Bile duct matombo akakamurwa kuita matombo akajairika uye matombo akaoma. Nhasi tichanyanya kudzidza nzira yekubvisa bile duct matombo ayo akaoma kuitaERCP.
"Kuoma" kwematombo akaoma kunonyanya kukonzerwa nechimiro chakaoma, nzvimbo isina kujairika, kuoma uye njodzi yekubvisa. Kuenzaniswa neERCPkune bile duct tumors, njodzi yakaenzana kana kutokwira. Pakusangana nematambudziko mazuva eseERCPbasa, tinofanira kushongedza pfungwa dzedu neruzivo uye torega mafungiro edu achinje hunyanzvi hwedu kuti tigone kurarama nematambudziko.
01Etiological classification ye "matombo akaoma"
Matombo akaoma anogona kukamurwa kuva mapoka ematombo, anatomical abnormality mapoka, mapoka ezvirwere zvakasiyana nevamwe zvichienderana nezvikonzero zvavo.
① Boka rematombo
Iwo makuru anosanganisira hombe bile duct matombo, akawandisa matombo (slam matombo), intrahepatic matombo, uye matombo akakanganiswa (akaomeswa neAOSC). Aya ndiwo mamiriro ezvinhu apo zvakaoma kubvisa matombo uye zvinoda kunyevera kwekutanga.
·Dombo rakanyanya kukura (dhayamita>1.5 cm). Dambudziko rekutanga pakubvisa dombo nderekuti ibwe harigone kubviswa kana kuputswa nemidziyo. Dambudziko rechipiri nderekuti ibwe harigone kubviswa kana kuputswa mushure mekubviswa. Emergency gravel inodiwa panguva ino.
· Matombo madiki haafanire kutorwa senhando. Kunyanya matombo maduku anogona nyore kuchinja kana kumhanya muchiropa, uye matombo maduku akaoma kuwana uye kuvhara, zvichiita kuti zvive zvakaoma kurapa ne endoscopic treatment.
·Kune matombo akazara nebile duct,ERCPkubviswa kwedombo kunotora nguva yakareba uye zviri nyore kusungwa. Kuvhiya kunowanzodiwa kubvisa matombo.
②Anatomical abnormalities
Anatomical abnormalities anosanganisira bile duct distortion, Mirrizi syndrome, uye kusaenzana kwechimiro muchikamu chepasi uye kubuda kwebile duct. Peripapillary diverticula zvakare yakajairika anatomic abnormality.
·Mushure mekuvhiyiwa kweLC, chimiro chebile duct haina kujairika uye iyo bile duct inomonyoroka. PanguvaERCPkushanda, waya yemutungamiri "iri nyore kuisa pasi asi haisi nyore kuisa" (inowira kunze netsaona mushure mokunge yakwira kumusoro), saka kana tambo yekufambisa yaiswa, inofanira kuchengetwa kudzivirira kutungamira waya kudonha uye kuwira kunze kwe bile duct.
·Mirizz Syndrome is a atomical abnormality iyo inopotsa nekufuratirwa zviri nyore. Nyaya yekudzidza: Mushure mekuvhiyiwa kweLC, murwere ane cystic duct matombo akadzvanya yakajairika bile duct, zvichikonzera Mirrizz syndrome. Matombo haana kukwanisa kubviswa pasi pekutariswa kweX-ray. Pakupedzisira, dambudziko rakagadziriswa mushure mekuongororwa uye kubviswa pasi pechiratidzo chakananga nezisoMAX.
·ForERCPbile duct dombo kubviswa muvarwere vegastric mushure mekuvhiyiwa kweBi II, kiyi ndeyekusvika pazamu kuburikidza nechiyero. Dzimwe nguva zvinotora nguva yakareba (inoda mafungiro akasimba) kuti isvike pazamu, uye kana gwara risina kuchengetedzwa zvakanaka, rinogona kubuda nyore nyore.
③Mamwe mamiriro
Peripapillary diverticulum yakasanganiswa nebile duct matombo inowanzoitika. Kuomerwa mukushanda panguva ino injodzi yekuchekeresa nyini nekuwedzera. Iyi njodzi yakakura kune ma nipples mukati me diverticulum, uye njodzi yemazamu padyo ne diverticulum idiki.
Panguva ino, zvinodiwawo kubata dhigirii rekuwedzera. Nheyo yakawanda yekuwedzera ndeyekudzikisa kukuvadza kunodiwa kubvisa matombo. Kukuvadza kudiki kunoreva njodzi diki. Mazuva ano, kuwedzera kwebharumu (CRE) yezamhu yakatenderedza diverticula inowanzoshandiswa kudzivirira EST.
Varwere vane hematological zvirwere, cardiopulmonary basa vasingagoni kushiviriraERCP, kana zvirwere zvemuzongoza zvisingakwanisi kushivirira kwenguva yakareba zvakasara zvakasara zvinofanirwa kutariswa uye kuongororwa paunosangana nematombo akaoma.m
02 Psychology yekutarisana ne "matombo akaoma"
Mafungiro asina kunaka kana akatarisana ne "matombo akaoma": kukara uye kubudirira, kusava nehanya, pre-operative kuzvidza, nezvimwe.
·Makaro nerudo rwekubudirira kukuru
Kana takatarisana nematombo e-bile duct, kunyanya aya ane matombo akawanda, tinogara tichida kubvisa matombo ese. Iyi imhando ye "makaro" uye kubudirira kukuru.
Zvechokwadi, zvakarurama kutora zvose uye zvakachena, asi kutora zvakachena zvachose "zvakakodzera", izvo zvisina kuchengeteka uye zvinounza matambudziko akawanda nematambudziko. Multiple bile duct matombo anofanirwa kusarudzwa zvakakwana zvichienderana nemamiriro emurwere. Muzviitiko zvakakosha, iyo tube inofanira kuiswa chete kana kubviswa mumatche.
Kana matombo makuru e-bile duct achinetsa kubvisa kwenguva pfupi, "stent dissolution" inogona kutariswa. Usamanikidzira kubviswa kwematombo makuru, uye usazviisa mumamiriro ezvinhu ane ngozi zvikuru.
·vasina hanya
Ndiko kuti, kushanda kwebofu pasina kuongororwa kwakadzama uye tsvakurudzo kunowanzoita kuti dombo rekubvisa kukundikana. Naizvozvo, nyaya dze bile duct matombo dzinofanirwa kuongororwa zvizere pamberi pekuvhiyiwa, kuongororwa zvine hungwaru (zvichida kugona kweERCPvanachiremba kuverenga mifananidzo), kunyatsoita sarudzo uye zvirongwa zvekukurumidzira zvinofanira kuitwa kudzivirira kubviswa kwebwe kusingatarisirwi.
TheERCPchirongwa chekuchera dombo chinofanira kunge chiri chesainzi, chinangwa, chakazara, uye chinokwanisa kutsungirira kuongororwa uye kufunga. Tinofanira kuomerera kumusimboti wekuwedzera kubatsirwa kwemurwere uye kusave nekupokana.
·kuzvidza
Matombo madiki ari pasi peiyo bile duct ari nyore kufuratira. Kana matombo madiki akasangana nezvinetso zvekuumbwa muchikamu chezasi che bile duct uye kubuda kwayo, zvichave zvakaoma kubvisa ibwe.
ERCPkurapwa kwebile duct matombo kune zvakawanda zvakasiyana uye njodzi huru. Zvakaoma uye zvine njodzi sekunge kana kutokwira kupfuuraERCPkurapwa kwe bile duct tumors. Naizvozvo, kana ukasazvitora zvishoma, unozozvisiira wega nzira yekutiza yakakodzera.
03Maitiro ekuita ne "matombo akaoma"
Paunenge uchisangana nematombo akaoma, kuongororwa kwakadzama kwemurwere kunofanirwa kuitwa, kuwedzera kwakakwana kunofanirwa kuitwa, aibwe rekudzosa tswandainofanira kusarudzwa uye lithotripter yakagadzirirwa, uye chirongwa chakagadzirirwa uye chirongwa chekurapa chinofanira kugadzirwa.
Seimwe nzira, zvakanakira nezvayakaipira zvinofanirwa kuongororwa zvichienderana nemamiriro emurwere asati aenderera mberi.
·Kuvhura kugadzirisa
Kukura kwekuvhura kunoenderana nemamiriro eibwe rakanangwa uye bile duct. Kazhinji, diki incision + yakakura (yepakati) dilation inoshandiswa kuwedzera kuvhura. Munguva yeEST, zvinodikanwa kudzivirira yakakura kunze uye diki mukati.
Kana usina ruzivo, zviri nyore kuita mucheki "hombe kunze asi diki mukati", kureva kuti, zamu rinotaridzika rakakura kunze, asi mukati hamuna kuchekwa. Izvi zvichaita kuti kubviswa kwebwe kukundikana.
Paunenge uchiita EST incision, "shallow bow uye slow incision" inofanira kushandiswa kudzivirira zipper incision. Iko kuchekwa kunofanirwa kunge kuri kukurumidza seyakachekwa yega yega. Banga harifanire "kuramba rakanyarara" panguva yekucheka kudzivirira kukanganiswa kwezamu uye kukonzera pancreatitis. .
·Kugadzirisa kuongororwa kwechikamu chepasi uye kunze kwenyika
Yakajairwa bile duct matombo inoda kuongororwa kwechikamu chepasi uye kubuda kweiyo yakajairika bile duct. Nzvimbo mbiri idzi dzinofanirwa kuongororwa. Iko kusanganiswa kwezvose zviri zviviri kunogadzirisa njodzi uye kuoma kweiyo nipple incision process.
·Emergency lithotripsy
Matombo makuru uye akaomarara nematombo asingakwanise kubviswa anofanira kurapwa ne emergency lithotripter (emergency lithotripter).
Bile pigment matombo anogona kunyanya kuputswa kuita zvidimbu, uye mazhinji ematombo akaomarara echolesterol anogonawo kugadziriswa nenzira iyi. Kana chigadzirwa chacho chisingagoni kusunungurwa mushure mekutora, uye lithotripter haigoni kuputsa matombo, ichokwadi "kuoma". Panguva ino, zisoMAX rinogona kudikanwa kuti riongorore uye kurapa matombo.
Cherechedza: Usashandise lithotripsy muchikamu chezasi uye kubuda kweiyo yakajairika bile duct. Usashandise lithotripsy yakazara panguva ye lithotripsy, asi siya nzvimbo yayo. Emergency lithotripsy ine njodzi. Munguva yekukurumidzira lithotripsy, iyo axis yekupedzisira inogona kunge isingaenderane neiyo bile duct axis, uye kushushikana kungave kwakanyanya kukonzeresa perforation.
Ibwe rinonyungudika
Kana ibwe rakakura uye rakaoma kubvisa, unogona kufunga stent dissolution - kureva, kuisa stent yepurasitiki. Mirira kusvikira ibwe richiderera risati rabvisa dombo, ipapo mukana wekubudirira uchave wakakwirira zvikuru.
·Intrahepatic stones
Vanachiremba vechidiki vane ruzivo rushoma vari nani kuti vasaite endoscopic kurapwa kwe intrahepatic bile duct matombo. Nemhaka yokuti matombo ari munzvimbo iyi anogona kusakwanisa kuvharirwa kana kuti anogona kudzika zvakadzika uye kudzivirira kuwedzera kushanda, mugwagwa une ngozi uye wakatetepa.
·Matombo eBile duct akasanganiswa neperipapillary diverticulum
Izvo zvinodiwa kuti uongorore njodzi uye tarisiro yekuwedzera. Ngozi yeEST perforation yakakwira, saka parizvino nzira yekuwedzera bharumu inosarudzwa. Ukuru hwekuwedzera hunofanira kunge hwakakwana kuti ubvise dombo. Nzira yekuwedzera inofanira kunonoka uye nhanho nhanho, uye hapana kuwedzera kwechisimba kana kuwedzera kunobvumirwa. Sirinji inowedzera pakuda. Kana pane kubuda ropa mushure mekuwedzera, kurapwa kwakakodzera kunodiwa.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., inogadzira muChina inyanzvi mune endoscopic consumables, senge.biopsy forceps,hemoclip,polyp musungo,sclerotherapy tsono,pfapfaidza catheter,cytology brushes,guidewire,dombo rekudzosa tswanda,nasal biliary drainage catheter nezvimwewo. ayo anoshandiswa zvakanyanya muEMR,ESD,ERCP. Zvigadzirwa zvedu ndezveEC Certified, uye zvidyarwa zvedu ISO certified. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East uye chikamu cheAsia, uye zvakanyanya kuwana mutengi wekuzivikanwa nekurumbidzwa!
Nguva yekutumira: Jul-26-2024