Izixhobo ze-ERCP-Stone Extraction Basket
Ibhaskithi yokubuyiswa kwamatye isetyenziswa ngokuqhelekileyo umncedisi wokufumana ilitye kwii-ERCP accessories. Kwabaninzi oogqirha abatsha kwi-ERCP, ibhasikithi yamatye isenokukhawulelwa kwingcamango "yezixhobo zokuchola amatye", kwaye akwanelanga ukujongana nemeko enzima ye-ERCP. Namhlanje, ndiza kushwankathela kwaye ndifunde ulwazi olufanelekileyo lweebhasikithi zamatye e-ERCP ngokusekwe kulwazi olufanelekileyo endiye ndadibana nalo.
Ukuhlelwa ngokubanzi
Ibhaskithi yokubuyiswa kwamatye yahlulwe yaba yibhaskithi ekhokela ucingo ekhokelwayo, ingobozi engenamkhombandlela ekhokelwa ngocingo, kunye nebhaskithi ehlanganisiweyo yokuchola amatye. Phakathi kwazo, iibhasikidi ezidibeneyo zokubuyiswa-ukutyumza iibhasikidi eziqhelekileyo zokubuyiswa-ziqhekezeke ezimelwe yi-Micro-Tech kunye ne-Rapid Exchange (RX) yokubuyisela-ibhasikidi emele i-Boston Scientifi. Ngenxa yokuba ibhasikithi edibeneyo yokubuyisela-i-crush kunye nebhasikithi yokutshintsha ngokukhawuleza zibiza kakhulu kuneebhasikithi eziqhelekileyo, ezinye iiyunithi kunye noogqirha abasebenzayo banokunciphisa ukusetyenziswa kwabo ngenxa yeendleko zeendleko. Nangona kunjalo, nokuba zithini na iindleko zokuyishiya nje, oogqirha abaninzi abasebenzayo bazimisele ngakumbi ukusebenzisa ibhaskithi (ngocingo lwesikhokelo) ukuqhekeka, ngakumbi amatye amakhulu kancinane.
Ngokwemilo yebhaskithi, inokwahlulwa ibe yi "hexagonal", "diamond" kunye ne "spiral", ezizezi idayimane, iDormia kunye ne-spiral, phakathi kwazo zisetyenziswa kakhulu iibhasikithi zeDormia. Ezi bhaskithi zingentla zineengenelo kunye nezingeloncedo zazo, kwaye kufuneka zikhethwe ngokuguquguqukayo ngokwemeko eyiyo kunye nemikhwa yokusetyenziswa komntu.
Kuba ibhaskithi emile okwedayimani kunye neDormia sisakhiwo sebhaskithi esiguquguqukayo esine "end end eyandisiweyo kunye nesiphelo esincitshisiweyo", inokwenza kube lula ukuba ibhaskithi ibuyise amatye. Ukuba ilitye alinakukhutshelwa ngaphandle emva kokuba livalelwe ngenxa yokuba ilitye likhulu kakhulu, ibhaskithi inokukhululwa ngokutyibilikayo, ukuze kuphetshwe iingozi ezihlazisayo.
Ibhaskithi "yediamond" eqhelekileyo
Iibhasikithi eziqhelekileyo "ze-hexagon-rhombus" zisetyenziswa ngokungaqhelekanga, okanye kuphela kwiibhasikithi ze-crusher. Ngenxa yesithuba esikhulu sebhasikithi ye "diamond", kulula ukuba amatye amancinci abaleke kwibhasikithi. Ibhaskithi emile njenge-spiral ineempawu "zokunxiba kulula kodwa akukho lula ukuyikhulula". Ukusetyenziswa kwebhaskithi emile okwe-spiral kufuna ukuqondwa ngokupheleleyo kwelitye kunye nomsebenzi oqikelelweyo ukuthintela ukuxinga kwelitye kangangoko.
Ingobozi ye-Spiral
Ibhasikithi yokutshintshiselana ngokukhawuleza edityaniswe ngokutyumza kunye nokutyumza isetyenziswe ngexesha lokukhutshwa kwamatye amakhulu, anokunciphisa ixesha lokusebenza kunye nokuphucula izinga lokuphumelela lokutyumza. Ukongezelela, ukuba ibhasikidi kufuneka isetyenziswe kwi-imaging, i-agent echaseneyo inokutshitshiswa kwangaphambili kwaye iphele ngaphambi kokuba ibhasikidi ingene kwi-bile duct.
Okwesibini, inkqubo yemveliso
Isakhiwo esiphambili sebhasikithi yamatye siqulunqwe ngundoqo webhasikidi, i-sheath yangaphandle kunye nokubamba. Undoqo webhasikithi wenziwa ngocingo lwebhasikithi (i-titanium-nickel alloy) kunye nocingo lokutsala (304 intsimbi yonyango engenasici). Ucingo lwebhasikithi luyi-alloy braided structure, efana nesakhiwo esilukiweyo somgibe, onceda ukubamba ithagethi, ukuthintela ukutshitshiswa, kunye nokugcina uxinzelelo oluphezulu kwaye akulula ukuphuka. Ucingo lokutsala lucingo olukhethekileyo lwezonyango olunamandla okuqina kunye nokuqina, ke andizukungena kwiinkcukacha apha.
Inqaku eliphambili lokuthetha malunga nesakhiwo se-welding phakathi kocingo lokutsala kunye nocingo lwebhasikithi, ucingo lwebhasikithi kunye nentloko yentsimbi yebhasikithi. Ngokukodwa, i-welding point phakathi kocingo lokutsala kunye nocingo lwebhasikithi lubaluleke kakhulu. Ngokusekelwe kuyilo olunjalo, iimfuno zenkqubo ye-welding ziphezulu kakhulu. Ingobozi ekumgangatho ophantsi kancinci ayinakusilela nje ukutyumza ilitye kodwa ikwabangela ukuba indawo yokuwelda phakathi kocingo olutsalayo kunye nocingo lwebhaskithi olunomnatha ukuba luqhawuke ngexesha lokutyunyuzwa kwamatye emva kokuba lisusiwe, nto leyo ekhokelela kwingobozi kunye ne-mesh. ilitye eliseleyo kwi-bile duct, kunye nokususwa okulandelayo. Ubunzima (budla ngokufunyanwa ngebhaskithi yesibini) kwaye kunokufuna utyando.
Inkqubo ye-welding embi yocingo kunye nentloko yentsimbi yeebhasikithi ezininzi eziqhelekileyo zinokubangela ukuba ibhasikidi iphuke ngokulula. Nangona kunjalo, iingobozi zeBoston Scientific zenze iinzame ezingakumbi kulo mba kwaye ziyila indlela yokhuseleko lokhuseleko. Oko kukuthi, ukuba amatye asenako ukuphulwa ngoxinzelelo oluphezulu lwamatye atyumkileyo, ibhasikidi eqinisa amatye inokukhusela intloko yentsimbi kwisiphelo sangaphambili sebhasikidi ukuqinisekisa ukuhlanganiswa kocingo lwebhasikithi kunye nocingo lokutsala. Ukunyaniseka, ngaloo ndlela ukuphepha iibhasikithi kunye namatye ashiywe kwi-bile duct.
Andiyi kungena kwiinkcukacha malunga netyhubhu ye-sheath yangaphandle kunye nesibambo. Ukongeza, abavelisi abahlukeneyo bamatye abatyumzayo baya kuba nezityumli zamatye ezahlukeneyo, kwaye ndiza kuba nethuba lokufunda ngakumbi kamva.
Kusetyenziswa kwanjani
Ukususwa kwamatye avalelweyo yinto enzima ngakumbi. Oku kunokuba kukujongelwa phantsi komqhubi wemeko yesigulane kunye nezixhobo, okanye ingaba yinto yamatye e-bile duct ngokwabo. Kuyo nayiphi na imeko, kufuneka siqale sazi indlela yokuphepha ukuvalelwa, kwaye ke kufuneka sazi ukuba senze ntoni xa kuvalelwa.
Ukuze ugweme ukuvalelwa kwebhasikithi, ibhaluni ye-columnar kufuneka isetyenziswe ukukhulula ukuvulwa kwengono ngaphambi kokutsalwa kwamatye. Ezinye iindlela ezinokuthi zisetyenziswe ukususa ibhasikidi evalelweyo ziquka: ukusetyenziswa kwebhasikithi yesibini (ibhasikithi ukuya kwibhaskithi) kunye nokususwa ngotyando, kunye nenqaku lakutshanje liye labika ukuba isiqingatha (2 okanye 3) seentambo sinokutshiswa kusetyenziswa. APC. qhekeza, kwaye uyikhulule ingobozi evalelweyo.
Okwesine, unyango lokuvalelwa kwebhasikithi yamatye
Ukusetyenziswa kwebhaskithi ikakhulu kubandakanya: ukukhethwa kwebhaskithi kunye neziqulatho ezibini zebhaskithi ukuthatha ilitye. Ngokumalunga nokukhethwa kwebhaskithi, ubukhulu becala kuxhomekeke kwimilo yebhaskithi, ububanzi bebhasikithi, kunye nokuba kusetyenziswe okanye kugcinwe i-lithotripsy engxamisekileyo (ngokubanzi, iziko le-endoscopy lilungiswa rhoqo).
Okwangoku, ibhasikithi "yedayimani" isetyenziswa rhoqo, oko kukuthi, ibhasikithi yaseDormia. Kwisikhokelo se-ERCP, olu hlobo lwebhasikithi lukhankanyiwe ngokucacileyo kwicandelo lokukhutshwa kwamatye kumatye aqhelekileyo e-bile duct. Inezinga eliphezulu lempumelelo yokukhutshwa kwamatye kwaye kulula ukuyisusa. Lukhetho lomgca wokuqala kuninzi lokutsalwa kwamatye. Ngobubanzi bebhasikidi, ibhasikidi ehambelanayo kufuneka ikhethwe ngokobukhulu belitye. Akunzima ukuthetha ngakumbi malunga nokukhethwa kweempawu zebhasikithi, nceda ukhethe ngokwemikhwa yakho yobuqu.
Izakhono zokususa ilitye: Ibhaskithi ibekwe ngaphezu kwelitye, kwaye ilitye livavanywa phantsi kwe-angiographic observation. Ngokuqinisekileyo, i-EST okanye i-EPBD kufuneka yenziwe ngokobungakanani belitye ngaphambi kokuthatha ilitye. Xa i-bile duct yenzakala okanye iyancipha, kunokubakho indawo eyaneleyo yokuvula ibhasikidi. Kufuneka ithathwe ngokwemeko ethile. Ikwayindlela yokufumana indlela yokuthumela ilitye kumbhobho wenyongo othe kratya ukuze ulifumane. Ngamatye e-hilar bile duct, kufuneka kuqatshelwe ukuba amatye aya kutyhalwa esibindini kwaye akakwazi ukufunyanwa xa ibhasikidi ikhutshwe kwibhasikithi okanye uvavanyo lwenziwa.
Kukho imiqathango emibini yokuthatha amatye kwibhasikithi yamatye: enye kukuba kukho indawo eyaneleyo ngaphezu kwelitye okanye ecaleni kwelitye ukuvumela ibhasikidi ukuba ivule; enye kukuphepha ukuthatha amatye amakhulu kakhulu, nokuba ibhasikidi ivulwe ngokupheleleyo, ayinakukhutshwa. Siphinde sadibana namatye angama-3 cm asuswe emva kwe-endoscopic lithotripsy, yonke into ekufuneka ibe yi-lithotripsy. Nangona kunjalo, le meko isenobungozi kwaye idinga ugqirha onamava ukuba asebenze.
Ixesha lokuposa: May-13-2022