Ekuxilongweni kunye nokunyangwa kwezifo ze-biliary, ukuphuhliswa kweteknoloji ye-endoscopic igxininise ngokuqhubekayo kwiinjongo zokuchaneka okukhulu, ukuhlaselwa okuncinci, kunye nokhuseleko olukhulu. I-Endoscopic retrograde cholangiopancreatography (ERCP), i-workhorse yokuxilongwa kwesifo se-biliary kunye nonyango, kudala yamkelwa ngokubanzi ngenxa yokungabikho kotyando kunye nendalo yayo encinci. Nangona kunjalo, xa ujongene nezilonda ezintsonkothileyo zebiliary, indlela enye ihlala isilela. Apha kulapho i-percutaneous transhepatic cholangioscopy (PTCS) iba yeyona nto ibalulekileyo kwi-ERCP. Le ndlela idityanisiweyo "yombini-umda" yogqitha imida yonyango lwesintu kwaye inika izigulane ukhetho olutsha ngokupheleleyo lokuxilonga kunye nonyango.
I-ERCP kunye ne-PTCS nganye inezakhono zayo ezizodwa.
Ukuqonda amandla osetyenziso oludityanisiweyo oluphindwe kabini, umntu kufuneka aqale aqonde ngokucacileyo ubunakho obubodwa bezi zixhobo zibini. Nangona zombini zizixhobo zokuxilongwa kunye nonyango lwe-biliary, zisebenzisa iindlela ezahlukeneyo, ukudala umphelelisi ogqibeleleyo.
I-ERCP: Ingcaphephe ye-Endoscopic ingena kwi-Digestive Tract
I-ERCP imele i-Endoscopic Retrograde Cholangiopancreatography. Ukusebenza kwayo kufana nendlela ejikelezayo yokwenza izinto. Ugqirha ufaka i-duodenoscope ngomlomo, umqala, kunye nesisu, ekugqibeleni ifikelele kwi-duodenum ehlayo. Ugqirha ufumana ukuvuleka kwamathumbu e-bile kunye ne-pancreatic ducts (i-duodenal papilla). I-catheter ifakwa kwi-endoscopic biopsy port. Emva kokujova i-agent echaseneyo, uvavanyo lwe-X-ray okanye i-ultrasound luyenziwa, luvumela ukuxilongwa okubonakalayo kwe-bile kunye ne-pancreatic ducts.
Ngesi siseko,I-ERCPunokwenza uluhlu lweenkqubo zonyango: umzekelo, ukuhlanjululwa kwe-bile ducts kunye nebhaluni, ukuvula iipaseji ezivaliweyo kunye ne-stents, ukususa amatye kwi-bile duct ngebhasikithi yokususa ilitye, kunye nokufumana izicubu ezigulayo zohlalutyo lwe-pathological usebenzisa i-biopsy forceps. Inzuzo yayo engundoqo ixhomekeke kwinto yokuba isebenza ngokupheleleyo kwi-cavity yendalo, isusa imfuno yokwakheka komhlaba. Oku kuvumela ukubuyisela ngokukhawuleza emva kokuhlinzwa kunye nokuphazamiseka okuncinci kumzimba wesigulane. Ilungele kakhulu ukunyanga iingxaki zenyongo kufutshane namathumbu, anje ngamatye aphakathi kunye namazantsi asezantsi etyholo lenyongo, imibhobho yenyongo esezantsi, kunye nezilonda kwi-pancreatic kunye ne-bile duct junction.
Nangona kunjalo, i-ERCP nayo ine "ubuthathaka" bayo: ukuba i-bile duct obstruction inzima kwaye i-bile ayikwazi ukukhutshwa kakuhle, i-agent echaseneyo iya kuba nobunzima bokugcwalisa yonke i-bile duct, eya kuchaphazela ukuchaneka kokuxilongwa; kwi-intrahepatic bile duct stones (ingakumbi amatye abekwe nzulu esibindini) kunye ne-high-positioned bile duct stenosis (kufuphi ne-hilum yesibindi nangaphezulu), umphumo wonyango udla ngokuncitshiswa kakhulu ngenxa yokuba i-endoscope "ayikwazi ukufikelela" okanye indawo yokusebenza ilinganiselwe.
I-PTCS: I-Percutaneous Pioneer Eqhekeza uMphezulu Wesibindi
I-PTCS, okanye i-choledochoscopy ye-percutaneous transhepatic, isebenzisa indlela "yangaphandle", ngokungafaniyo nendlela "yangaphakathi" ye-ERCP. Ngaphantsi kwe-ultrasound okanye i-CT isikhokelo, ugqirha wotyando ugqobhoza ulusu kwisifuba sasekunene okanye kwisisu sesigulane, enqumla ngokuchanekileyo izicubu zesibindi kunye nokufikelela kwi-dilated intrahepatic bile duct, ukudala itonela eyenziwe "yesikhumba-isibindi-bile". I-choledochoscope iye ifakwe kule tonela ukujonga ngokuthe ngqo i-intrahepatic bile duct ngelixa ngaxeshanye isenza unyango olufana nokususwa kwamatye, i-lithotripsy, i-dilation of strictures, kunye nokubekwa kwe-stent.
“Isixhobo sokubulala” se-PTCS sisekukwazini kwayo ukufikelela ngokuthe ngqo kwizilonda zentunja kwi-intrahepatic. Kubaluleke kakhulu ukujongana "neengxaki ezinzulu" kunzima ukufikelela kuzo nge-ERCP: umzekelo, amatye amakhulu e-bile duct angaphezu kwe-2 cm ububanzi, "amatye amaninzi" ahlakazekile kumasebe amaninzi e-intrahepatic bile duct, i-high-positioned bile duct strictures ebangelwa ngamathumba okanye ukuvutha, kunye neengxaki ezinzima ezifana ne-anastomotic stenosis eyenzeka emva kotyando lwe-bile. Ngapha koko, xa izigulane zingakwazi ukwenza i-ERCP ngenxa yezizathu ezifana ne-duodenal papillary malformation kunye nokuphazamiseka kwamathumbu, i-PTCS inokusebenza njengenye indlela, ikhuphe i-bile ngokukhawuleza kunye nokunciphisa i-jaundice, ngaloo ndlela ithenga ixesha lonyango olulandelayo.
Nangona kunjalo, i-PTCS ayifezekanga: kuba ifuna ukugqobhoza kumphezulu womzimba, iingxaki ezinjengokopha, ukuvuza kwenyongo, kunye nosulelo lunokwenzeka. Ixesha lokubuyisela emva kokuhlinzwa lide kancinane kune-ERCP, kwaye iteknoloji ye-puncture kagqirha kunye nokuchaneka kwesikhokelo somfanekiso kuphezulu kakhulu.
Umdibaniso onamandla: Ingqiqo "yeSynergistic Operation" kunye neDual-Scope Combination
Xa "izibonelelo ze-endovascular" ze-ERCP zidibana "nenzuzo ye-percutaneous" ye-PTCS, ezi zimbini azisekho kuphela kwindlela enye, kodwa endaweni yoko zenza isakhelo sokuxilonga kunye nonyango "esibetha ngaphakathi nangaphandle komzimba." Le ndibaniselwano ayilongezo lulula lobuchwepheshe, kodwa isicwangciso somntu siqu “1+1>2″ esilungiselelwe imeko yesigulana.
Ukudityaniswa okulandelelanayo: "Vula iNdlela kuqala, emva koko uNyango oluchanekileyo"
Le yeyona ndlela ixhaphakileyo yokudibanisa, elandela umthetho-siseko "wokukhutshelwa kwamanzi kuQala, Unyango Kamva." Ngokomzekelo, kwizigulane ezine-jaundice ephazamisayo enzima ebangelwa ngamatye e-intrahepatic bile duct, inyathelo lokuqala kukuseka umjelo we-biliary drainage ngokusebenzisa i-PTCS ukuhlatywa kwe-bile eqokelelweyo, ukukhulula uxinzelelo lwesibindi, ukunciphisa umngcipheko wosulelo, kwaye ngokuthe ngcembe ubuyisele ukusebenza kwesibindi kunye nesimo somzimba wesigulane. Nje ukuba imeko yesigulane izinzile, i-ERCP iye yenziwa ukusuka kwicala lamathumbu ukususa amatye kwi-bile duct eqhelekileyo, ukunyanga izilonda kwi-duodenal papilla, kunye nokwandisa ngakumbi i-bile duct stricture usebenzisa ibhaluni okanye i-stent.
Ngokwahlukileyo, ukuba isigulane sihamba nge-ERCP kwaye sifunyenwe sinamatye esibindi aseleyo okanye i-stenosis ephezulu engenakunyangwa, i-PTCS ingasetyenziselwa ukugqiba "umsebenzi wokugqiba" kamva. Lo mzekelo ubonelela ngenzuzo "yenyathelo ngamanyathelo kunye nemingcipheko elawulekayo," eyenza ukuba ifaneleke ngokukodwa kwizigulane ezineemeko ezinzima kunye neemeko zempilo esele zikhona.
Umsebenzi oDityanisiweyo ngaxeshanye: “Ukusebenza kwemida emibini ngaxeshanye,
Isisombululo esiSingle-Stop”
Kwizigulane ezinokuxilongwa okucacileyo kunye nokunyamezela komzimba kakuhle, oogqirha banokukhetha inkqubo "yokudityaniswa ngaxeshanye". Ngexesha lotyando olufanayo, amaqela e-ERCP kunye ne-PTCS asebenza kunye. Ugqirha we-ERCP usebenzisa i-endoscope ukusuka kwicala lamathumbu, ukukhulula i-duodenal papilla kunye nokubeka i-guidewire. Ugqirha we-PTCS, okhokelwa ngumfanekiso, ugqobhoza isibindi kwaye usebenzisa i-choledochoscope ukufumana i-ERCP-placed guidewire, ukuphumeza ulungelelwaniso oluchanekileyo "lwemijelo yangaphakathi nangaphandle." La maqela mabini emva koko asebenzisana ukwenza i-lithotripsy, ukususwa kwamatye, kunye nokubekwa kwe-stent.
Inzuzo enkulu yalo mzekelo kukuba ijongene nemiba emininzi ngenkqubo enye, ukuphelisa imfuno ye-anesthesia eninzi kunye notyando, ukunciphisa kakhulu umjikelo wonyango. Ngokomzekelo, kwizigulana ezinamatye amabini e-intrahepatic kunye namatye aqhelekileyo e-bile duct, i-PTCS ingasetyenziselwa ngaxeshanye ukucima amatye e-intrahepatic kunye ne-ERCP ukujongana namatye aqhelekileyo e-bile duct, ukuphelisa isidingo sokuba izigulane ziqhube imijikelo emininzi ye-anesthesia kunye notyando, ukuphucula kakhulu unyango olusebenzayo.
Imeko eSebenzayo: Zeziphi izigulana ezifuna ukudityaniswa okuphindwe kabini?
Ayizizo zonke izifo zebiliary ezifuna umfanekiso odityanisiweyo we-double-scope. Umfanekiso odityanisiweyo we-double-scope ulungele ikakhulu iimeko ezinzima ezingenakulungiswa ngobuchule obunye, okubandakanya oku kulandelayo:
Amatye antsonkothileyo etyhubhulu yenyongo: Le yeyona meko iphambili yesicelo se-CT edityanisiweyo kabini. Ngokomzekelo, izigulane ezine-intrahepatic bile duct stones (ingakumbi ezo zibekwe kwiindawo ezikude ezifana ne-left lateral lobe okanye i-right posterior lobe yesibindi) kunye namatye aqhelekileyo e-bile duct; izigulane ezinamatye anzima angaphezu kwe-2 cm ububanzi obungenakususwa yi-ERCP yodwa; kunye nezigulane ezinamatye afakwe kwii-bile ducts ezinqamlekileyo, ukuthintela ukuhamba kwezixhobo ze-ERCP. Ukusebenzisa i-CTCS edibeneyo emibini, i-CTCS "iqhekeza" amatye amakhulu kwaye icoca amatye e-branching ngaphakathi kwesibindi, ngelixa i-ERCP "icoca" iipaseji ezisezantsi ukusuka emathunjini ukukhusela amatye ashiyekileyo, ukufezekisa "ukukhutshwa okupheleleyo kwamatye."
Izinga eliphezulu le-bile duct strictures: Xa i-bile duct strictures ibekwe ngaphezu kwe-hepatic hilum (apho i-hepatic ducts ye-hepatic idibana khona), i-ERCP endoscopes inzima ukufikelela kuyo, okwenza kube nzima ukuvavanya ngokuchanekileyo ubunzima kunye nesizathu sokuqina. Kwezi meko, i-PTCS ivumela ukubonwa ngokuthe ngqo kwe-stricture ngokusebenzisa iziteshi ze-intrahepatic, ivumela i-biopsies ukuba iqinisekise ubume be-lesion (njengokuvuvukala okanye i-tumor) ngelixa kwangaxeshanye iqhuba ibhaluni yokuhlanjululwa okanye ukubekwa kwe-stent. I-ERCP, ngakolunye uhlangothi, ivumela ukubekwa kwe-stent engezantsi, esebenza njenge-relay ye-PTCS stent, iqinisekisa ukukhutshwa okungenakunqandwa kwayo yonke i-bile duct.
Iingxaki ze-postoperative yotyando lwe-biliary: I-Anastomotic stenosis, i-bile fistula, kunye namatye ashiyekileyo angenzeka emva kotyando lwe-biliary. Ukuba isigulane sinamathumbu emathunjini anzima emva kokuhlinzwa kwaye i-ERCP ayinakwenzeka, i-PTCS ingasetyenziselwa ukukhupha kunye nonyango. Ukuba i-anastomotic stenosis iphezulu kwaye i-ERCP ayikwazi ukuhlanjululwa ngokupheleleyo, i-PTCS inokudibaniswa ne-dilation yamazwe amabini ukuphucula izinga lokuphumelela kwonyango.
Izigulane ezingakwaziyo ukunyamezela utyando olunye: Ngokomzekelo, izigulane ezikhulileyo okanye izigulane ezinezifo ezinzima ze-cardiopulmonary azikwazi ukumelana notyando olunye olude. Ukudityaniswa kwezibuko eziphindwe kabini kunokwahlula umsebenzi onzima ukuba ube "yi-invasive encinci + encinci ye-invasive", ukunciphisa imingcipheko yotyando kunye nomthwalo womzimba.
Ikamva lekamva: “Umkhomba-ndlela ophuculweyo” weNdibaniselwano yoMda oMabini
Ngenkqubela phambili yetekhnoloji, indibaniselwano ye-ERCP kunye ne-PTCS iyaqhubeka nokuvela. Kwelinye icala, inkqubela phambili yetekhnoloji yokucinga yenza ukuba iipunctures ezichanekileyo kunye neenkqubo ezichanekileyo. Ngokomzekelo, ukudibanisa kwe-intraoperative endoscopic ultrasound (EUS) kunye ne-PTCS inokubona isakhiwo sangaphakathi se-bile duct ngexesha langempela, ukunciphisa iingxaki ze-puncture. Kwelinye icala, iinguqulelo kwizixhobo zenza unyango lusebenze ngakumbi. Umzekelo, i-choledochoscopes eguquguqukayo, i-lithotripsy probes eyomelele ngakumbi, kunye ne-bioresorbable stents zenza indibaniselwano yobubanzi obumbini ukulungisa izilonda ezinzima ngakumbi.
Ngaphaya koko, "i-robot-incediswe kabini-i-scope edibeneyo" iye yavela njengesikhokelo esitsha sophando: ngokusebenzisa iinkqubo zerobhothi ukulawula i-endoscopes kunye nezixhobo zokubhoboza, oogqirha banokwenza iinkqubo ezibuthathaka kwindawo ekhululekile ngakumbi, bephucula ngakumbi ukuchaneka kotyando kunye nokhuseleko. Kwixesha elizayo, ngokunyuka kokwamkelwa kwentsebenziswano ye-multidisciplinary (MDT), i-ERCP kunye ne-PTCS iya kuhlanganiswa ngakumbi kunye ne-laparoscopy kunye nonyango lokungenelela, ukubonelela ngokuxilongwa komntu kunye nomgangatho ophezulu wokuxilongwa kunye nonyango lwezigulane ezinezifo ze-biliary.
Indibaniselwano ye-double-scope ye-ERCP kunye ne-PTCS iphula imida yendlela enye yokuxilongwa kunye nonyango lwe-biliary, ukujongana nezifo ezininzi ze-biliary eziyinkimbinkimbi kunye neyona ndlela incinci kunye nechanekileyo. Intsebenziswano yale "duo inetalente" ayibonisi nje ukuqhubela phambili kobugcisa bezonyango kodwa iquka indlela egxininise kwisigulane ekuxilongeni nasekunyangweni. Iguqula into eyayikade ifuna i-laparotomy enkulu ibe lunyango olungenabuncinci olunokwenzakala kancinci kunye nokuchacha ngokukhawuleza, ivumela izigulane ezininzi ukuba zoyise izifo zazo ngelixa zigcina umgangatho wobomi obuphezulu. Sikholelwa ukuba ngokuqhubeleka kwenkqubela phambili yetekhnoloji, indibaniselwano ye-double-scope iya kuvula izakhono ezingakumbi, izise amathuba amatsha kuxilongo kunye nonyango lwezifo zebiliary.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ngumenzi e-China okhethekileyo kwizinto ezityiwayo ze-endoscopic, zibandakanya umgca we-GI onjei-biopsy forceps, i-hemoclip, polyp umgibe, inaliti ye-sclerotherapy, fafaza i-catheter, iibrashi zecytology, guidewire, ibhasikithi yokubuyiswa kwamatye, i-catheter ye-biliary drainage yeempumlo, kwayeSphincterotome njl. ezisetyenziswa ngokubanzi kwiI-EMR, ESD, I-ERCP.
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Ixesha lokuposa: Nov-14-2025