Mukuongororwa uye kurapwa kwezvirwere zvebiliary, kuvandudzwa kwe endoscopic tekinoroji yakagara yakatarisana nezvinangwa zvekunyatsoita, kushomeka kwekupinda, uye kuchengetedzwa kwakanyanya. Endoscopic retrograde cholangiopancreatography (ERCP), iro basa rekuongororwa kwechirwere chebiliary uye kurapwa, rakagara richigamuchirwa zvakanyanya nekuda kwekusavhiya uye kusanyanya kupindira. Nekudaro, kana watarisana neakaomesesa maronda emabiliary, nzira imwe chete inowanzotadza. Apa ndipo apo percutaneous transhepatic cholangioscopy (PTCS) inova yakakosha mukwanisi kuERCP. Iyi nzira yakasanganiswa ye "dual-scope" inodarika miganhu yekurapa kwechinyakare uye inopa varwere nzira nyowani yekuongorora uye yekurapa.
ERCP nePTCS imwe neimwe ine hunyanzvi hwayo hwakasiyana.
Kuti unzwisise simba rehuviri-mwero wakabatanidzwa kushandiswa, munhu anofanira kutanga anzwisisa zvakajeka kugona kwakasiyana kwezviridzwa zviviri izvi. Kunyangwe ese ari maturusi ekuongororwa uye kurapwa kwebiliary, vanoshandisa nzira dzakasiyana, vachigadzira yakakwana.
ERCP: Nyanzvi yeEndoscopic Inopinda muDigestive Tract
ERCP inomirira Endoscopic Retrograde Cholangiopancreatography. Kushanda kwayo kwakafanana nenzira yekutenderera yekuita zvinhu. Chiremba anoisa duodenoscope kuburikidza nemuromo, esophagus, uye mudumbu, pakupedzisira inosvika pakadzika duodenum. Chiremba anotsvaga mavhuriro emukati e bile uye pancreatic ducts (iyo duodenal papilla). A catheter inobva yaiswa kuburikidza ne endoscopic biopsy port. Mushure mekubaya jekiseni rekusiyanisa, kuongororwa kweX-ray kana ultrasound kunoitwa, zvichiita kuti kuonekwe kweiyo bile uye pancreatic ducts.
Pachikonzero ichi,ERCPinogonawo kuita nzira dzakasiyana-siyana dzekurapa: semuenzaniso, kuwedzera yakamanikana bile ducts nebharumu, kuvhura yakavharika ndima nema stents, kubvisa matombo kubva mubile duct nebhasikiti rekubvisa dombo, uye kuwana matishu ane chirwere chekuongorora pathological uchishandisa biopsy forceps. Kubatsira kwayo kukuru kuri muchokwadi chekuti inoshanda zvachose kuburikidza negomba rechisikigo, ichibvisa kudiwa kwepamusoro incisions. Izvi zvinobvumira kukurumidza kupora mushure mekuvhiyiwa uye kukanganisa kudiki kumuviri wemurwere. Iyo inonyanya kukodzera kurapa bile duct matambudziko padyo neura, sematombo ari pakati uye akaderera akajairika bile duct, yakaderera bile duct strictures, uye maronda papancreatic uye bile duct junction.
Zvisinei, ERCP inewo "kushaya simba" kwayo: kana iyo bile duct obstruction yakaoma uye bile haigoni kubudiswa zvakanaka, iyo yakasiyana-siyana ichave yakaoma kuzadza iyo yose duct duct, iyo inokanganisa kururamisa kwekuongororwa; kune intrahepatic bile duct matombo (kunyanya matombo ari mukati mechiropa) uye yakakwirira-yakagadzika bile duct stenosis (pedyo nechiropa hilum uye pamusoro), maitiro ekurapa anowanzo kuderedzwa zvikuru nokuti endoscope "haigoni kusvika" kana nzvimbo yekushanda ishoma.
PTCS: A Percutaneous Pioneer Anopaza Nepakati peChiropa
PTCS, kana percutaneous transhepatic choledochoscopy, inoshandisa nzira ye "kunze-mukati", kusiyana ne "mukati-kunze" nzira yeERCP. Ari pasi pe ultrasound kana CT nhungamiro, chiremba anovhiya anobaya ganda pachipfuva chekurudyi kana dumbu remurwere, achinyatsofamba nechiropa uye achipinda mugero re intrahepatic bile duct, achigadzira “ganda-chiropa-bile duct” mugero. Choledochoscope inozopinzwa nemumugero uyu kuti itarise zvakananga intrahepatic bile duct panguva imwe cheteyo ichiita marapiro akadai sekubvisa dombo, lithotripsy, dilation of strictures, uye stent kuiswa.
PTCS "chombo chinouraya" chiri mukukwanisa kwayo kusvika zvakananga intrahepatic bile duct maronda. Inonyanya hunyanzvi pakugadzirisa "matambudziko akadzama" akaoma kusvika neERCP: semuenzaniso, hofori bile duct matombo anodarika 2 cm mudhayamita, "matombo akawanda" akapararira kune akawanda intrahepatic bile duct matavi, yakakwirira-positioned bile duct strictures anokonzerwa nemamota kana kuzvimba, uye matambudziko akaomarara akadai seanastomotic stenosis inoitika mushure mekuvhiyiwa kwebile fistula. Uyezve, kana varwere vasingakwanisi kuita ERCP nekuda kwezvikonzero zvakadai seduodenal papillary malformation uye kuvharwa kwematumbo, PTCS inogona kushanda seimwe nzira, inokurumidza kubudisa bile uye kuderedza jaundice, nokudaro kutenga nguva yekurapa kunotevera.
Nekudaro, PTCS haina kukwana: sezvo ichida kubaya pamusoro pemuviri, matambudziko akadai sekubuda ropa, kubuda bile, uye kutapukirwa zvinogona kuitika. Iyo postoperative kudzoreredza nguva yakati rebei pane ERCP, uye chiremba puncture tekinoroji uye mufananidzo kutungamira kwechokwadi kwakakwira zvakanyanya.
Musanganiswa Une Simba: Iyo Logic ye "Synergistic Operation" ine Dual-Scope Combination
Kana "endovascular advantages" yeERCP inosangana ne "percutaneous advantages" yePTCS, maviri acho haasisina kugumira kune imwe nzira, asi panzvimbo iyo anoumba chirongwa chekuongorora uye chekurapa "chinorova mukati nekunze kwemuviri." Musanganiswa uyu hausi wekuwedzera kweruzivo rwemichina, asi kuti chirongwa chemunhu "1+1> 2" chakaenderana nemamiriro emurwere.
Sequential Combination: "Vhura Nzira Kutanga, Wobva Wanyatso Kurapa"
Iyi ndiyo nzira yakajairika yekusanganisa, kazhinji ichitevera musimboti we "mvura Yekuchera Chekutanga, Kurapa Gare gare." Semuenzaniso, kune varwere vane chirwere chejaundice chakakomba chinokonzerwa ne-intrahepatic bile duct stones, danho rokutanga nderokugadzira biliary drainage channel kuburikidza nePTCS puncture kuti ibudise iyo yakaunganidzwa bile, kuderedza chiropa, kuderedza dambudziko rehutachiona, uye zvishoma nezvishoma kudzorera kushanda kwechiropa chemurwere uye chimiro chemuviri. Kana mamiriro emurwere angogadzikana, ERCP inobva yaitwa kubva mudumbu kubvisa matombo ari muzasi common bile duct, kurapa maronda ari muduodenal papilla, uye kuwedzera kuwedzera bile duct stricture uchishandisa bharumu kana stent.
Sezvineiwo, kana murwere achipinda ERCP uye akawanikwa aine matombo echiropa akasara kana yakakwirira-level stenosis isingagoni kurapwa, PTCS inogona kushandiswa kupedzisa "basa rekupedzisa" gare gare. Iyi modhi inopa mukana we "nhanho-ne-nhanho nzira ine njodzi dzinogoneka," ichiita kuti ive yakakosha kune varwere vane mamiriro akaomarara uye pre-epo hutano hutano.
Kushanda Kwakasanganiswa Kwakabatana: “Simultaneous Dual-scope Operation,
Single-Stop Solution”
Kune varwere vane chirwere chakajeka uye kushivirira kwakanaka kwemuviri, vanachiremba vanogona kusarudza "nguva imwe chete yakabatanidzwa" nzira. Panguva yekuvhiyiwa kumwe chete, zvikwata zveERCP nePTCS zvinoshanda pamwechete. Chiremba anovhiya ERCP anoshandisa endoscope kubva kudivi remukati, achiwedzera duodenal papilla uye nekuisa gwara. Chiremba wePTCS, achitungamirwa nekufungidzira, anobaya chiropa uye anoshandisa choledochoscope kutsvaga iyo ERCP-yakaiswa gwara, achiwana kurongeka chaiko kwe "nzira dzemukati nekunze." Zvikwata zviviri izvi zvinozobatana kuita lithotripsy, kubviswa kwematombo, uye kuisa stent.
Kubatsira kukuru kwemuenzaniso uyu ndekwekuti inogadzirisa nyaya dzakawanda nenzira imwe chete, kubvisa kudiwa kweanesthesia yakawanda uye kuvhiyiwa, kupfupisa kutenderera kwekurapa. Semuenzaniso, kune varwere vane ese ari maviri intrahepatic bile duct matombo uye akajairika bile duct matombo, PTCS inogona kushandiswa panguva imwe chete kubvisa matombo e intrahepatic uye ERCP kugadzirisa iyo yakajairika bile duct matombo, kubvisa kudiwa kwevarwere kuti vaende kwakawanda kutenderera kweanesthesia uye kuvhiyiwa, zvakanyanya kuvandudza kushanda kwekurapa.
Inoshanda Mamiriro ezvinhu: Ndevapi Varwere Vanoda Dual-Scope Combination?
Hadzisi dzese hosha dzebiliary dzinoda mbiri-scope yakasanganiswa imaging. Dual-scope yakasanganiswa imaging inonyanya kukodzera nyaya dzakaomarara dzisingagone kugadziriswa nehunyanzvi humwe, kunyanya kusanganisira zvinotevera:
Complex bile duct matombo: Iyi ndiyo yekutanga application mamiriro ehuviri-scope yakasanganiswa CT. Semuenzaniso, varwere vane ese ari maviri intrahepatic bile duct matombo (kunyanya ayo ari munzvimbo dziri kure senge kuruboshwe lateral lobe kana kurudyi posterior lobe yechiropa) uye akajairika bile duct matombo; varwere vane matombo akaoma anopfuura 2 cm mudhayamita asingakwanisi kubviswa neERCP chete; uye varwere vane matombo akaiswa mune yakamanikana bile ducts, kudzivirira kupfuura kweERCP zviridzwa. Ichishandisa maviri-scope yakasanganiswa CTCS, CTCS "inopwanya" matombo makuru uye inobvisa matombo emapazi kubva mukati mechiropa, nepo ERCP "inobvisa" nzira dzezasi kubva muura kudzivirira matombo akasara, kuwana "yakakwana dombo kubvumidzwa."
High-level bile duct strictures: Kana bile duct strictures iri pamusoro pehepatic hilum (apo nzira yekuruboshwe neyokurudyi yehepatic inosangana), ERCP endoscopes inonetsa kusvika, zvichiita kuti zvive zvakaoma kunyatsoongorora kuoma uye chikonzero chekuoma. Muzviitiko izvi, PTCS inobvumira kuona kwakananga kweiyo yakasimba kuburikidza ne intrahepatic chiteshi, ichibvumira biopsies kusimbisa chimiro cheronda (sekuzvimba kana bundu) panguva imwe chete ichiita bharumu dilatation kana stent kuiswa. ERCP, kune rumwe rutivi, inobvumira kuiswa kwe stent pazasi, iyo inoshanda senge relay ye PTCS stent, kuve nechokwadi chekusavharwa kwemvura yese ye bile duct.
Zvinetso zvepashure zvekuvhiyiwa kwebiliary: Anastomotic stenosis, bile fistula, uye matombo akasara anogona kuitika mushure mekuvhiyiwa kwebhiriyari. Kana murwere ane maronda akasimba emukumbo mushure mekuvhiyiwa uye ERCP haigoneki, PTCS inogona kushandiswa kudhiraivha uye kurapwa. Kana iyo anastomotic stenosis iri kumusoro uye ERCP haigone kudzika zvakazara, PTCS inogona kusanganiswa nebilateral dilation kuvandudza mwero webudiriro yekurapa.
Varwere vasingakwanisi kushivirira kuvhiyiwa kumwe chete: Somuenzaniso, varwere vakwegura kana varwere vane zvirwere zvakakomba zvecardiopulmonary havagoni kumira kwenguva refu kuvhiyiwa kamwe chete. Iko kusanganiswa kwemagirazi maviri kunogona kupatsanura kushanda kwakaoma kuita "minimally invasive + minimally invasive", kuderedza njodzi dzekuvhiya uye mutoro wemuviri.
Ramangwana Ramangwana: Iyo "Kukwidziridza Direction" yeDual-Scope Combination
Nekufambira mberi kwetekinoroji, musanganiswa weERCP nePTCS unoenderera mberi nekushanduka. Kune rimwe divi, kufambira mberi kwehunyanzvi hwekufungidzira kuri kugonesa kunyatsoita punctures uye maitiro. Semuenzaniso, kusanganiswa kweiyo intraoperative endoscopic ultrasound (EUS) uye PTCS inogona kuona chimiro chemukati cheiyo bile duct munguva chaiyo, kuderedza puncture complications. Nekune rumwe rutivi, hutsva muzviridzwa zviri kuita kuti kurapwa kuve kwakanyanya. Semuyenzaniso, anochinjika choledochoscopes, anogara akasimba lithotripsy probe, uye bioresorbable stents ari kugonesa mbiri-mwero musanganiswa kugadzirisa maronda akaomarara.
Uyezve, "robhoti-yakabatsira mbiri-yakasanganiswa" yabuda segwara idzva rekutsvagisa: nekushandisa marobhoti masisitimu kudzora endoscopes uye puncture zviridzwa, vanachiremba vanogona kuita maitiro akapfava munzvimbo yakasununguka, vachiwedzera kuvandudza kurongeka nekuchengetedzeka. Mune ramangwana, nekuwedzera kugamuchirwa kwekudyidzana kwakasiyana-siyana (MDT), ERCP nePTCS ichave yakabatanidzwa zvakare nelaparoscopy uye marapirwo ekupindira, achipa mamwe emunhu uye emhando yepamusoro kuongororwa uye nzira dzekurapa kune varwere vane biliary zvirwere.
Iko kusanganiswa kweviri-scope yeERCP uye PTCS inotyora miganhu yenzira imwe-yenzira yekuongororwa uye kurapwa kwebiliary, kugadzirisa akawanda akaomarara ezvirwere zvebiliary zvine nzira shoma uye chaiyo. Kudyidzana kweiyi "tarenda duo" haingoratidzi kufambira mberi kwehunyanzvi hwekurapa asiwo inomiririra nzira yemurwere yekuongororwa uye kurapwa. Inoshandura izvo zvaimboda kuti laparotomy huru kuita kurapa kushoma kusinganyanyi kunetseka uye kupora nekukurumidza, zvichibvumira varwere vazhinji kukunda zvirwere zvavo vachichengetedza hupenyu hwepamusoro. Isu tinotenda kuti nekuenderera mberi kwehunyanzvi hwekuita tekinoroji, iyo mbiri-mwero musanganiswa unovhura zvakatowanda kugona, zvichiunza mikana mitsva yekuongororwa uye kurapwa kwezvirwere zvebiliary.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., inogadzira muChina inyanzvi mune endoscopic consumables, inosanganisira GI mutsara senge.biopsy forceps, hemoclip, polyp musungo, sclerotherapy tsono, pfapfaidza catheter, cytology brushes, guidewire, dombo rekudzosa tswanda, nasal biliary drainage catheter,uyeSphincterotome nezvimwe. ayo anoshandiswa zvakanyanya muEMR, ESD, ERCP.
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Nguva yekutumira: Nov-14-2025