Mumakore makumi mashanu apfuura,ERCPtekinoroji yashanduka kubva pakushandisa nzira iri nyore yekuongorora kusvika pakuva nzira isinganyanyi kukuvadza inobatanidza kuongororwa nekurapwa. Nekuunzwa kwetekinoroji itsva dzakadai se biliary ne pancreatic duct endoscopy uye ultra-thin endoscopy,ERCPiri kuchinja zvishoma nezvishoma nzira yekuongorora nekurapa zvirwere zvechivanhu nepancreas. 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 kushoma," zvichipa varwere vakawanda sarudzo dzekurapa dzakarurama uye dzinoshanda. Zvisinei, inosanganawo nemiganhu mukushandiswa kwekiriniki, senge hunyanzvi hwepamusoro uye kuvimba kwakasimba nemidziyo.
ItsvaERCPmatekinoroji anonyanya kuwira muzvikamu zvitatu: masisitimu e endoscopic emutsinga dze bile nepancreas, ma endoscope 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 chinobatsira pane zvitsvaERCPtekinoroji ndeyekuti yabudirira kubva pakuongorora zvisina kunanga kuenda pakuongororwa 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 yekuongororwa. 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 dumbu nedumbu remudumbu, zvichivandudza zvikuru kugona kusiyanisa pakati pezvirwere zvisina njodzi nezvinouraya.ERCPZvinoshandisa zvinhu zvinosiyanisa mavara kuti zvionekwe muchimiro chemwenje, uye kuongororwa kwekukuvara kwemucosal kunoenderana nezviratidzo zvisina kunanga. Kunzwa kwekukwesha masero emudumbu nebhinzi i45%-63% chete, uye kunzwa kwebiopsy yematishu 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 kunyatsoongorora kwematombo emudumbu >9mm mudhayamita kuri pedyo ne100%. Nezvemhedzisiro yekurapa, tsika dzechivanhuERCPine mwero wekubudirira kukuru pakubvisa matombo epancreatic duct ane dhayamita ye5mm, asi mwero wekutadza kushanda kwematombo akaomarara (akadai seaya ari >2cm kana mushure mekugadzirisa gastrointestinal). CP pamwe chete ne laser lithotripsy zvinogona kuvandudza mwero wekubudirira kusvika padanho rekuvhiyiwa kwakavhurika.
Panyaya yekuwedzera huwandu hwezviratidzo, tekinoroji itsva inovandudza zvakanyanya mwero wekubudirira kweERCPmuvarwere mushure mekuvhiyiwa kwekubviswa kwechirwere chemudumbu, zvichivabatsira kubata zvirwere zvakaoma zvechiropa nepancreas. Semuenzaniso, muzviitiko zvakaoma zvakaita se post-liver transplant cholangitis uye pancreatic duct IPMN, biliary nepancreatic duct endoscopy zvinogona kupa maonero akajeka, zvichiita kuti zvikwanise kuongororwa uye kurapwa kwakanyatsojeka.
Kuwanda kwechirwere chepancreatitis mushure menguva yechinyakareERCPiri pa3%-10%. Matekiniki matsva, kuburikidza nekuona zvakananga, anoderedza kusapinza zvakanaka kwemugero wepancreatic, kugadzirisa maitiro, uye kupfupisa nguva yekuvhiyiwa, zvichideredza zvakanyanya kuwanda kwepancreatitis mushure mekuvhiyiwa nezvimwe zvinetso. Mukuongorora kwevarwere makumi mashanu vane cholangiocarcinoma yakakwira, nguva yekurapa stent uye mhedzisiro yekurapwa muboka re transoral cholangiopancreatography (TCP) zvakafanana nezviri muboka rekare.ERCPboka reTCP, asi boka reTCP rakaratidza mukana mukuru muhuwandu hwezvinetso.
ItsvaERCPTekinoroji ichiri kutarisana 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 emangwana ekuvandudza kwezvitsvaERCPmatekinoroji anonyanya kutarisa pazvinhu zvitatu: kukwidziridzwa kwevanhu vepasi, kubatanidzwa kweAI, uye kufarirwa kwevanhu vanovhiya masikati. Nezvekukwidziridzwa kwevanhu vepasi, mapurogiramu ekudzidzisa uye mabhenefiti emitengo yemidziyo inogadzirwa munyika zvichavandudza zvishoma nezvishomaERCPkugona kwezvipatara zvepuraimari. Panyaya yekubatanidzwa kweAI, tekinoroji yekuziva mifananidzo panguva chaiyo ine vimbiso yekuvandudza mashandiro ekuongorora, asi inosangana nematambudziko akadai sekugadziriswa kwedata uye kujeka kwemuenzaniso, zvichida kugadziriswa kwakawedzerwa.
Nezvekufarirwa kwevanhu vanovhiyiwa masikati, chibvumirano cha2025 chinokurudzira kubatanidzwa kweERCPmukutarisira kuvhiyiwa kwezuva, zvichiita kuti varwere vazhinji vakwanise 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 mberi kwehunyanzvi,ERCPinotarisirwa kushandiswa muzvipatara zvakawanda, ichipa mabasa ekuongorora nekurapa akarurama uye anoshanda kune varwere vakawanda vane zvirwere zve biliary nepancreas.
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 zvehunyanzvi zvakanyanya uye kuvimba zvakanyanya nemidziyo, zvinoda rutsigiro rwemapoka ekurapa ane hunyanzvi uye michina yepamusoro. Zvinokurudzirwa kuti masangano ekurapa asimbiseERCPkudzidziswa nekudyara mari mumidziyo yekuvandudza hunyanzvi hwechiremba uye kuwanikwa kwemidziyo. Zvinokurudzirwawo kusarudza nzira dzakakodzera dzekurapa zvichienderana nemamiriro emurwere; pazvirwere zvakaoma zvechiropa nepancreas,ERCPkurapwa kunobatsirwa netekinoroji itsva kunogona kufungwa nezvako. Uyezve, zvinokurudzirwa kuwedzera kushanda uye mutengo weERCP, kugadzirisa nyaya dzekujekesa uye kujekesa masisitimu anobatsirwa neAI, uye kukurudzira kushandiswa kwakapararira kweERCPmuzvipatara zvevana vadiki.
ERCPZvinhu zvinotengeswa zvinotengeswa zvakanyanya 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,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!
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