

Kukuvadzwa nemwaranzi kwakakamurwa muzvikamu zviviri:

1) Kukuvara kwakasimba (kunoitika kana dose yacho yakakwana)

● Kutsvuka kweganda

● Kudonha kwebvudzi

● Kubviswa kwemavara

● Maronda

● Matumbu (anowanzo unganidzwa kwenguva refu nezvinhu zvine chepfu)

Lenzi iyi ndeimwe yenhengo dzisina kusimba zvakanyanya, uye ICRP yakadzikisa mwero wekushandiswa kwayo kusvika pa20 mSv pagore.

VazhinjiERCPNyanzvi dzakashanda kwemakore anopfuura gumi dzakatoona kusaonekwa kwemalenzi.

2) Kukuvadzwa kusingatarisirwi (kukuvara kungangodaro)

Hapana muganho.

Kana dose yakakwira, njodzi yacho inowedzerawo.

Kufungidzira kweICRP: 1 mSv = 0.005% kuwedzera kwengozi yekenza muhupenyu hwese.ERCP≈ 6 mSv → kuwedzera kwengozi ne 0.03%.

Hausi kuzviita "kamwe chete".

Uri kuzviita kakawanda pagore, kane zviuru muhupenyu hwako.

III. Nzvimbo ine njodzi zvikuru muERCPImba ndiyo yaunomira zuva nezuva.

Muchidimbu: Kana chubhu yeX-ray iri pedyo, ndipo panowedzera mwero wemushonga.

Nzvimbo dzine njodzi huru dzekusangana nevashandi dzinosanganisira:

● Rutivi rumwe rwechubhu yeX-ray yeC-arm

● Panguva yekufungidzira makona akachenuruka

● Nzvimbo yakatenderedza murwere (nzvimbo huru yemwaranzi yakapararira)

● Nzvimbo dzinoshandiswa vanachiremba vanorapisa varwere nevanamukoti

Vanhu vazhinji havazivi izvozvo: Nzvimbo dzavanomira ndidzo nzvimbo dzakanyanya kusvikwa nemwaranzi.

IV. Kuferefeta Chaiko: 90% yeVashandi vezvekurapa Havana Kutora Matanho Akakodzera ekudzivirira

Zvakawanikwa muongororo yeSociedad Interamericana de Endoscopía Digestiva (SIED) zvinokatyamadza:

● Vanachiremba vanosvika 22% chete ndivo vakadzidziswa kudzivirira mwaranzi.

● 17% chete yevanamukoti ndivo vakadzidziswa.

● Kunze kwemaapuroni emutobvu, mwero wekushandiswa kwemimwe michina yekudzivirira wakaderera zvikuru.

Unoona sekuti "wakachengeteka" here? Chokwadi ndechekuti: Vanhu vazhinji vari kumhanya-mhanya vasina kupfeka.

V. Nheyo yeALARA: Mitemo Mitatu Inofanira Kutevedzerwa Nemunhu Wese

ALARA = Yakaderera Zvine Mufungo Zvinogoneka Kuwanikwa

1.Nguva: Ipfupi sezvinobvira.

● Kuongororwa kwepulse fluoroscopy

● Shandisa "Frozen Last Frame"

● Dzivisa fluoroscopy inoramba ichienderera mberi

2. Kureba: Kana nhanho imwe neimwe ichidzokera shure, chiyero → chinova 1/4 chepakutanga.

3. Kudzivirira: Kuvhara zvakanyanya sezvinobvira.

● Epuroni yemutobvu (≥0.35 mmPb)

● Kudzivirirwa kwegland re thyroid

● Magirazi emutobvu (ekudzivirira cataract)

● Maketeni emutobvu

● Masikirwo akarembera

Keteni remutobvu rinogona kuderedza mwaranzi yakapararira neinopfuura 95%.

VI. Ngozi dzechokwadi dziri kupi kuvarwere?

BMI Yakakwira, inodzokororwaERCP, madhigirii akasiyana-siyana, nguva refu yekuvhiyiwa. Izvi zvinogona kukonzera kuti ganda riungane nekukurumidza muvarwere.

Kunyatsotarisirwa:

● Vakadzi

● Vakadzi vane pamuviri

● Vana (kunzwa kwemuviri ×3–5)

● Kuratidzwa kwemwaranzi kakawanda munzvimbo imwe chete

Varwere ava vanofanira kunge vaine mishonga mishoma chete.

VII. Vakadzi Vane Mimba Nevana: Mapoka Ane Ngozi Yakanyanya Anofanira Kukurukurwa Ari Ega.

ERCPNheyo dzeVakadzi Vane Mimba

● "Zvinodiwa zvechokwadi here"?

● Inogona kunonotswa here?

● Inoitiswa nachiremba ane ruzivo rwakakura here?

● Nguva ye fluoroscopy inoderedzwa zvakanyanya here?

● Nguva ine njodzi huru yekuzvitakura (mavhiki 10–25).

ERCPmisimboti yevana

● Kunzwa kwakanyanya kwemushonga.

● chiedza chakasimba uye kudzora kupenya kwemvura kwakakosha.

● Vashandi vane ruzivo rwakakura chete ndivo vanobvumirwa.

VIII. Zvinhu zvishanu zvine hunyanzvi hwechokwadiERCPimba inofanira kuita:

1. Sisitimu yedosimita mbiri (yakajairwa): Imwe iri kunze kweapuroni yemutobvu, imwe iri mukati.

2. Gadzira DRL (Diagnostic Reference Level): DRL yazvino yeJapan: 32 Gy·cm² (75th percentile).

3. Ongorora maapuroni emutobvu gore rega rega (uchashamiswa nekuwanda kwawo).

4. Kupa varwere mapepa eruzivo rwemwaranzi (maitiro akajairika mumadhipatimendi anotarisirwa zvakanaka).

5. Tevedzera varwere vane mishonga yakawanda kwemavhiki maviri kusvika mana (kukuvara kweganda kunogona kunonoka).

Mukupedzisa: Kuzvidzivirira ndiyo chete nzira yekudzivirira varwere vakawanda.

Mwaranzi yaunosangana nayo: haioneki, hairwadzi, uye haikonzeri kutsvuka, hauinzwi ipapo ipapo, asi inoungana uye inokukuvadza zuva nezuva.

Dzidza dziviriro yakakodzera kuti ugone:

● Shanda kwenguva yakareba

● Shanda zvakachengeteka

● Shanda zvine hutano

● Shanda zvine hunyanzvi

Dai zveseERCPchiremba ngaave pasi pechiedza, asi usambokuvadzwa nacho.

ERCPZvinhu zvinotengeswa zvinotengeswa zvakanyanya kubva kuZRHmed.

Sphincterotome	Waya Dzinotungamirira Dzisina Mtsipa	Matengu Ekutora Matombo Anoraswa	Makemikari eNasobiliary Anoraswa

Isu, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., tinogadzira zvinhu muChina zvine chekuita ne endoscopic consumables, zvinosanganisira GI line dzakadai se biopsy forceps, hemoclip, polyp snare, sclerotherapy needle, spray catheter, cytology brushes,waya yekufambisa, tswanda yekutorwa kwematombo, cathete yekubuda kwemvura mumhino nezvimwewo zvinoshandiswa zvakanyanya muEMR, ESD,ERCPZvigadzirwa zvedu zvakanyoreswa neCE uye zvine mvumo yeFDA 510K, uye mafekitori edu akanyoreswa neISO. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East nechikamu cheAsia, uye zvinowana mukurumbira nerumbidzo kubva kune vatengi!