Matombo emugero we bile akakamurwa kuita matombo akajairwa uye matombo akaomarara. Nhasi tichadzidza zvakanyanya kubvisa matombo emugero we bile akaoma kuita.ERCP.
"Kuoma" kwematombo akaoma kunonyanya kukonzerwa nechimiro chakaoma, nzvimbo isina kujairika, kuoma uye njodzi yekubvisa. Zvichienzaniswa neERCPPanyaya yemabundu emumugero we bile, njodzi yacho yakafanana kana kuti yakakwira. Kana uchisangana nematambudziko ezuva nezuvaERCPkushanda, tinofanira kugadzirira pfungwa dzedu neruzivo uye kurega mafungiro edu achinje hunyanzvi hwedu kuti tikwanise kukunda matambudziko.
01 Kupatsanurwa kwe "matombo akaoma" kwezvikonzero zvekuzvarwa
Matombo akaoma anogona kukamurwa kuita mapoka ematombo, mapoka ezvisina kujairika mumuviri, mapoka ezvirwere zvakasiyana nezvimwe zvichienderana nezvikonzero zvazvo.
① Boka rematombo
Zvikuru zvinosanganisira matombo makuru emugero wenyongo, matombo akawandisa (matombo eslam), matombo emukati mehepatic, uye matombo akabatwa (anoomeswa neAOSC). Aya ese mamiriro ezvinhu apo zvakaoma kubvisa matombo uye zvinoda yambiro nekukurumidza.
·Dombo racho rakakura zvikuru (dhayamita >1.5 cm). Dambudziko rekutanga pakubvisa dombo nderekuti dombo harigone kubviswa kana kuputswa nezvinhu zvinorishandisa. Dambudziko rechipiri nderekuti dombo harigone kubviswa kana kuputswa mushure mekubviswa. Matombo enjodzi anodiwa panguva ino.
· Matombo madiki haafanirwe kutorwa seasina basa. Kunyanya matombo madiki anogona kusuduruka kana kupinda muchiropa, uye matombo madiki akaoma kuwana nekuavhara, zvichiita kuti aome kurapa nekurapwa ne endoscopic.
·Kune matombo akazara nenyongo,ERCPkubviswa kwematombo kunotora nguva yakareba uye zviri nyore kuti munhu asungwe. Kuvhiyiwa kunowanzo diwa kuti matombo acho abviswe.
②Kusagadzikana kwemuviri
Kusarongeka kwemuviri kunosanganisira kukanganiswa kwenzira ye bile, Mirrizi syndrome, uye kusarongeka kwechimiro muchikamu chezasi uye chinobuda munzira ye bile. Kusarongeka kwe peripapillary diverticula kunowanzoitikawo muchimiro chemuviri.
Mushure mekuvhiyiwa kweLC, chimiro chemugero we bile hachina kujairika uye duct ye bile inomonyoroka.ERCPKana tambo iyi ichishanda, waya yekufambisa iri "nyore kuisa pasi asi haisi nyore kuisa" (inodonha netsaona mushure mekunge yakwira), saka kana waya yekufambisa yaiswa, inofanira kuchengetwa kudzivirira waya yekufambisa kuti isadonhe uye isadonhe kunze kwemugero wenyongo.
·Mirizz syndrome chirwere chisina kujairika mumuviri uye chinorasika nyore nyore. Chidzidzo chemuenzaniso: Mushure mekuvhiyiwa kweLC, murwere ane matombo emudumbu akadzvanya duct yemudumbu, zvichikonzera Mirrizz syndrome. Matombo acho aisagona kubviswa pasi pekutarisa kweX-ray. Pakupedzisira, dambudziko rakagadziriswa mushure mekuongororwa uye kubviswa pasi pekuona zvakananga ne eyeMAX.
·KuneERCPKubviswa kwematombo emudumbu mushure mekuvhiyiwa kweBi II, chinhu chikuru ndechekusvika pazamu nepaburi remudumbu. Dzimwe nguva zvinotora nguva yakareba (izvo zvinoda pfungwa dzakasimba) kusvika pazamu, uye kana waya yekufambisa isina kuchengetwa zvakanaka, inogona kubuda zviri nyore.
③Mamwe mamiriro ezvinhu
Kuvhiyiwa kwe peripapillary diverticulum pamwe chete nematombo emugero we bile kwakajairika. Dambudziko rekuvhiyiwa panguva ino injodzi yekuchekwa kwe nipple uye kukura kwayo. Njodzi iyi yakanyanya kune nipple dziri mukati me diverticulum, uye njodzi ye nipple dziri pedyo ne diverticulum idiki.
Panguva ino, zvakakoshawo kunzwisisa mwero wekukura. Nheyo huru yekukura ndeyekuderedza kukuvara kunodiwa kubvisa matombo. Kukuvara kudiki kunoreva njodzi diki. Mazuva ano, kuwedzera kwebharumu (CRE) kwenipple yakakomberedza diverticula kunowanzo shandiswa kudzivirira EST.
Varwere vane zvirwere zveropa, kushanda kwemwoyo nemapapu vasingakwanise kutsungiriraERCP, kana zvirwere zvemusana zvisingakwanise kushivirira kugara kuruboshwe kwenguva refu zvinofanira kutariswa uye kuongororwa kana zvikasangana nematombo akaomarara.
02 Pfungwa dzekutarisana ne "matombo akaoma"
Pfungwa dzisina kunaka kana uchitarisana ne "matombo akaoma": makaro nekubudirira, kushaya hanya, kusaremekedza usati wavhiyiwa, nezvimwewo.
· Makaro nerudo rwekubudirira kukuru
Patinenge tichitarisana nematombo emugero wenyongo, kunyanya ane matombo akawanda, tinoda kubvisa matombo ese. Uku ndiko "kukara" uye kubudirira kukuru.
Kutaura zvazviri, zvakanaka kutora mushonga wese newakachena, asi kutora mushonga wacho chero zvodini "kwakanaka kwazvo", izvo zvisina kuchengetedzeka uye zvinounza matambudziko akawanda. Matombo akawanda emudumbu anofanira kusarudzwa zvakakwana zvichienderana nemamiriro emurwere. Muzviitiko zvakakosha, mushonga wacho unofanira kungoiswa kana kubviswa muzvikamu.
Kana matombo makuru emutsinga wenyongo achinetsa kubvisa kwenguva pfupi, "kunyungudika kwestent" kunogona kufungwa nezvako. Usamanikidza kubvisa matombo makuru, uye usazviise mumamiriro ezvinhu ane njodzi zvikuru.
·kusangwarira
Kureva kuti, kuvhiyiwa kwemaziso pasina ongororo yakazara uye tsvakurudzo kunowanzoita kuti matombo asabviswe zvakanaka. Nokudaro, nyaya dzematombo emugero we bile dzinofanira kuongororwa zvizere vasati vavhiyiwa, dzichiongororwa zvakanaka (zvichida kugona kweERCPvanachiremba kuti vaverenge mifananidzo), kuita sarudzo dzakangwarira uye kuronga kwekukurumidzira kunofanirwa kuitwa kudzivirira kubviswa kwematombo asingatarisirwi.
IyoERCPChirongwa chekubvisa matombo chinofanira kunge chiri chesainzi, chisina kwachakarerekera, chakakwana, uye chinokwanisa kutsungirira kuongororwa nekufungwa. Tinofanira kutevedzera musimboti wekuwedzera kubatsirwa kwemurwere kwete kungotevedzera mitemo.
·kuzvidza
Matombo madiki ari muchikamu chezasi chemugero wenyongo ari nyore kufuratira. Kana matombo madiki akasangana nematambudziko ekuvaka muchikamu chezasi chemugero wenyongo uye pakubuda kwawo, zvichave zvakaoma kubvisa dombo racho.
ERCPKurapa matombo emutsinga wenyongo kune zvakawanda zvakasiyana uye njodzi huru. Kwakaoma uye kune njodzi dzakafanana kana kuti dzakatopfuuraERCPkurapwa kwebundu remumudzira wenyongo. Saka, kana usingazvitore sezvisina basa, uchazvisiira nzira yakakodzera yekubuda nayo.
03 Maitiro ekugadzirisa "matombo akaoma"
Kana matombo akaomarara akasangana, kuongororwa kwakazara kwemurwere kunofanirwa kuitwa, kuwedzera kwakakwana kunofanirwa kuitwa,tswanda yekuburitsa matomboinofanira kusarudzwa uye kugadzirwa kwe lithotripter, uye chirongwa chakatogadzirwa kare uye chirongwa chekurapa chinofanira kugadzirwa.
Imwe nzira, zvakanakira nezvakaipira zvinofanira kuongororwa zvichienderana nemamiriro emurwere asati aenderera mberi.
·Kugadzira kuvhura
Kukura kweburi kunoenderana nemamiriro edombo rakananga uye duct yenyongo. Kazhinji, kucheka kudiki + kukura kukuru (kwepakati) kunoshandiswa kuwedzera buri. Munguva yeEST, zvakakosha kudzivirira kukura kukuru kwekunze uye diki mukati.
Kana usina ruzivo, zviri nyore kugadzira kucheka "kwakakura kunze asi kadiki mukati", kureva kuti, zamu rinotaridzika rakakura kunze, asi pasina kucheka mukati. Izvi zvichaita kuti kubviswa kwedombo kusashande.
Pakuita EST incision, "shallow bow and slow incision" inofanira kushandiswa kudzivirira zipper incision. Kucheka kwacho kunofanira kunge kwakakurumidza sekucheka kwega kwega. Banga harifanirwe "kuramba rakanyarara" panguva yekucheka kudzivirira kupindira kwemazamu uye kukonzera pancreatitis.
·Kugadzirisa ongororo yechikamu chezasi uye kutumira kunze kwenyika
Matombo emugero wenyongori anoda kuongororwa kwechikamu chezasi uye nzira inobuda nayo mugero wenyongori. Nzvimbo dzese mbiri dzinofanira kuongororwa. Kusanganiswa kwezvose zviri zviviri kunosarudza njodzi nekuoma kwekucheka nipple.
·Emergency lithotripsy
Matombo makuru uye akaomarara asingakwanise kubviswa magiravhu anofanira kurapwa ne emergency lithotripter (emergency lithotripter).
Matombo ane pigment ye bile anogona kupwanywa kuita zvidimbu, uye matombo akawanda akaomarara echolesterol anogonawo kugadziriswa nenzira iyi. Kana mudziyo usingakwanise kuburitswa mushure mekutorwa, uye lithotripter isingakwanise kupwanya matombo, idambudziko guru. Panguva ino, eyeMAX ingangodiwa kuti iongorore uye irape matombo zvakananga.
Cherechedza: Usashandise lithotripsy muchikamu chezasi uye chekubuda kwemugero wenyongo. Usashandise lithotripsy yakazara panguva yemugero wenyongo, asi siya nzvimbo yacho. Emergency lithotripsy ine njodzi. Munguva yemugero wenyongo, mutsetse wekupedzisira unogona kusawirirana ne axis yenyongo, uye kushushikana kunogona kunge kwakanyanya zvekuti hazvigone kukonzera kubooka.
·Dombo rinonyungudutsa rine stent
Kana dombo racho rakakura zvakanyanya uye rakaoma kubvisa, unogona kufunga nezvekunyungudika kwestent - kureva kuisa stent yepurasitiki. Mirira kusvika dombo radzikira usati wabvisa dombo, ipapo mukana wekubudirira uchava mukuru kwazvo.
·Matombo emukati meropa
Vanachiremba vechidiki vane ruzivo rushoma vanonyanya kunaka kusaita endoscopic treatment yematombo emutsinga we bile muropa. Nekuti matombo ari munzvimbo iyi angasakwanise kuvharirwa kana kuti anogona kudzika zvakanyanya zvoita kuti asashande zvakare, mugwagwa wacho une njodzi uye wakamanikana.
·Matombo emutsinga wenyongo akabatanidzwa ne peripapillary diverticulum
Zvakakosha kuongorora njodzi uye tarisiro yekuwedzera. Njodzi yekuboorwa kweEST yakakura, saka pari zvino nzira yekuwedzera mabharumu ndiyo inosarudzwa. Saizi yekuwedzera inofanira kukwana kubvisa dombo. Maitiro ekuwedzera anofanira kunge achinonoka uye nhanho nhanho, uye hapana kuwedzera kwakasimba kana kuwedzera kunobvumirwa. Sirinji inokura painoda. Kana paine kubuda ropa mushure mekuwedzerwa, kurapwa kwakakodzera kunodiwa.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., tinogadzira zvinhu muChina zvine chekuita ne endoscopic consumables, zvakaita sesimba re biopsy,hemoclip,musungo wepolyp,tsono yekurapa sclerotherapy,katheta yekupfapfaidza,mabhurashi e cytology,waya yekufambisa,tswanda yekutorwa kwematombo,katheta yekubuditsa mvura yemhino nezvimwewo. anoshandiswa zvakanyanya muEMR,ESD,ERCPZvigadzirwa zvedu zvakanyoreswa neCE, uye mafekitori edu akanyoreswa neISO. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East nedzimwe nzvimbo dzeAsia, uye zviri kuita kuti mutengi azivikanwe uye arumbidzwe zvikuru!
Nguva yekutumira: Chikunguru-26-2024