Mukuongorora nekurapa zvirwere zvechiropa, kuvandudzwa kwetekinoroji ye endoscopic kwagara kuchitarisa pazvinangwa zvekunyatsojeka, kusapinda zvakanyanya, uye kuchengetedzeka kwakanyanya. Endoscopic retrograde cholangiopancreatography (ERCP), iyo inoshanda pakuongorora nekurapa chirwere chechiropa, yagara ichigamuchirwa nevanhu vakawanda nekuda kwekusavhiyiwa uye kusapinda zvishoma. Zvisinei, kana yatarisana nemaronda akaomarara echiropa, nzira imwe chete inowanzo kundikana. Apa ndipo panowanikwa percutaneous transhepatic cholangioscopy (PTCS) inobatsira zvikuru kuERCP. Iyi nzira yakabatana ye "dual-scope" inopfuura miganhu yekurapa kwechinyakare uye inopa varwere sarudzo itsva yekuongorora nekurapa.
ERCP nePTCS imwe neimwe ine hunyanzvi hwayo hwakasiyana.
Kuti unzwisise simba rekushandisa dual-scope pamwe chete, munhu anofanira kutanga anzwisisa zvakajeka kugona kwakasiyana kwezvishandiso zviviri izvi. Kunyangwe zvese zviri zvishandiso zvekuongorora nekurapa nyongo, zvinoshandisa nzira dzakasiyana, zvichigadzira musanganiswa wakakwana.
ERCP: Unyanzvi hweEndoscopic hunopinda muDigestive Tract
ERCP inomiririra Endoscopic Retrograde Cholangiopancreatography. Kushanda kwayo kwakafanana nenzira yekutenderera. Chiremba anoisa duodenoscope nemuromo, gurokuro, nedumbu, achizosvika ku duodenum inoburuka. Chiremba anotsvaga maburi emudumbu e bile nepancreas (duodenal papilla). Catheter inozoiswa kuburikidza ne endoscopic biopsy port. Mushure mekubaya contrast agent, X-ray kana ultrasound inoongororwa, zvichiita kuti pave nekuongorora kwe bile nepancreas.
Pahwaro uhwu,ERCPinogonawo kuita nzira dzakasiyana-siyana dzekurapa: semuenzaniso, kuwedzera ducts dze bile dzakatetepa nebharumu, kuvhura nzira dzakavharika dzine stents, kubvisa matombo kubva muducts dze bile nedengu rekubvisa matombo, uye kuwana tissue dzine chirwere kuti dziongororwe nechirwere uchishandisa biopsy forceps. Chinhu chikuru chayo chiri muchokwadi chekuti inoshanda zvizere kuburikidza nepaburi rechisikigo, ichibvisa kudiwa kwekucheka pamusoro. Izvi zvinobvumira kupora nekukurumidza mushure mekuvhiyiwa uye kusakanganiswa kwakanyanya mumuviri wemurwere. Yakakodzera zvakanyanya kurapa matambudziko educts dze bile ari pedyo neura, akadai sematombo ari pakati nepazasi peducts dze bile, strictures dzeducts dze bile, uye maronda papancreas neducts dze bile.
Zvisinei, ERCP inewo "kusasimba" kwayo: kana kuvharika kwemugero wenyongori kwakanyanya uye nyongori isingakwanise kuburitswa zvakanaka, mushonga wekuenzanisa uchaomerwa nekuzadza mugero wese wenyongori, izvo zvinokanganisa kururama kwekuongorora; kune matombo emugero wenyongori ari mukati mechiropa (kunyanya matombo ari mukati mechiropa) uye stenosis yemugero wenyongori uri panzvimbo yakakwirira (pedyo nehilum yechiropa uye pamusoro), mhedzisiro yekurapa inowanzo deredzwa zvakanyanya nekuti endoscope "haigone kusvika" kana kuti nzvimbo yekushanda yakaganhurirwa.
PTCS: Mushonga wePercutaneous Pioneer Unopinda Pamusoro peChiropa
PTCS, kana kuti percutaneous transhepatic choledochoscopy, inoshandisa nzira ye "kunze-mukati", kusiyana nenzira ye "mukati-kunze" yeERCP. Pasi pekurapwa kwe ultrasound kana CT, chiremba anobaya ganda riri pachipfuva chekurudyi chemurwere kana mudumbu, achinyatsopfuura nepakati pechiropa uye achipinda mu intrahepatic bile duct yakakurisa, achigadzira nzira yekugadzira "ganda-chiropa-bile duct". Choledoscope inozoiswa nemu duct iyi kuti ione zvakananga intrahepatic bile duct uku ichiita kurapwa kwakadai sekubvisa matombo, lithotripsy, kuwedzera kwe strictures, uye kuiswa kwe stent.
"Chombo chinouraya" chePTCS chiri mukukwanisa kwayo kusvika zvakananga pamaronda emutsinga wenyongori mukati mechiropa. Inonyanya kugona kugadzirisa "matambudziko akadzika" akaoma kusvika neERCP: semuenzaniso, matombo makuru emutsinga wenyongori anopfuura 2 cm mudhayamita, "matombo akawanda" akapararira pamatavi akawanda emutsinga wenyongori mukati mechiropa, zvidimbu zvemutsinga wenyongori zvakamira panzvimbo yakakwirira zvinokonzerwa nemabundu kana kuzvimba, uye matambudziko akaomarara akadai se anastomotic stenosis uye bile fistulas zvinoitika mushure mekuvhiyiwa kwenyongori. Uyezve, kana varwere vasingakwanise kuita ERCP nekuda kwezvikonzero zvakaita se duodenal papillary malformation uye kuvharika kwemudumbu, PTCS inogona kushanda seimwe nzira, ichibvisa bile nekukurumidza uye ichideredza jaundice, nokudaro ichitenga nguva yekurapwa kunotevera.
Zvisinei, PTCS haina kukwana: sezvo ichida kuboorwa pamusoro pemuviri, matambudziko akadai sekubuda ropa, kubuda kwenyongo, uye hutachiona hunogona kuitika. Nguva yekupora mushure mekuvhiyiwa yakareba zvishoma pane ERCP, uye tekinoroji yachiremba yekuboorwa uye kurongeka kwemufananidzo kwakanyanya kwazvo.
Musanganiswa Une Simba: Pfungwa ye "Kushanda Kwekubatana" neMusanganiswa Wezvikamu Zviviri
Kana "zvakanakira zvemuropa" zveERCP zvikasangana ne "zvakanakira zvepaganda" zvePTCS, zviviri izvi hazvichagumiri panzira imwe chete, asi zvinoumba hurongwa hwekuongorora nekurapa "hunobata mukati nekunze kwemuviri." Musanganiswa uyu hausi wekuwedzera matekinoroji, asi pane kudaro chirongwa che "1+1>2" chakagadzirirwa mamiriro emurwere. Chinonyanya kuumbwa nemhando mbiri: "sequential combined" uye "timeline combined."
Kusanganiswa Kwakatevedzana: "Vhura Nzira Kutanga, Wobva Warapa Zvakanyatsonaka"
Iyi ndiyo nzira inonyanya kushandiswa mukubatanidza, inowanzo tevera musimboti wekuti "kubvisa mvura Kutanga, Kurapwa Gare gare." Semuenzaniso, kune varwere vane jaundice yakanyanya kuvharika inokonzerwa nematombo emuchiropa ari mudumbu, danho rekutanga nderekugadzira nzira yekubuditsa nyongo kuburikidza nePTCS puncture kuti ibudise nyongo yakaungana, kuderedza kumanikidzwa kwechiropa, kuderedza njodzi yehutachiona, uye kudzoreredza zvishoma nezvishoma mashandiro echiropa chemurwere nemamiriro emuviri. Kana mamiriro emurwere agadzikana, ERCP inozoitwa kubva kurutivi rwemudumbu kubvisa matombo ari mudumbu remudumbu, kurapa maronda mudumbu repapilla, uye kuwedzera kuwedzera kwehuremu hwemudumbu uchishandisa bharumu kana stent.
Kusiyana neizvi, kana murwere akavhiyiwa ERCP uye akaonekwa aine matombo echiropa akasara kana stenosis yepamusoro isingarapike, PTCS inogona kushandiswa kupedzisa "basa rekupedzisa" gare gare. Iyi modhi inopa mukana we "nzira nhanho nhanho ine njodzi dzinogoneka," zvichiita kuti ive yakakodzera varwere vane mamiriro akaomarara uye mamiriro ehutano aripo kare.
Kushanda Pamwe Chete Panguva Imwe Chete: "Kushanda Pamwe Chete Kwemascope Aviri,
Mhinduro Yekumira Imwe Chete”
Kune varwere vane chirwere chakajeka uye vane kutsungirira kwakanaka kwemuviri, vanachiremba vanogona kusarudza nzira "yakabatana panguva imwe chete". Munguva yekuvhiyiwa kumwe chete, timu dzeERCP nePTCS dzinoshanda pamwe chete. Chiremba weERCP anoshandisa endoscope kubva kurutivi rwemudumbu, achivhura duodenal papilla uye achiisa waya yekutungamira. Chiremba wePTCS, achitungamirirwa nemifananidzo, anobaya chiropa uye anoshandisa choledochoscope kuti awane waya yekutungamira yakaiswa neERCP, zvichiita kuti "nzira dzemukati nedzekunze dzienderane zvakanaka." Mapoka maviri aya anobva abatana kuita lithotripsy, kubvisa matombo, uye kuisa stent.
Chinhu chikuru chemuenzaniso uyu ndechekuti unobata matambudziko akawanda nekuita imwe chete, zvichibvisa kudiwa kweanesthesia yakawanda uye kuvhiyiwa, zvichipfupisa zvakanyanya kutenderera kwekurapwa. Semuenzaniso, kune varwere vane matombo emudumbu weropa mukati mehepatic uye matombo emudumbu weropa, PTCS inogona kushandiswa panguva imwe chete kubvisa matombo emudumbu weropa mukati mehepatic uye ERCP kugadzirisa matombo emudumbu weropa, zvichibvisa kudiwa kwevarwere kuti vapihwe anesthesia kakawanda uye kuvhiyiwa, zvichivandudza zvakanyanya kushanda kwekurapa.
Mamiriro Anoshanda: Varwere Vapi Vanoda Kusanganiswa Kwema "Dual-Scope"?
Hazvisi zvese zvirwere zve nyongo zvinoda dual-scope combined imaging. Dual-scope combined imaging inonyanya kukodzera nyaya dzakaoma dzisingagone kugadziriswa nenzira imwe chete, kunyanya kusanganisira zvinotevera:
Matombo emugero wenyongori akaomarara: Uyu ndiwo mamiriro ekutanga ekushandiswa kweCT yakabatana netwo-scope. Semuenzaniso, varwere vane matombo emugero wenyongori wemukati mechiropa (kunyanya ayo ari munzvimbo dziri kure dzakadai seruboshwe rwedivi rezasi kana kurudyi rweposterior lobe yechiropa) uye matombo emugero wenyongori akajairika; varwere vane matombo akaomarara anodarika 2 cm mudhayamita asingakwanise kubviswa neERCP chete; uye varwere vane matombo akaiswa mumigero yenyongori yakamanikana, zvichidzivirira kupfuura kweERCP instruments. Ichishandisa dual-scope combined CTCS, CTCS "inopwanya" matombo makuru uye inobvisa matombo ari mumatavi kubva muchiropa, nepo ERCP "ichibvisa" nzira dzezasi kubva muura kudzivirira matombo akasara, zvichiita kuti "matombo abviswe zvachose."
Kugadzika kwemugero we bile wepamusoro: Kana maburi emugero we bile ari pamusoro pechiropa (panosangana migero yehepatic yekuruboshwe nerudyi), ma ERCP endoscopes akaoma kusvika, zvichiita kuti zviome kuongorora nemazvo kuomarara uye chikonzero chemugero. Muzviitiko izvi, PTCS inobvumira kuona zvakananga mugero we bile kuburikidza ne intrahepatic channels, zvichibvumira biopsies kusimbisa rudzi rwechironda (senge kuzvimba kana bundu) ukuwo vachiita bharuni kuwedzera kana kuisa stent. ERCP, kune rumwe rutivi, inobvumira kuiswa kwe stent iri pasi, iyo inoshanda se relay ye PTCS stent, ichivimbisa kubuda kwemugero wese we bile pasina kuvharwa.
Matambudziko ekuvhiyiwa kwechiropa mushure mekuvhiyiwa: Kuvhiyiwa kwechiropa mushure mekuvhiyiwa: Kuvhiyiwa kwechiropa mushure mekuvhiyiwa, fistula yechiropa, uye matombo akasara anogona kuitika mushure mekuvhiyiwa kwechiropa. Kana murwere aine matumbu akasimba mushure mekuvhiyiwa uye ERCP isingaite, PTCS inogona kushandiswa kurapa nekuburitsa mvura. Kana stenosis yechiropa mushure mekuvhiyiwa yakakwira uye ERCP isingakwanise kuwedzera zvizere, PTCS inogona kusanganiswa nekuwedzerwa kwemativi maviri kuti ivandudze mwero wekubudirira kwekurapwa.
Varwere vasingagoni kushivirira kuvhiyiwa kamwe chete: Semuenzaniso, varwere vakwegura kana varwere vane zvirwere zvakakomba zvemwoyo nemapapu havagone kutsungirira kuvhiyiwa kwenguva refu. Kusanganiswa kwemagirazi maviri kunogona kupatsanura kuvhiyiwa kwakaoma kuita "kusingapindi zvakanyanya + kusingapindi zvishoma", zvichideredza njodzi dzekuvhiyiwa uye mutoro wemuviri.
Maonero Eramangwana: "Nzira Yekusimudzira" yeMusanganiswa WeDual-Scope
Nekufambira mberi kwetekinoroji, musanganiswa weERCP nePTCS unoramba uchichinja. Kune rumwe rutivi, kufambira mberi kwetekinoroji yemifananidzo kuri kuita kuti pave nekuboorwa kwakanyatsojeka uye maitiro. Semuenzaniso, musanganiswa we intraoperative endoscopic ultrasound (EUS) nePTCS zvinogona kuona chimiro chemukati me bile duct munguva chaiyo, zvichideredza matambudziko ekuboorwa. Kune rumwe rutivi, hunyanzvi muzvishandiso huri kuita kuti kurapwa kuve kunobudirira. Semuenzaniso, flexible choledochoscopes, lithotripsy probes dzakasimba, uye bioresorbable stents zviri kuita kuti dual-scope combination igadzirise maronda akaomarara.
Uyezve, "robhoti-assisted dual-scope combined" yave nzira itsva yekutsvaga: nekushandisa marobhoti systems kudzora endoscopes nemidziyo yekubooresa, vanachiremba vanogona kuita maitiro akaomarara munzvimbo yakasununguka, zvichiwedzera kuvandudza kunyatsoshanda kwekuvhiya uye kuchengetedzeka. Mune ramangwana, nekuwedzera kushandiswa kwekubatana kwemarudzi akawanda (MDT), ERCP nePTCS zvichabatanidzwa zvakare ne laparoscopy uye mishonga yekurapa, zvichipa kuongororwa kwakasarudzika uye kwemhando yepamusoro uye sarudzo dzekurapa kune varwere vane chirwere chenduru.
Kusanganiswa kweERCP nePTCS nenzira mbiri kunoderedza zvipingamupinyi zvenzira imwe chete yekuongorora nekurapa chirwere chenyongo, kugadzirisa zvirwere zvakawanda zvakaoma zvenyongo nenzira isinganyanyi kupinda uye chaiyo. Kushanda pamwe chete kwe "vaviri vane tarenda" uku hakungoratidzi kufambira mberi kwetekinoroji yezvekurapa asiwo kunoratidza nzira yekuongorora nekurapa inotarisa murwere. Inoshandura zvaimboda laparotomy huru kuita mishonga isinganyanyi kupinda ine kukuvara kushoma uye kupora nekukurumidza, zvichibvumira varwere vakawanda kukunda zvirwere zvavo uku vachichengetedza hupenyu hwepamusoro. Tinotenda kuti nekufambira mberi kwetekinoroji, musanganiswa wemhando mbiri uchavhura hunyanzvi hwakawanda, zvichiunza mikana mitsva yekuongorora nekurapa zvirwere zvenyongo.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., tinogadzira zvinhu muChina zvine chekuita ne endoscopic consumables, zvinosanganisira GI line dzakadai sesimba re biopsy, hemoclip, musungo wepolyp, tsono yekurapa sclerotherapy, katheta yekupfapfaidza, mabhurashi e cytology, waya yekufambisa, tswanda yekutorwa kwematombo, katheta yekubuditsa mvura yemumhinouyeSphincterotome nezvimwewo. anoshandiswa zvakanyanya muEMR, ESD, ERCP.
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Nguva yekutumira: Mbudzi-14-2025