Ekuxilongweni nasekunyangweni kwezifo zenyongo, uphuhliso lwetekhnoloji ye-endoscopic luye lwagxila rhoqo kwiinjongo zokuchaneka okukhulu, ukungenelela okuncinci, kunye nokhuseleko olukhulu. I-Endoscopic retrograde cholangiopancreatography (ERCP), ihashe elisebenzayo lokuxilongwa nonyango lwesifo senyongo, kudala lamkelwe ngokubanzi ngenxa yendalo yalo engeyoyotyando kwaye ingena kakhulu. Nangona kunjalo, xa ijongene nezilonda zenyongo ezintsonkothileyo, indlela enye idla ngokusilela. Kulapho i-percutaneous transhepatic cholangioscopy (PTCS) iba yinkxaso ebalulekileyo kwi-ERCP. Le ndlela idibeneyo "ye-dual-scope" idlula imida yonyango lwendabuko kwaye inika izigulane ukhetho olutsha ngokupheleleyo lokuxilonga nonyango.
I-ERCP kunye ne-PTCS nganye inezakhono zayo ezizodwa.
Ukuze uqonde amandla okusetyenziswa okudibeneyo kwe-dual-scope, umntu kufuneka aqale aqonde ngokucacileyo amandla akhethekileyo ezi zixhobo zimbini. Nangona zombini zizixhobo zokuxilonga kunye nonyango lwe-biliary, zisebenzisa iindlela ezahlukeneyo, zenze ukongeza okugqibeleleyo.
I-ERCP: Ubuchule be-Endoscopic obungena kwiNdlela yoKutya
I-ERCP imele i-Endoscopic Retrograde Cholangiopancreatography. Ukusebenza kwayo kufana nendlela ejikelezayo yokwenza izinto. Ugqirha ufaka i-duodenoscope ngomlomo, emsongweni, nasesiswini, ekugqibeleni afikelele kwi-duodenum ehlayo. Ugqirha ufumana imingxuma yamathumbu e-bile kunye ne-pancreatic ducts (i-duodenal papilla). Emva koko kufakwa i-catheter nge-endoscopic biopsy port. Emva kokufaka i-contrast agent, kwenziwa uvavanyo lwe-X-ray okanye lwe-ultrasound, olwenza ukuba kubonwe ukuxilongwa kwe-bile kunye ne-pancreatic ducts.
Ngokwale njongo,I-ERCPIngenza neenkqubo ezahlukeneyo zonyango: umzekelo, ukwandisa imibhobho yenyongo enciphileyo ngebhaluni, ukuvula iipaseji ezivaliweyo ezine-stents, ukususa amatye kwi-bile duct ngebhasikithi yokususa ilitye, kunye nokufumana izicubu ezinesifo ukuze kuhlalutywe i-pathological usebenzisa i-biopsy forceps. Inzuzo yayo ephambili ikukuba isebenza ngokupheleleyo nge-natural cavity, isusa isidingo sokusikwa komphezulu. Oku kuvumela ukuchacha ngokukhawuleza emva kotyando kunye nokuphazamiseka okuncinci emzimbeni wesigulana. Ifanelekile ngakumbi ekunyangeni iingxaki ze-bile duct kufutshane namathumbu, njengamatye kwi-common bile duct ephakathi nesezantsi, i-low bile duct strictures, kunye nezilonda kwi-pancreatic kunye ne-bile duct junction.
Nangona kunjalo, i-ERCP ikwanazo "ubuthathaka" bayo: ukuba ukuvaleka kwe-bile duct kukhulu kwaye i-bile ayinakukhutshwa kakuhle, i-contrast agent iya kuba nobunzima bokuzalisa yonke i-bile duct, nto leyo eya kuchaphazela ukuchaneka kokuxilongwa; kwi-intrahepatic bile duct stones (ingakumbi amatye akwisibindi) kunye ne-bile duct stenosis ephezulu (kufutshane ne-liver hilum nangaphezulu), isiphumo sonyango sihlala sincipha kakhulu kuba i-endoscope "ayikwazi ukufikelela" okanye indawo yokusebenza incinci.
I-PTCS: Uvulindlela Ohamba Ngolusu Oqhekeza Umphezulu Wesibindi
I-PTCS, okanye i-percutaneous transhepatic choledochoscopy, isebenzisa indlela "yangaphandle-ngaphakathi", ngokungafaniyo nendlela "yangaphakathi-ngaphandle" ye-ERCP. Phantsi kwesikhokelo se-ultrasound okanye se-CT, ugqirha ugqobhoza ulusu esifubeni sasekunene okanye esiswini sesigulana, edlula ngqo kwizicubu zesibindi aze afikelele kwi-intrahepatic bile duct evulekileyo, edala i-"skin-liver-bile duct" eyenziweyo. I-choledochoscope emva koko ifakwa kule tunnel ukuze ijonge ngqo i-intrahepatic bile duct ngelixa ngaxeshanye isenza unyango olufana nokususwa kwamatye, i-lithotripsy, ukwandiswa kwe-strictures, kunye nokubekwa kwe-stent.
“Isixhobo sokubulala” se-PTCS sikwikhono layo lokufikelela ngqo kwizilonda ze-bile duct ngaphakathi kwesibindi. Inobuchule ngakumbi ekusombululeni “iingxaki ezinzulu” ekunzima ukuzifikelela nge-ERCP: umzekelo, amatye amakhulu e-bile duct angaphezu kwe-2 cm ububanzi, “amatye amaninzi” asasazeke kumasebe amaninzi e-bile duct ngaphakathi kwesibindi, ukuqina kwe-bile duct okubangelwa ziithumba okanye ukudumba, kunye neengxaki ezinzima ezifana ne-anastomotic stenosis kunye ne-bile fistula ezenzeka emva kotyando lwe-biliary. Ngaphezu koko, xa izigulana zingakwazi ukwenza i-ERCP ngenxa yezizathu ezifana nokukhubazeka kwe-duodenal papillary kunye nokuvaleka kwamathumbu, i-PTCS inokusebenza njengendlela eyahlukileyo, ikhuphe i-bile ngokukhawuleza kwaye inciphise i-jaundice, ngaloo ndlela ithenge ixesha lonyango olulandelayo.
Nangona kunjalo, i-PTCS ayigqibelelanga: kuba ifuna ukubhobozwa emzimbeni, iingxaki ezinje ngokopha, ukuvuza kwenyongo, kunye nosulelo zinokwenzeka. Ixesha lokuchacha emva kotyando lide kancinci kune-ERCP, kwaye iteknoloji kagqirha yokubhoboza kunye nokuchaneka kwesikhokelo somfanekiso ziphezulu kakhulu.
Indibaniselwano Enamandla: Ingcamango "yokusebenza ngokubambisana" kunye neNdibaniselwano yeDual-Scope
Xa "iingenelo ze-endovascular" ze-ERCP zihlangabezana "neengenelo ze-percutaneous" ze-PTCS, ezi zimbini azisekho kuphela kwindlela enye, kodwa endaweni yoko zenza isakhelo sokuxilonga kunye nonyango "esichaphazela ngaphakathi nangaphandle komzimba." Olu dibaniso aluyonto yokongeza nje ubuchwepheshe, kodwa luyilo olwenziwe ngokwezifiso "1+1>2" olulungiselelwe imeko yesigulana. Ngokuyintloko luqulathe iimodeli ezimbini: "ezidibeneyo ngokulandelanayo" kunye "nezidibeneyo ngaxeshanye."
Udibaniso Olulandelelanayo: "Vula Indlela Kuqala, Emva koko Unyango Oluchanekileyo"
Le yindlela eqhelekileyo yokudibanisa, edla ngokulandela umgaqo othi “ukukhupha amanzi kuqala, unyango kamva.” Umzekelo, kwizigulana ezine-jaundice evalekileyo ebangelwa ngamatye e-bile duct angaphakathi kwesibindi, inyathelo lokuqala kukumisela umjelo wokukhupha amanzi e-bile ngokusebenzisa i-PTCS puncture ukuze kukhutshwe i-bile eqokelelweyo, kuncitshiswe uxinzelelo lwesibindi, kuncitshiswe umngcipheko wosulelo, kwaye kubuyiselwe kancinci kancinci ukusebenza kwesibindi sesigulana kunye nemeko yomzimba. Nje ukuba imeko yesigulana izinze, i-ERCP yenziwa ukusuka kwicala lamathumbu ukuze kususwe amatye kwi-bile duct esezantsi, kunyangwe izilonda kwi-duodenal papilla, kwaye kwandiswe ngakumbi i-bile duct stricture kusetyenziswa ibhaluni okanye i-stent.
Ngokwahlukileyo koko, ukuba isigulane sifumana i-ERCP kwaye kufunyaniswa ukuba sinamatye esibindi aseleyo okanye i-stenosis ephezulu enganyangekiyo, i-PTCS ingasetyenziselwa ukugqiba "umsebenzi wokugqiba" kamva. Le modeli inika inzuzo "yendlela yenyathelo ngenyathelo enemingcipheko elawulekayo," nto leyo eyenza ukuba ifaneleke ngakumbi kwizigulane ezineemeko ezinzima kunye neemeko zempilo esele zikhona.
Umsebenzi oDibeneyo ngaxeshanye: “Umsebenzi we-Dual-scope ngaxeshanye,
Isisombululo Sokuma Kanye”
Kwizigulane ezixilongiweyo ngokucacileyo kwaye zinyamezela kakuhle emzimbeni, oogqirha banokukhetha inkqubo "edibeneyo ngaxeshanye". Ngexesha lotyando olufanayo, amaqela e-ERCP kunye ne-PTCS asebenza kunye. Ugqirha we-ERCP usebenzisa i-endoscope kwicala lamathumbu, evula i-duodenal papilla aze abeke i-guidewire wire. Ugqirha we-PTCS, ekhokelwa yi-imaging, uhlaba isibindi aze asebenzise i-choledochoscope ukufumana i-guidewire wire ebekwe yi-ERCP, efezekisa ulungelelwaniso oluchanekileyo "lwemijelo yangaphakathi neyangaphandle." Amaqela amabini emva koko asebenzisana ukwenza i-lithotripsy, ukususa amatye, kunye nokubeka i-stent.
Eyona nzuzo inkulu yale modeli kukuba ijongana nemiba emininzi ngenkqubo enye, isusa isidingo sokuthomalalisa iintlungu ezininzi kunye notyando, inciphisa kakhulu umjikelo wonyango. Umzekelo, kwizigulane ezinee-intrahepatic bile duct stones kunye nee-common bile duct stones, i-PTCS ingasetyenziswa ngaxeshanye ukususa amatye e-intrahepatic kunye ne-ERCP ukulungisa amatye e-common bile duct stones, isusa isidingo sokuba izigulane zenze i-anesthesia kunye notyando izihlandlo ezininzi, nto leyo ephucula kakhulu ukusebenza kakuhle konyango.
Imeko Efanelekileyo: Ngabaphi Abaguli Abafuna Udibaniso Lwe-Dual-Scope?
Ayizizo zonke izifo zenyongo ezifuna ukuboniswa kwe-dual-scope combined imaging. Ukuboniswa kwe-dual-scope combined imaging kulungele kakhulu iimeko ezinzima ezingenakulungiswa ngendlela enye, kubandakanya oku kulandelayo:
Amatye e-bile duct antsonkothileyo: Le yindlela eyintloko yokusetyenziswa kwi-CT edibeneyo ye-dual-scope. Umzekelo, izigulane ezinee-intrahepatic bile duct stones (ingakumbi ezo zikwiindawo ezikude ezifana ne-left lateral lobe okanye i-right posterior lobe yesibindi) kunye nee-common bile duct stones; izigulane ezinee-hard stones ezingaphezu kwe-2 cm ububanzi ezingenakususwa yi-ERCP yodwa; kunye nezigulane ezinee-stones ezifakwe kwi-bile ducts ezinciphileyo, nto leyo ethintela ukudlula kwezixhobo ze-ERCP. Isebenzisa i-dual-scope combined CTCS, i-CTCS "iyaqhekeza" amatye amakhulu kwaye isuse amatye aqhekekileyo ngaphakathi kwesibindi, ngelixa i-ERCP "isusa" ii-passages ezisezantsi ezivela emathunjini ukuthintela amatye aseleyo, ifezekisa "ukususwa ngokupheleleyo kwamatye."
Ii-strictures ze-bile duct ezikumgangatho ophezulu: Xa ii-strictures ze-bile duct zibekwe ngaphezulu kwe-hepatic hilum (apho ii-hepatic ducts zasekhohlo nasekunene zidibana khona), ii-endoscopes ze-ERCP kunzima ukuzifikelela, okwenza kube nzima ukuvavanya ngokuchanekileyo ubukhali kunye nesizathu se-stricture. Kwezi meko, i-PTCS ivumela ukubonakala ngokuthe ngqo kwe-stricture ngemijelo ye-intrahepatic, ivumela ii-biopsies ukuba ziqinisekise uhlobo lwesilonda (njengokuvuvukala okanye ithumba) ngelixa ngaxeshanye zenza i-balloon dilatation okanye i-stent placement. I-ERCP, kwelinye icala, ivumela ukubekwa kwe-stent engezantsi, esebenza njenge-relay ye-PTCS stent, iqinisekisa ukuphuma kwamanzi kwi-bile duct yonke ngaphandle kokuphazamiseka.
Iingxaki emva kotyando lwenyongo: I-anastomotic stenosis, i-bile fistula, kunye namatye aseleyo anokwenzeka emva kotyando lwenyongo. Ukuba isigulana sinamatheli aqatha emathunjini emva kotyando kwaye i-ERCP ayinakwenzeka, i-PTCS ingasetyenziselwa ukukhupha amanzi kunye nonyango. Ukuba i-anastomotic stenosis iphezulu kwaye i-ERCP ayinakukwazi ukwandiswa ngokupheleleyo, i-PTCS inokudityaniswa nokwandiswa kwamacala omabini ukuphucula izinga lempumelelo lonyango.
Izigulana ezingakwaziyo ukunyamezela utyando olunye: Umzekelo, izigulana ezikhulileyo okanye izigulana ezinezifo ezinzima zentliziyo nemiphunga azikwazi ukumelana notyando olunye olude. Ukudibanisa izibuko ezimbini kunokwahlula utyando oluntsonkothileyo lube "lungena kakhulu + lungena kancinci", kunciphisa iingozi zotyando kunye nomthwalo womzimba.
Imbono Yekamva: "Indlela Yokuphucula" yeNdibaniselwano yeDual-Scope
Ngokuhambela phambili kwetekhnoloji, indibaniselwano ye-ERCP kunye ne-PTCS iyaqhubeka nokukhula. Kwelinye icala, inkqubela phambili kwitekhnoloji yokufota ivumela ukubhobozwa kunye neenkqubo ezichanekileyo ngakumbi. Umzekelo, indibaniselwano ye-intraoperative endoscopic ultrasound (EUS) kunye ne-PTCS inokuyibona kakuhle indlela engaphakathi ye-bile duct ngexesha langempela, inciphisa iingxaki zokubhobozwa. Kwelinye icala, izinto ezintsha kwizixhobo zenza unyango lube ngcono ngakumbi. Umzekelo, ii-choledochoscopes eziguquguqukayo, ii-lithotripsy probes ezihlala ixesha elide, kunye nee-bioresorbable stents zivumela indibaniselwano ye-dual-scope ukujongana nezilonda ezinzima ngakumbi.
Ngaphezu koko, "i-robot-assisted dual-scope combined" ivele njengesikhokelo esitsha sophando: ngokusebenzisa iinkqubo zerobhothi ukulawula ii-endoscopes kunye nezixhobo zokubhoboza, oogqirha banokwenza iinkqubo ezibuthathaka kwindawo ekhululekileyo, nto leyo ephucula ngakumbi ukuchaneka kotyando kunye nokhuseleko. Kwixesha elizayo, ngokwamkelwa okwandayo kwentsebenziswano yamacandelo amaninzi (MDT), i-ERCP kunye ne-PTCS ziya kuhlanganiswa ngakumbi ne-laparoscopy kunye nonyango lokungenelela, zibonelela ngokuchonga okulungiselelwe wena kunye nomgangatho ophezulu kunye neendlela zonyango kwizigulana ezinezifo ze-biliary.
Indibaniselwano ye-ERCP kunye ne-PTCS enee-scope ezimbini iphula imida yendlela enye yokuxilonga nonyango lwe-biliary, ijongana nezifo ezininzi ezintsonkothileyo ze-biliary ngendlela engangeni kakhulu kwaye echanekileyo. Intsebenziswano yale "mbini inetalente" ayibonisi nje kuphela ukuqhubela phambili kwetekhnoloji yezonyango kodwa ikwabonisa indlela egxile kwisigulana yokuxilonga nonyango. Iguqula oko kwakukade kufuna i-laparotomy enkulu ibe lunyango olungangeni kakhulu olungenazintlungu kangako kunye nokuchacha ngokukhawuleza, okuvumela izigulana ezininzi ukuba zoyise izifo zazo ngelixa zigcina umgangatho wobomi ophezulu. Sikholelwa ukuba ngokuqhubela phambili kwezobuchwepheshe, indibaniselwano ye-dual-scope iya kuvula amandla angakumbi, izise amathuba amatsha ekuxilongweni nasekunyangweni kwezifo ze-biliary.
Thina, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumvelisi eTshayina ogxile kwizinto ezisetyenziswayo ze-endoscopic, kuquka umgca we-GI ofana noi-biopsy forceps, i-hemoclip, umgibe we-polyp, inaliti ye-sclerotherapy, i-catheter yokutshiza, iibhrashi ze-cytology, ucingo lwesikhokelo, ibhaskithi yokuqokelela amatye, i-catheter yokukhupha amanzi empumlwenikunyeI-Sphincterotome njl.njl.ezisetyenziswa kakhulu kwiI-EMR, I-ESD, I-ERCP.
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Ixesha leposi: Novemba-14-2025