Amatye e-bile duct ahlulwe abe ngamatye aqhelekileyo kunye namatye anzima. Namhlanje siza kufunda ngokuyintloko indlela yokususa amatye e-bile duct ekunzima ukuwasebenzisa.I-ERCP.
"Ubunzima" bamatye anzima bubangelwa kakhulu yimo enzima, indawo engaqhelekanga, ubunzima kunye nomngcipheko wokususwa kwawo. Xa kuthelekiswaI-ERCPkwi-bile duct tumors, umngcipheko ulingana okanye uphezulu. Xa ujongene nobunzima bemihla ngemihlaI-ERCPemsebenzini, kufuneka sixhobise iingqondo zethu ngolwazi size sivumele ingqondo yethu iguqule izakhono zethu ukuze sikwazi ukumelana nemingeni.
01 Uhlu lwe-Etiological "lwamatye anzima"
Amatye anzima anokwahlulwa abe ngamaqela amatye, amaqela angaqhelekanga emzimbeni, amaqela ezifo ezikhethekileyo kunye namanye ngokusekelwe kwizizathu zawo.
① Iqela lelitye
Ezona ziphambili ziquka amatye amakhulu e-bile duct, amatye amaninzi (amatye aqhoqhoqho), amatye angaphakathi kwesibindi, kunye namatye achaphazelekileyo (anzima yi-AOSC). Zonke ezi ziimeko apho kunzima ukususa amatye kwaye zifuna isilumkiso kwangethuba.
·Ilitye likhulu kakhulu (ububanzi >1.5 cm). Ubunzima bokuqala ekususeni ilitye kukuba ilitye alinakususwa okanye laphulwe zizixhobo. Ubunzima besibini kukuba ilitye alinakususwa okanye laphulwe emva kokuba lisusiwe. Kufuneka ilitye elingxamisekileyo ngeli xesha.
· Amatye amancinci kakhulu akufuneki athathwe lula. Ingakumbi amatye amancinci anokushukuma okanye angene esibindini ngokulula, kwaye amatye amancinci kunzima ukuwafumana nokuwagquma, nto leyo eyenza kube nzima ukuwanyanga ngonyango lwe-endoscopic.
·Kwiilitye ezizaliswe yimibhobho yenyongo eqhelekileyo,I-ERCPUkususwa kwamatye kuthatha ixesha elide kakhulu kwaye kulula ukuvalelwa entolongweni. Ngokuqhelekileyo kufuneka utyando ukuze kususwe amatye.
②Ukungasebenzi kakuhle komzimba
Ukuphazamiseka kwendlela yokwakheka komzimba kuquka ukuphazamiseka kwendlela yokugaya inyongo, i-Mirrizi syndrome, kunye nokuphazamiseka kwendlela yokwakheka komzimba kwicandelo elisezantsi kunye neliphumayo kwindlela yokugaya inyongo. I-Peripapillary diverticula ikwayimeko eqhelekileyo yokungasebenzi kakuhle kwendlela yokwakheka komzimba.
·Emva kotyando lwe-LC, ulwakhiwo lwe-bile duct aluqhelekanga kwaye i-bile duct iyajijeka.I-ERCPXa isetyenziswa, ucingo olukhokelayo "kulula ukulubeka phantsi kodwa alulula ukulufaka" (luyawa ngengozi emva kokuba ekugqibeleni lunyukile), ngoko ke xa ucingo olukhokelayo lubekwe phezulu, kufuneka lugcinwe ukuze kuthintelwe ukuba ucingo olukhokelayo lungawi kwaye luwe ngaphandle kombhobho wenyongo.
·I-Mirizz syndrome sisifo esinganyangekiyo esibonakala lula kwaye singanakwa. Isifundo setyala: Emva kotyando lwe-LC, isigulana esinamatye e-cystic duct sacinezela i-common bile duct, nto leyo eyabangela i-Mirrizz syndrome. La matye awazange asuswe phantsi koqwalaselo lwe-X-ray. Ekugqibeleni, ingxaki yasonjululwa emva kokuxilongwa nokususwa phantsi kombono othe ngqo nge-eyeMAX.
·NgenxaI-ERCPUkususwa kwamatye e-bile duct kwizigulana zesisu emva kotyando lwe-Bi II, eyona nto ibalulekileyo kukufikelela kwi-nipple ngokusebenzisa i-scope. Ngamanye amaxesha kuthatha ixesha elide (okufuna ingqondo eqinileyo) ukufikelela kwi-nipple, kwaye ukuba ucingo olukhokelayo alugcinwanga kakuhle, lunokuphuma lula.
③Ezinye iimeko
I-peripapillary diverticulum edibene namatye e-bile duct ixhaphakile. Ubunzima botyando ngeli xesha bumngcipheko wokusikwa kwe-nipple kunye nokwanda kwayo. Le ngozi inkulu kakhulu kwii-nipple ngaphakathi kwe-diverticulum, kwaye umngcipheko wee-nipple ezikufutshane ne-diverticulum uncinci.
Ngeli xesha, kubalulekile ukuqonda inqanaba lokwanda. Umgaqo-nkqubo oqhelekileyo wokwandiswa kukunciphisa umonakalo ofunekayo ukususa amatye. Umonakalo omncinci uthetha iingozi ezincinci. Kule mihla, ukwanda kwebhaluni (CRE) ye-nipple ejikeleze i-diverticula kudla ngokusetyenziswa ukuphepha i-EST.
Izigulane ezinezifo zegazi, umsebenzi wentliziyo neepulmonary ongakwaziyo ukunyamezelaI-ERCP, okanye izifo zamalungu omqolo ezingakwaziyo ukunyamezela ukuma ngasekhohlo ixesha elide kufuneka ziqwalaselwe kwaye zihlolwe xa zidibana namatye anzima.
02 Ingqondo yokujongana "namatye anzima"
Ingqondo engalunganga xa ujongene "namatye anzima": ukubawa nempumelelo, ukungakhathali, indelelo ngaphambi kotyando, njl.
·Uburhalarhume nothando lwezinto ezinkulu ezifeziweyo
Xa sijongene namatye e-bile duct, ingakumbi lawo anamatye amaninzi, sisoloko sifuna ukususa onke amatye. Olu luhlobo "lokubawa" kwaye luyimpumelelo enkulu.
Enyanisweni, kulungile ukuthatha yonke into kunye ne-pure, kodwa ukuthatha i-pure ngazo zonke iindleko "kulungile kakhulu", nto leyo engakhuselekanga kwaye iya kuzisa ubunzima nobunzima obuninzi. Amatye amaninzi e-bile duct kufuneka agqitywe ngokupheleleyo ngokusekelwe kwimeko yesigulana. Kwiimeko ezikhethekileyo, ityhubhu kufuneka ibekwe okanye isuswe kuphela ngamaqashiso.
Xa amatye amakhulu emibhobho yenyongo kunzima ukuwasusa okwethutyana, "ukunyibilika kwe-stent" kunokucingelwa. Musa ukunyanzela ukususwa kwamatye amakhulu, kwaye ungazifaki kwimeko eyingozi kakhulu.
·ukungakhathali
Oko kukuthi, utyando olungaboniyo ngaphandle kohlalutyo olupheleleyo nophando ludla ngokukhokelela ekusileleni kokususwa kwamatye. Ke ngoko, amatyala amatye e-bile duct kufuneka ahlolwe ngokupheleleyo ngaphambi kotyando, ahlolwe ngokungenamkhethe (kufuneka amandlaI-ERCPoogqirha ukuze bafunde imifanekiso), kufuneka kwenziwe izigqibo ngononophelo kunye nezicwangciso zongxamiseko ukuthintela ukususwa kwelitye okungalindelekanga.
II-ERCPIsicwangciso sokukhutshelwa kwamatye kufuneka sibe sesayensi, singathathi cala, siphelele, kwaye sikwazi ukumelana nohlalutyo kunye nokuqwalaselwa. Simele sinamathele kumgaqo wokwandisa inzuzo yesigulana kwaye singabi ngabangenamkhethe.
·ukudelela
Amatye amancinci akwinxalenye esezantsi ye-bile duct kulula ukuwatyeshela. Ukuba amatye amancinci adibana neengxaki zesakhiwo kwinxalenye esezantsi ye-bile duct kunye nendawo ephuma kuyo, kuya kuba nzima kakhulu ukususa ilitye.
I-ERCPUnyango lwamatye e-bile duct lunezinto ezininzi ezahlukeneyo kunye neengozi eziphezulu. Lunzima kwaye luyingozi kakhulu okanye luphezulu kakhulu kuneI-ERCPunyango lwezimila ze-bile duct. Ngoko ke, ukuba awuyithathi lula, uya kuzishiyela indlela efanelekileyo yokuphuma.
03 Indlela yokujongana "namatye anzima"
Xa udibana namatye anzima, kufuneka kwenziwe uvavanyo olupheleleyo lwesigulana, kufuneka kwandiswe ngokwaneleyo,ibhaskithi yokukhupha ilityekufuneka kukhethwe kwaye kulungiswe i-lithotripter, kwaye kufuneka kuyilwe isicwangciso esenziwe kwangaphambili kunye nesicwangciso sonyango.
Njengenye indlela, izinto ezilungileyo nezingalunganga kufuneka zihlolwe ngokusekelwe kwimeko yesigulana ngaphambi kokuba siqhubeke.
·Ukusebenza kokuvula
Ubungakanani bomngxuma busekelwe kwimeko yelitye ekujoliswe kulo kunye nomsele wenyongo. Ngokubanzi, ukunqunyulwa okuncinci + ukwandiswa okukhulu (okuphakathi) kusetyenziswa ukwandisa umngxuma. Ngexesha le-EST, kuyimfuneko ukuphepha umngxuma omkhulu ngaphandle nangaphakathi okuncinci.
Xa ungenamava, kulula ukwenza umsikelo "omkhulu ngaphandle kodwa omncinci ngaphakathi", oko kukuthi, ingono ibonakala inkulu ngaphandle, kodwa akukho msikelo ngaphakathi. Oku kuya kubangela ukuba ukususwa kwelitye kungaphumeleli.
Xa kusenziwa i-EST incision, kufuneka kusetyenziswe "i-shallow bow kunye ne-slow incision" ukuthintela i-zipper incision. I-incision kufuneka ikhawuleze njenge-incision nganye. Imela akufuneki "ihlale ithule" ngexesha le-incision ukuthintela ukuphazamiseka kweengono kunye nokubangela i-pancreatitis.
·Ukucubungula uvavanyo lwecandelo elisezantsi kunye nokuthumela ngaphandle
Amatye e-common bile duct afuna uvavanyo lwecandelo elisezantsi kunye nomngxuma we-common bile duct. Zombini iindawo kufuneka zihlolwe. Ukudibana kwazo zombini kumisela umngcipheko kunye nobunzima benkqubo yokusikwa kweengono.
·I-lithotripsy yongxamiseko
Amatye amakhulu kakhulu naqinileyo kunye namatye angenakususwa iiglavu kufuneka anyangwe nge-emergency lithotripter (emergency lithotripter).
Amatye e-Bile pigment anokwaphulwa abe ziingceba, kwaye uninzi lwamatye e-cholesterol aqinileyo anokusonjululwa ngale ndlela. Ukuba isixhobo asinakukhululwa emva kokufunyanwa, kwaye i-lithotripter ayinakuqhekeza amatye, "yingxaki" yokwenyani. Okwangoku, i-eyeMAX inokufuneka ukuze kuchongwe ngqo kwaye kunyangwe amatye.
Qaphela: Musa ukusebenzisa i-lithotripsy kwicandelo elisezantsi kunye nokuphuma kwe-common bile duct. Musa ukusebenzisa i-lithotripsy epheleleyo ngexesha le-lithotripsy, kodwa yishiyele indawo yayo. I-emergency lithotripsy iyingozi. Ngexesha le-emergency lithotripsy, i-end axis isenokungahambelani ne-bile duct axis, kwaye uxinzelelo lunokuba lukhulu kakhulu ukuba lungabangela ukugqobhoka.
·Ilitye elinyibilikisayo elithambileyo
Ukuba ilitye likhulu kakhulu kwaye kunzima ukulisusa, ungacinga ngokulinyibilikisa - oko kukuthi, ukubeka i-stent yeplastiki. Linda de ilitye linciphe ngaphambi kokuba ulisuse, amathuba okuphumelela aya kuba phezulu kakhulu.
·Amatye angaphakathi kwemithambo yegazi
Oogqirha abaselula abanamava amancinci kungcono bangenzi unyango lwe-endoscopic lwamatye e-bile duct angaphakathi kwesibindi. Ngenxa yokuba amatye akule ndawo asenokungakwazi ukubanjwa okanye angene nzulu aze athintele ukusebenza okungakumbi, indlela iyingozi kakhulu kwaye imxinwa.
·Amatye e-bile duct adityaniswe ne-peripapillary diverticulum
Kuyimfuneko ukuvavanya umngcipheko kunye nolindelo lokwanda. Umngcipheko wokugqobhoka kwe-EST uphezulu, ngoko ke okwangoku indlela yokwandisa ibhaluni ikhethwa ngokusisiseko. Ubungakanani bokwandisa kufuneka bube banele ukususa ilitye. Inkqubo yokwandisa kufuneka icothe kwaye inyathelo ngenyathelo, kwaye akukho ukwanda okanye ukwanda okunamandla okuvunyelweyo. Isirinji iyakhula ngokuthanda kwayo. Ukuba kukho ukopha emva kokwandiswa, kufuneka unyango olufanelekileyo.
Thina, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumvelisi eTshayina ogxile kwizinto ezisetyenziswayo ze-endoscopic, ezifanai-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 empumlweni njl.njl.ezisetyenziswa kakhulu kwiI-EMR,I-ESD,I-ERCPIimveliso zethu ziqinisekisiwe yi-CE, kwaye izityalo zethu ziqinisekisiwe yi-ISO. Iimpahla zethu zithunyelwe eYurophu, eMntla Melika, eMbindi Mpuma nakwinxalenye yeAsia, kwaye zifumana umthengi udumo nodumo!
Ixesha leposi: Julayi-26-2024