Izixhobo ze-ERCP-Ibhasikithi yokuKhupha ilitye
Ingobozi yokufunyanwa kwamatye yindlela esetyenziswa kakhulu ekufumaneni amatye kwizixhobo ze-ERCP. Kwabaninzi oogqirha abatsha kwi-ERCP, ingobozi yamatye isenokuba ilinganiselwe kwingcamango "yezixhobo zokuqokelela amatye", kwaye akwanelanga ukujongana nemeko enzima ye-ERCP. Namhlanje, ndiza kushwankathela kwaye ndifunde ulwazi olufanelekileyo lweengobozi zamatye ze-ERCP ngokusekelwe kulwazi olufanelekileyo endilubonileyo.
Udidi ngokubanzi
Ingobozi yokubuyisa amatye yahlulwe yaba yingobozi ekhokelwa ngocingo olukhokelayo, ingobozi engakhokelwa ngocingo olukhokelayo, kunye nengobozi yokubuyisa amatye edibeneyo. Phakathi kwazo, iingobozi zokubuyisa ezidibeneyo ziingobozi eziqhelekileyo zokubuyisa ezimelwe yiMicro-Tech kunye neengobozi zokubuyisa ezikhawulezayo (RX) ezimelwe yiBoston Scientifi. Ngenxa yokuba ingobozi yokubuyisa edibeneyo kunye nengobozi yokutshintsha ngokukhawuleza zibiza kakhulu kuneengobozi eziqhelekileyo, ezinye iiyunithi kunye noogqirha abasebenza banokunciphisa ukusetyenziswa kwazo ngenxa yeengxaki zeendleko. Nangona kunjalo, kungakhathaliseki ukuba iindleko zokuyishiya nje, uninzi loogqirha abasebenza bazimisele ngakumbi ukusebenzisa ingobozi (enocingo olukhokelayo) ukuze iqhekeke, ingakumbi kumatye amakhulu kancinci e-bile duct.
Ngokwemilo yengobozi, inokwahlulwa ibe "yi-hexagonal", "idayimani" kunye "ne-spiral", oko kukuthi idayimani, iDormia kunye ne-spiral, apho iingobozi zeDormia zisetyenziswa kakhulu khona. Ezi ngobozi zingasentla zineengenelo kunye neengxaki zazo, kwaye kufuneka zikhethwe ngokuguquguquka ngokwemeko yokwenyani kunye nemikhwa yokusetyenziswa komntu.
Ngenxa yokuba ibhaskithi emile okwedayimani kunye nebhaskithi yeDormia zizinto eziguquguqukayo ezinomphetho ongaphambili okhutshiweyo kunye nomphetho oncitshisiweyo, kunokwenza kube lula ukuba ibhaskithi ifumane amatye. Ukuba ilitye alinakukhutshelwa emva kokuba libanjiwe kuba ilitye likhulu kakhulu, ibhaskithi inokukhululwa kakuhle, ukuze kuthintelwe iingozi ezibangela iintloni.
Ingobozi eqhelekileyo "yedayimani"
Iibhasikithi eziqhelekileyo ze-"hexagon-rhombus" azisetyenziswa rhoqo, okanye zisetyenziswa kuphela kwiibhasikithi zokuqhekeza amatye. Ngenxa yendawo enkulu yebhasikithi ye-"diamond", kulula ukuba amatye amancinci aphume kwibhasikithi. Ibhasikithi emile okwe-spiral ineempawu zokuba "kulula ukuyibeka kodwa akulula ukuyikhulula". Ukusetyenziswa kwebhasikithi emile okwe-spiral kufuna ukuqonda ngokupheleleyo ilitye kunye nomsebenzi oqikelelweyo wokuthintela ilitye ukuba libambeke kangangoko kunokwenzeka.
Ingobozi ejikelezayo
Ingobozi yokutshintshiselana ngokukhawuleza edityaniswe nokutyumza nokutyumza isetyenziswa ngexesha lokukhupha amatye amakhulu, nto leyo enokunciphisa ixesha lokusebenza kwaye iphucule izinga lempumelelo yokutyumza. Ukongeza, ukuba ingobozi kufuneka isetyenziswe kwimifanekiso, i-contrast agent ingahlanjwa kwangaphambili kwaye ikhutshwe ngaphambi kokuba ingobozi ingene kwi-bile duct.
Okwesibini, inkqubo yemveliso
Ulwakhiwo oluphambili lwengobozi yelitye lwenziwe yingqokelela yengobozi, isigqubuthelo sangaphandle kunye nesiphatho. Ingqokelela yengobozi yenziwe yingqokelela yengobozi (i-titanium-nickel alloy) kunye nengqokelela yokutsala (intsimbi engagqwali yezonyango engama-304). Ingqokelela yengobozi sisakhiwo esilukiweyo se-alloy, esifana nesakhiwo esilukiweyo se-snare, esinceda ukubamba ithagethi, ukuthintela ukutyibilika, kunye nokugcina uxinzelelo oluphezulu kwaye kulula ukuphuka. Ingqokelela yokutsala yingqokelela ekhethekileyo yezonyango enamandla okutsala kunye nokuqina, ngoko ke andizukungena kwiinkcukacha apha.
Ingongoma ephambili ekufuneka sithethe ngayo sisakhiwo sokuwelda phakathi kwentambo yokutsala kunye nentambo yebhasikithi, ucingo lwebhasikithi kunye nentloko yentsimbi yebhasikithi. Ngokukodwa, indawo yokuwelda phakathi kwentambo yokutsala kunye nentambo yebhasikithi ibaluleke ngakumbi. Ngokusekelwe kuyilo olunjalo, iimfuno zenkqubo yokuwelda ziphezulu kakhulu. Ibhasikithi enomgangatho ophantsi kancinci isenokungaphumeleli nje kuphela ukutyumza ilitye kodwa inokubangela ukuba indawo yokuwelda phakathi kwentambo yokutsala kunye nentambo yebhasikithi enemingxuma iqhekeke ngexesha lenkqubo yokutyumza ilitye emva kokuba ilitye lisusiwe, nto leyo ebangela ukuba ibhaskithi kunye nelitye lisale kwi-bile duct, kwaye emva koko lisuswe. Ubunzima (ngokuqhelekileyo bunokufunyanwa ngebhasikithi yesibini) kwaye bunokufuna utyando.
Inkqubo yokuwelda engalunganga yocingo kunye nentloko yesinyithi yeebhasikithi ezininzi eziqhelekileyo inokubangela ukuba ibhaskithi iqhekeke ngokulula. Nangona kunjalo, iibhasikithi zeBoston Scientific zenze imizamo engaphezulu kule meko kwaye zayila indlela yokukhusela ukhuseleko. Oko kukuthi, ukuba amatye akasakwazi ukuqhekeka ngamatye atyumzayo anoxinzelelo oluphezulu, ibhaskithi eqinisa amatye inokukhusela intloko yesinyithi engaphambili kwebhasikithi ukuqinisekisa ukuhlanganiswa kocingo lwebhasikithi kunye nocingo olutsalayo. Ukunyaniseka, ngaloo ndlela kuthintelwe iibhasikithi kunye namatye ashiywe kwi-bile duct.
Andiyi kungena kwiinkcukacha malunga netyhubhu yesingxobo sangaphandle kunye nesiphatho. Ukongeza, abavelisi bee-crushers zamatye ezahlukeneyo baya kuba nee-crushers zamatye ezahlukeneyo, kwaye ndiza kuba nethuba lokufunda okungakumbi kamva.
Kusetyenziswa kwanjani
Ukususwa kwamatye afakwe entolongweni yinto ebangela ingxaki ngakumbi. Oku kusenokuba kukungawuthatheli ngqalelo umgangatho wesigulane kunye nezinto ezincedisayo, okanye kusenokuba luphawu lwamatye e-bile duct ngokwawo. Nokuba kunjalo, kufuneka sazi kuqala indlela yokuphepha ukuvalelwa entolongweni, size emva koko sazi ukuba masenze ntoni xa kusenzeka ukuvalelwa entolongweni.
Ukuze kuthintelwe ukuvalelwa ebhaskithi, kufuneka kusetyenziswe ibhaluni ekholamu ukuze kwandiswe umngxuma wengono ngaphambi kokuba kukhutshwe amatye. Ezinye iindlela ezinokusetyenziswa ukususa ibhaskithi ebotshelelweyo ziquka: ukusebenzisa ibhaskithi yesibini (ibhaskithi ukuya kwibhaskithi) kunye nokususwa ngotyando, kwaye inqaku lakutshanje likwabike ukuba isiqingatha (2 okanye 3) seengcingo sinokutshiswa kusetyenziswa i-APC. ukuqhekeza, kunye nokukhulula ibhaskithi ebotshelelweyo.
Okwesine, unyango lokuvalelwa entolongweni ngengobozi yamatye
Ukusetyenziswa kwengobozi kubandakanya ikakhulu: ukhetho lwengobozi kunye nezinto ezimbini ezikwingobozi zokuthatha ilitye. Ngokuphathelele ukhetho lwengobozi, kuxhomekeke kakhulu kwimo yengobozi, ububanzi bengobozi, kunye nokuba kusetyenziswe okanye kugcinwe i-lithotripsy engxamisekileyo (ngokubanzi, iziko le-endoscopy lilungiswa rhoqo).
Okwangoku, ibhaskithi "yedayimani" isetyenziswa rhoqo, oko kukuthi, ibhaskithi yeDormia. Kwisikhokelo se-ERCP, olu hlobo lwebhaskithi lukhankanyiwe ngokucacileyo kwicandelo lokukhupha amatye kwimibhobho yenyongo eqhelekileyo. Inezinga eliphezulu lempumelelo yokukhupha amatye kwaye kulula ukuyisusa. Lukhetho lomgca wokuqala lokukhupha amatye amaninzi. Ngobubanzi bebhaskithi, ibhaskithi ehambelanayo kufuneka ikhethwe ngokobukhulu belitye. Akulula ukuthetha ngakumbi malunga nokukhetha iimpawu zebhaskithi, nceda ukhethe ngokwemikhwa yakho.
Izakhono zokususa ilitye: Ingobozi ibekwa phezu kwelitye, kwaye ilitye livavanywa phantsi koqwalaselo lwe-angiographic. Kakade ke, i-EST okanye i-EPBD kufuneka yenziwe ngokobukhulu belitye ngaphambi kokuba ithathwe ilitye. Xa i-bile duct yonakele okanye inciphile, kusenokungabikho ndawo yaneleyo yokuvula ingobozi. Kufuneka ithathwe ngokwemeko ethile. Kukwayindlela yokufumana indlela yokuthumela ilitye kwi-bile duct enkulu ukuze lithathwe. Kumatye e-bile duct e-hilar, kufuneka kuqatshelwe ukuba amatye aya kutyhalelwa esibindini kwaye awanakuthatyathwa xa ingobozi ikhutshwa kwingobozi okanye kwenziwa uvavanyo.
Kukho iimeko ezimbini zokukhupha amatye kwingobozi yelitye: enye kukuba kubekho indawo eyaneleyo phezu kwelitye okanye ecaleni kwelitye ukuvumela ingobozi ukuba ivuleke; enye kukuphepha ukuthatha amatye amakhulu kakhulu, nokuba ingobozi ivuliwe ngokupheleleyo, ayinakukhutshwa. Sikwabone amatye angama-3 cm asuswe emva kwe-endoscopic lithotripsy, onke ekufuneka ukuba yi-lithotripsy. Nangona kunjalo, le meko isenobungozi kwaye ifuna ugqirha onamava ukuba atyande.
Ixesha lokuthumela: Meyi-13-2022