Mumakore makumi mashanu apfuura, tekinoroji yeERCP yakashanduka kubva pakushandisa nzira iri nyore yekuongorora kuita puratifomu isinganyanyi kukuvadza inobatanidza kuongororwa nekurapwa. Nekuunzwa kwetekinoroji itsva dzakadai se biliary ne pancreatic duct endoscopy uye ultra-thin endoscopy, ERCP iri kuchinja zvishoma nezvishoma nzira yekuongorora nekurapa zvirwere zve biliary ne pancreatic. Yafambira mberi zvikuru mukuvandudza kunyatsoongorora, kuwedzera huwandu hwezviratidzo, uye kuderedza njodzi yezvinetso, zvichiratidza mafambiro ekukura kwe "kuvhiyiwa kwechiremba kuri kuwedzera kuvhiyiwa uye kuvhiyiwa kuri kuwedzera kukuvadza," zvichipa varwere vakawanda sarudzo dzekurapa dzakarurama uye dzinoshanda. Zvisinei, inosanganawo nemiganho mukushandiswa kwekiriniki, senge miganho yepamusoro yehunyanzvi uye kuvimba kwakasimba kwemidziyo.
Matekinoroji matsva eERCP anonyanya kupatsanurwa muzvikamu zvitatu: masisitimu e endoscopic ema ducts e bile nepancreas, ma endoscopes akatetepa zvakanyanya, uye masisitimu matsva akagadzirwa munyika. Masisitimu e endoscopic akadai seSpyGlass neInsight-eyeMax anopa kuona zvakananga uye anobatsira pakurapa kwakanyatsojeka.
Pakati pazvo, sisitimu yeSpyGlass ine dhayamita yekunze yecatheter ye9F-11F uye dhayamita yemugero inoshanda ye1.2mm kana 2.0mm, zvichibvumira munhu mumwe chete kuisa duct subscope ye biliary nepancreatic kuti vaone zvakananga mucosa. Sisitimu yeInsight-eyeMax ine mufananidzo wemhando yepamusoro we160,000-pixel, nzvimbo yekuona ye120°, uye jira rinotsvedza zvakanyanya, zvichipa nzvimbo yakajeka uye yakafara yekuona. Ma endoscopes akatetepa kwazvo anoshandisa dhayamita diki yechubhu (kazhinji isingasviki 5mm) kuti apinde zvakananga muduct ye bile, asi nekuda kwechimiro chakaoma chenzira yepamusoro yekugaya, zvishandiso zvekubatsira zvakaita semabharuni ekunamira, ma cannula ekunze, uye snares zvinowanzodiwa. Masisitimu aya ane zvakanakira pakuona mucous ye bile duct uye kuita biopsy, asi akaoma kushandisa.
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| SpyGlass | Insight-eyeMax |
Chinhu chikuru chakanakira tekinoroji itsva yeERCP ndechekuti yabudirira kubva pakuongorora zvisina kunanga kuenda pakuongorora zvakananga, zvichiita kuti vanachiremba vakwanise kuona maronda emudumbu nedumbu uye pancreatic duct mucosa zviri nyore uye kuita biopsy chaiyo uye kurapwa panguva imwe chete panguva yekuongorora. Kukosha kwayo mukurapa kunonyanya kuratidzwa muzvikamu zvitatu: kuvandudza kururama kwekuongorora, kuwedzera huwandu hwezviratidzo, uye kuderedza njodzi yematambudziko.
Panyaya yekuvandudza kunyatsoongorora, cholangiopancreatography (ERCP) inobvumira vanachiremba kuona zvakananga mucosa ye bile nepancreatic duct, zvichivandudza zvikuru kugona kusiyanisa pakati pema strictures asina njodzi neekenza. ERCP yechinyakare inoshandisa ma contrast agents kuona chimiro che luminal, uye kuongororwa kwezvironda zve mucosal kunoenderana nezviratidzo zvisina kunanga. Kunzwa kwekukwesha masero e bile duct i45%-63% chete, uye kunzwa kwe tissue biopsy i48.1% chete.
Kusiyana neizvi, cholangiopancreatography (CP) inobvumira kuona zvakananga mucosa, zvichivandudza zvakanyanya kunzwa kwekuongorora. Kana ikasanganiswa neMRCP, mwero wekunyatsoongorora unogona kusvika 97.4%, uye kurongeka kwekuongororwa kwematombo emudumbu ane dhayamita ye>9mm kuri pedyo ne100%. Nezvemhedzisiro yekurapa, ERCP yechinyakare ine mwero wekubudirira kukuru pakubvisa matombo emudumbu ane dhayamita ye<5mm, asi mwero wekukundikana wakakwira wematombo akaomarara (akadai seaya >2cm kana mushure mekuvakazve kwemudumbu). CP pamwe chete nelaser lithotripsy zvinogona kuvandudza mwero wekubudirira kusvika padanho rekuvhiyiwa kwakavhurika.
Panyaya yekuwedzera huwandu hwezviratidzo, tekinoroji itsva iyi inovandudza zvakanyanya mwero wekubudirira kweERCP muvarwere mushure mekuvhiyiwa kwekubviswa kwechirwere chemudumbu, zvichivagonesa kubata zvirwere zvakaoma zvemudumbu nepancreas. Semuenzaniso, muzviitiko zvakaoma zvakaita se post-liver transplant cholangitis ne pancreatic duct IPMN, biliary ne pancreatic duct endoscopy zvinogona kupa maonero akajeka, zvichiita kuti kuongororwa kwakarurama uye kurapwa kuve nyore.
Kuwanda kwechirwere chepancreatitis mushure me ERCP yechinyakare kunenge 3%-10%. Nzira itsva, kuburikidza nekuona zvakananga, dzinoderedza kusaiswa zvakanaka kwenzira dzepancreatitis, kugadzirisa maitiro, uye kupfupisa nguva yekuvhiyiwa, zvichideredza zvakanyanya kuwanda kwechirwere chepancreatitis mushure mekuvhiyiwa nezvimwe zvinetso. Mukuongorora kwevarwere makumi mashanu vane cholangiocarcinoma yakakwira, nguva ye stent patency uye mhedzisiro yekurapwa muboka re transoral cholangiopancreatography (TCP) zvakafanana nezviri muboka re ERCP yechinyakare, asi boka reTCP rakaratidza mukana wakakura muhuwandu hwezvinetso.
Tekinoroji itsva yeERCP ichiri kusangana nemimwe miganho mukushandiswa kwekiriniki. Chekutanga, ine mwero wepamusoro wehunyanzvi uye yakaoma, inoda vanachiremba vane ruzivo rwe endoscop. Chechipiri, inovimba zvakanyanya nemidziyo, ine mari yakawanda yekugadzirisa uye yekushandisa, zvichideredza kushandiswa kwayo muzvipatara zvevana vadiki. Chechitatu, zviratidzo zvichiri zvishoma, uye kuchine njodzi yekukundikana kwenzira mune mamwe mamiriro ezvinhu. Semuenzaniso, mune zviitiko zvekuoma kwakanyanya kwemudumbu (senge mavanga epahuro) kana kuvharika kwegomarara zvachose, kuchinjirwa kuPTCD kana kuvhiyiwa kungave kuchiri kudikanwa.
Mafambiro ekuvandudza tekinoroji itsva dzeERCP mune ramangwana anonyanya kutarisa pazvinhu zvitatu: kukwidziridzwa kwevanhu vepasi, kubatanidzwa kweAI, uye kufarirwa kwekuvhiyiwa kwemazuva ese. Nezvekukwidziridzwa kwevanhu vepasi, mapurogiramu ekudzidzisa uye mabhenefiti emitengo yemidziyo inogadzirwa munyika zvichavandudza zvishoma nezvishoma kugona kweERCP kwezvipatara zvepuraimari. Panyaya yekubatanidzwa kweAI, tekinoroji yekuziva mifananidzo munguva chaiyo ine vimbiso yekuvandudza kushanda zvakanaka kwekuongorora, asi inosangana nematambudziko akadai sekugadziriswa kwedata uye kujeka kwemuenzaniso, zvichida kugadziriswa kwakawedzerwa.
Nezvekufarirwa kwevanhu vanovhiyiwa masikati, chibvumirano chegore ra2025 chinokurudzira kubatanidzwa kweERCP mukutarisira kuvhiyiwa kwemazuva, zvichibvumira varwere vazhinji kupedzisa maitiro ekurapwa muchipatara, kuvhiyiwa, kuongororwa mushure mekuvhiyiwa, uye kubudiswa mukati memaawa makumi maviri nemana. Izvi hazvingopfupisi kugara muchipatara chete asiwo zvinoderedza mari yekurapwa uye zvinovandudza kushanda zvakanaka kwekushandisa zviwanikwa zvekurapa. Nekukura nekufambiswa kwehunyanzvi, ERCP inotarisirwa kushandiswa muzvipatara zvakawanda, ichipa masevhisi ekuongorora nekurapa akarurama uye anoshanda kune varwere vakawanda vane zvirwere zve biliary ne pancreatic.
Pfupiso uye Mazano
ERCP, tekinoroji itsva, inomiririra budiriro huru mukuongorora nekurapa zvirwere zve nyongo nepancreas. Inovandudza kunyatsoongorora kuburikidza nekuona zvakananga uye biopsy chaiyo, inoderedza njodzi yezvinetso nekugadzirisa maitiro uye kupfupisa nguva yekurapa, uye inobatsira varwere vakawanda nekuwedzera huwandu hwezviratidzo. Zvisinei, tekinoroji iyi itsva inosanganawo nemiganho mukushandiswa kwekiriniki, senge zvipingamupinyi zvepamusoro zvehunyanzvi uye kuvimba kwakasimba kwemidziyo, zvinoda rutsigiro rwemapoka ekurapa ane hunyanzvi nemidziyo yepamusoro. Zvinokurudzirwa kuti masangano ekurapa asimbise kudzidziswa kweERCP nekudyara mari mumidziyo kuti vavandudze hunyanzvi hwechiremba uye kuwanikwa kwemidziyo. Zvinokurudzirwawo kusarudza nzira dzakakodzera dzekurapa zvichienderana nemamiriro emurwere; kune zvirwere zvakaoma zvenyongo nepancreas, kurapwa kweERCP kunobatsirwa netekinoroji itsva kunogona kufungwa nezvako. Uyezve, zvinokurudzirwa kuwedzera kuvandudza mashandiro nemutengo weERCP, kugadzirisa nyaya dzekujekeswa uye kujeka kwemaitiro anobatsirwa neAI, uye kukurudzira kushandiswa kwakapararira kweERCP muzvipatara zvevanachiremba.
Zvinhu zvinotengeswa zvinotengeswa zvakanyanya zveERCP Series kubva kuZRHmed.
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| 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, guidewire wire, stone retrieval basket, nasal biliary drainage cathete nezvimwewo zvinoshandiswa zvakanyanya muEMR, ESD, ERCP. Zvigadzirwa zvedu zvakabvumidzwa neCE uye zvine mvumo yeFDA 510K, uye mafekitori edu akabvumidzwa neISO. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East neAsia, uye zvinowana vatengi vakawanda mukurumbira nerumbidzo!
Sphincterotome、Waya yekutungamira、Bhasikiti reKubvisa Matombo、Kuyerera kwemvura muchubhuCatheter、ERCP
Nguva yekutumira: Zvita-20-2025