Izixhobo ze-ERCP-zebasket
Ibhasikiti yokubuyisa ilitye ngumncedisi we-FITE osetyenzisiweyo kwilitye elisetyenziswa ngamatye kwizinto ze-ERCP. Ngobutyebi abaninzi abatsha kwi-ERCP, i-BOBY SBOBICKS isenokungaphelelanga kumxholo we "Izixhobo zokukhetha amatye", kwaye akwanelanga ukujongana nemeko ye-ERCP enzima. Namhlanje, ndiza kushwankathela kwaye ndifunde ulwazi olufanelekileyo lweebhasikiti zelitye ze-ERCP ngokusekwe kulwazi olufanelekileyo endinalo nabo.
Ukuhlelwa ngokubanzi
Ibhasikiti yokubuyisa ilitye yahlulwe yabe yingobozi ye-wire ye-wire yeWire yeWire, iBhasikithi engakhokelwanga kwi-wire ye-wire, kunye nebhasikithi edityanisiweyo yelitye. Phakathi kwazo, iibhasikithi ezihlanganisiweyo zokubuyisa ziibhasikiti eziqhelekileyo ezifundwayo-iibhasikithi ezimele i-Micro-Tech kunye notshintshiselwano olukhawulezayo (RX) ezimelwe yi-boston yesayensi. Ngenxa yokuba i-recerit-calket-caltit yebhasikithi kunye nebhasikithi yokutshintsha ngokukhawuleza ibiza kakhulu kwiibhasikithi eziqhelekileyo, ezinye iiyunithi kunye noogqirha banokunciphisa ukusetyenziswa kwabo ngenxa yemicimbi yeendleko. Nangona kunjalo, ngaphandle kwendleko zokuyeka nje oko, uninzi lwabasebenzi luzimisele ukusebenzisa ibhasikithi (ngecingo yesikhokelo) ngenxa yobuqhetseba, ngakumbi amatye amakhulu amancinci amnyama.
Ngokwemo yebhasikithi, inokwahlulwa ibe "Hexagonal", "idayimane", idayimani ", idayimane, i-Doria kunye neSpia kunye ne-Dormia isetyenziswa rhoqo. Ezi ziqwengana zingezantsi zinezibonelelo zabo ezilungileyo nezingalunganga, kwaye kufuneka zikhethwe ngokukhethwe ngokweyona meko kunye nemikhwa yokusetyenziswa kwakho.
Ngenxa yokuba ibhasikithi eyenziwe ngedayimani kunye ne-domia i-domia i-shect stalkity yebhasikithi ene- "Speended Speed Speed kwaye inciphise isiphelo", inokwenza kube lula ngebhasikithi. Ukuba ilitye alinakukhutshwa emva kokuba libanjiswa ngenxa yokuba ilitye likhulu kakhulu, ibhasikithi inokukhululwa kakuhle, ukwenzela ukuphepha iingozi ezingenazintloni.
Ibhasikithi eqhelekileyo "yedayimani"
Iibhasikithi eziqhelekileyo "ze-hexagon-rhombis" zisetyenziswa kunqabile, okanye kuphela kwi-cutsher yamatye. Ngenxa yendawo enkulu ye "yedayimani", kulula kumatye amancinci ukubaleka kwibhasikithi. Ibhasikithi eyenziwe yiSpiral ineempawu ze "lula ukubeka ngaphandle kodwa akukho lula ukukhukulisa". Ukusetyenziswa kwebhasikithi ebunjiweyo yeSpiral kufuna ukuqonda ngokupheleleyo kwelitye kunye nokusebenza okuqikelelwa ukuthintela ilitye libambekile kangangoko kunokwenzeka.
Ibhasikithi yeSpiral
Ibhasikithi yokutshintshiselana ekhawulezileyo edityaniswe nokutyunyuzelwa kwaye ityhefu isetyenziswa ngexesha lokukhutshwa kwamatye amakhulu, enokuthi inciphise ixesha lokusebenza kunye nokuphucula izinga lempumelelo lokutyumka. Ukongeza, ukuba ibhasikithi kufuneka isetyenziselwe ukucinga, iarhente yohlukileyo inokubangela kwangaphambili kwaye idiniwe ngaphambi kokuba i-basket ingena kwi-bile duct.
Okwesibini, inkqubo yemveliso
Eyona nto iphambili kwi-BOBSET yelitye idityaniswe ngebhasikithi ephambili, isithukuthezi sangaphandle kunye nesibambo. I-Basket Core yenziwe ngebhasikithi yeWisket Wire (Titanium-Nickel Allow) kunye nokutsala ucingo (i-304 yentsimbi engenasitali). I-Bire yeBhasikithi yindlela etyhafileyo ye-Alloty, efana nesakhiwo esibangelwa ngumgibe, esinceda ekuthinteleni ithagethi, thintela isilayidi, kwaye akukho lula ukuqhekeka. I-wire yokutsala yi-wire ekhethekileyo yonyango enamachaphaza amanxuwa aqinileyo kunye nobunzima, ngenxa yoko andizukuziinkcukacha apha.
Inqaku eliphambili lokuthetha malunga nolwakhiwo lwe-welding phakathi kocingo lokutsala kunye nebhasikithi, intambo yebhasikithi kunye nentloko yentsimbi. Ngokukodwa, indawo ye-welding phakathi kocingo lokudodobala kunye ne-wiret yebhasikithi kubaluleke kakhulu. Ngokusekwe kulolo, iimfuno zenkqubo ye-welding ziphezulu kakhulu. Ibhasikithi enomgangatho omncinci ongalunganga awunakusilela nje ukutyhoboza ilitye kodwa unokubangela inqaku le-welding phakathi kwebhasikithi yelitye, kwaye ilitye elisele. Ubunzima (ngokufuthi bunokufunyanwa kwakhona ngebhasikithi yesibini) kwaye banokuthi bafune utyando.
Inkqubo ye-oll yelding yocingo kunye nentloko yentsimbi yeebhasikithi ezininzi eziqhelekileyo zibangela ukuba ibhasikithi iphule. Nangona kunjalo, iingobisi zesayensi ze-boston zenze iinzame ezingakumbi kule nkalo kwaye zenze indlela yokhuseleko lokhuseleko. Oko kukuthi, ukuba amatye asele aphulwe kunye noxinzelelo oluphezulu lokucinezela amatye, ibhasikithi ekuqiniseni intloko yentsimbi yokuqinisekisa ukudityaniswa kwe-wire yebhasikithi kunye nentambo yokutsala. Ingqibelelo, ngaloo ndlela kukuphepha iingobozi kunye namatye kwi-bile duct.
Andizukufikelela kwiinkcukacha malunga netyhubhu yangaphandle kunye nomphamane. Ukongeza, abavelisi abahlukeneyo bamatye ahlukeneyo aya kuba nabatyubhu bamatye, kwaye ndiza kuba nethuba lokufunda ngakumbi kamva.
Kusetyenziswa kwanjani
Ukususwa kwamatye afunyenwe yinto enzima. Oku kunokuba kukugxininiswa kwemeko yesigulana kunye nezixhobo, okanye kunokuba yinto yamatye ebitye ngokwabo. Ngayiphi na imeko, kufuneka kuqala sazi indlela yokuphepha ukubethelwa, kwaye ke kufuneka sazi ukuba masenze ntoni xa ivarration yenzeka.
Ukuthintela ibhasikithi ivarceration, i-balmuokia ye-colloon kufuneka isetyenziselwe ukudinwa i-nipple ivuliwe ngaphambi kokukhutshelwa kwelitye. Ezinye iindlela ezinokuthi zisetyenziselwe ukususa ibhasikithi efakwe kwibhasikithi (i-Bykit-to-calket) kunye nenqaku elifudumeleyo) kunye nenqaku eli-2 okanye i-2 okanye i-3) litshiswe kusetyenziswa i-APC. Yaphula, kwaye ukhuphe ibhasikithi evalelwe.
Okwesine, ukuphathwa kwe-Byokis yelitye
Ukusetyenziswa kwebhasikithi kubandakanya: ukhetho lwebhasikithi kunye neziqulatho zimbini zebhasikithi ukuze uthathe ilitye. Ngokwendlela yokukhetha ibhasikithi, ikakhulu ixhomekeke kubume bebhasikithi, ububanzi bebhasikithi, kunye nokuba isetyenziselwe i-lithotricy engxamisekileyo (ngokubanzi, iZiko le-Endoscopy lilungiswa rhoqo).
Okwangoku, ibhasikithi "yedayimani" isetyenziswa rhoqo, oko kukuthi, ibhasikithi ye-domia. Kwisikhokelo se-ERCP, olu hlobo lwebhasikithi lukhankanywe ngokucacileyo kwicandelo lokukhutshelwa kwelitye kumatye aqhelekileyo amatye aqhelekileyo. Inomgangatho ophezulu wempumelelo wokukhutshelwa kwelitye kwaye kulula ukuyisusa. Luhlobo lolokokuqala kuluhlu lwelitye kakhulu. Ububanzi bebhasikithi, ingobozi ehambelana nayo kufuneka ikhethwe ngokobukhulu belitye. Kuyinto engalunganga ukuba ithethe ngakumbi malunga nokukhetha iikabhasi zebhasikithi, nceda ukhethe ngokwemikhwa yakho.
Izakhono zokuRhafaza ngamatye: Ibhasikithi ibekwe ngaphezulu kwelitye, kwaye ilitye livavanywa phantsi kophawu lwe-Angiographic. Ewe kunjalo, i-EPBD okanye i-EPBD kufuneka yenziwe ngokobukhulu belitye ngaphambi kokuthatha ilitye. Xa i-bing duct yenzekile okanye yancitshiswa, kusenokungabikho sithuba esaneleyo sokuvula ibhasikithi. Ifanele iphinde ibuyiselwe ngokwemeko ethile. Kukukhetha ukufumana indlela yokuthumela ilitye liye kwi-bile ye-bile yokufumana imali. Kumatye e-hilar bile, kufuneka kuqatshelwe ukuba amatye aya kutyhilwa esibindini kwaye akanakuphinda abuyiselwe xa ibhasikithi ikhutshwa kwibhasikithi okanye uvavanyo lwenziwa.
Zimbini iimeko zokuthatha amatye kwingobozi yamatye: enye kukuba kukho indawo eyaneleyo ngaphezulu kwelitye okanye ecaleni kwelitye ukuvumela ibhasikithi ukuba ivule; Omnye kukuphepha ukuthatha amatye amakhulu, nokuba ingobozi ivuliwe ngokupheleleyo, ayinakukhutshwa. Siphinde sadibana namatye ama-3 cm amatye asuswe emva kwe-Emoscopic Lithotripripy, zonke ezo zinto zimele ukuba zi-Lithotripty. Nangona kunjalo, le meko isengozini kwaye ifuna ugqirha onamava.
IXESHA LOKUQALA: I-13 ukuya kwi-13 ukuya ku-2002