Izesekeli ze-ECCPP - I-Stone Extraction Basket
Ibhasikidi lokubuyisa amatshe lingumsizi wamatshe osetshenziswa kakhulu kwizesekeli ze-ECCPP. Odokotela abaningi abasha ku-ECCP, ubhasikidi wamatshe angahle akhawulelwe emcabangweni we- "Amathuluzi wokuthatha amatshe", futhi akwanele ukubhekana nesimo sercp esiyinkimbinkimbi. Namuhla, ngizofingqa futhi ngifunde ulwazi olufanele lwamabhasikidi e-Ercp Stone ngokususelwa olwazini olufanele engisibonile.
Ukuhlukaniswa okujwayelekile
Ibhasikidi lokubuyisa amatshe lihlukaniswe ibhasikidi eliqondiswa nge-wire-eliqondiswa yi-wire, ongeyena umhlahlandlela, kanye nebhasikidi elihlanganisiwe lokubuyiselwa kwamatshe. Phakathi kwazo, amabhasikidi ahlanganisiwe wokubuyisa ama-Retrieval-Crush amabhasikidi ajwayelekile aqhekekile amelwe yi-micro-tech kanye namabhasikidi asheshayo (RX) abhebhetheki avuselelwayo (Rx) abhejise amelwe yi-Boston ScietiFi. Ngoba iqoqo elihlanganisiwe le-retrieval-crush kanye nebhasikidi elisheshayo libiza kakhulu kunamabhasikidi ajwayelekile, amanye amayunithi kanye nodokotela abasebenza kunganciphisa ukusetshenziswa kwawo ngenxa yezinkinga zezindleko. Kodwa-ke, kungakhathalekile ukuthi izindleko zimane nje ziyishiye, iningi lodokotela abasebenza kakhulu lizimisele ngokwengeziwe ukusebenzisa ubhasikidi (ngentambo yomhlahlandlela) ngokuqhekeka, ikakhulukazi amatshe amakhulu e-ntamba.
Ngokwesimo sebhasikidi, ingahlukaniswa "nge-hexagonal", "idayimane" kanye "nokuvunguza", okuyidayimane, i-dormia kanye ne-spiral, phakathi kwalo okusetshenziswa kakhulu. Amabhasikidi angenhla anezinzuzo zawo nobubi, futhi adinga ukukhethwa kalula ngokwesimo sangempela kanye nemikhuba yokusebenzisa komuntu siqu.
Ngenxa yokuthi ubhasikidi omise okwenziwe ngedayimane ne-dormia kuyindlela eguquguqukayo yebhasikidi "ekupheleni kwangaphambili okuncishisiwe futhi ancishisiwe ukuphela", kungenza kube lula kubhasikidi ukuthola amatshe. Uma itshe lingangeni ngemuva kokubanjwa ngoba itshe likhulu kakhulu, ibhasikidi lingadedelwa kahle, ukuze ligweme izingozi ezinamahloni.
Ibhasikidi le- "Diamond" elijwayelekile
Amabhasikidi ajwayelekile we- "Hexagon-Rhombus" asetshenziswa ngokungajwayelekile, noma obhasikidi bamatshe avusa amatshe. Ngenxa yesikhala esikhulu sebhasikidi "yedayimane", kulula ngamatshe amancane ukuze abalekele kubhasikidi. Ibhasikidi elimise okokwenziwe linezimpawu ze- "Kulula ukugqoka kodwa akulula ukukhulula". Ukusetshenziswa kwebhasikidi elimise okwenziwe ngokhuni kudinga ukuqonda okugcwele kwetshe kanye nokusebenza okulinganiselwa ukugwema itshe ukubambeka ngangokunokwenzeka.
Ibhalasi
Ibhasikidi elishintshashintshayo elisheshayo ngokuchotshozwa nokuchotshozwa lisetshenziswa ngesikhathi sokukhishwa kwamatshe amakhulu, anganciphisa isikhathi sokusebenza futhi athuthukise inani lempumelelo lokuchoboza. Ngaphezu kwalokho, uma ibhasikidi lidinga ukuthi lisetshenziselwe ukucabanga, i-ejenti ehlukile ingafushaniswa futhi ikhathele ngaphambi kokuba kubhasikidi kungene i-bile duct.
Okwesibili, inqubo yokukhiqiza
Isakhiwo esikhulu sebhasikidi yamatshe sakhiwa umnyombo webhasikidi, i-sheath yangaphandle nesibambo. I-basket core yakhiwa nge-baket wire (titanium-nickel alloy) kanye nokudonsa ngocingo (304 insimbi engagqwali yezokwelapha). I-basket basket is a alloy ahluthwe ukwakheka, okufana nokwakheka kwe-graited kwesigaxa, esiza ukufaka ithagethi, ukuvimbela ukushelela, futhi kugcinwe ukungezwani okuphezulu futhi akulula ukuphula. I-wire edonsayo iyisiyingi esikhethekile sezokwelapha esinamandla aqinile ashubile nokuqina, ngakho-ke ngeke ngikwazi ukuthola imininingwane lapha.
Iphuzu eliyisihluthulelo lokukhuluma ngesakhiwo se-welding phakathi kocingo oludonsela khona kanye nocingo lwebhasikidi, ucingo lwebhasikidi nekhanda lensimbi yebhasikidi. Ikakhulu, iphuzu le-welding phakathi kocingo lokudonsa kanye nocingo lwebhasikidi lubaluleke kakhulu. Ngokusekelwe ekwakhiweni okunjalo, izidingo zenqubo ye-welding ziphezulu kakhulu. Ibhasikidi elinekhwalithi elibi kancane kungenzeka lingaphumeleli kuphela ukuchoboza itshe kodwa futhi libangela nephuzu le-welding phakathi kocingo oludonsayo kanye ne-mesh basket wire asuswe ngesikhathi sokukhishwa kwetshe ngemuva kokususwa kwetshe, okuholele kubhasikidi lapho kususwa khona. Ubunzima (imvamisa bungatholwa ngebhasikidi lesibili) futhi kungadinga nokuhlinzwa.
Inqubo yokufakelwa kabi ye-wire kanye nekhanda lensimbi lamabhasikidi amaningi ajwayelekile angadala ukuthi ubhasikidi uphule. Kodwa-ke, obhasikidi besayensi kaBoston baye benza imizamo eminingi kulokhu futhi baklama indlela yokuvikela ukuphepha. Lokho kusho ukuthi, uma amatshe asaphulwa ngamatshe aphezulu okuchoboza amatshe, ibhasikidi eliqinisa amatshe lingavikela ikhanda lensimbi ekugcineni kwebhasikidi ukuze liqinisekise ukuhlanganiswa kocingo lwebhasikidi kanye nocingo lokudonsa. Ubuqotho, ngaleyo ndlela bugweme amabhasikidi namatshe ashiywe ku-bile duct.
Ngeke ngikwazi ukuthola imininingwane ngeshubhu elingaphandle le-sheath nesibambo. Ngaphezu kwalokho, abakhiqizi abahlukahlukene be-Crusher Crusher bazoba namatshe amatshe ahlukene, futhi ngizothola ithuba lokufunda kabanzi.
Isetshenziswa kanjani
Ukususwa kwamatshe okuvaliwe kuyinto enzima kakhulu. Lokhu kungaba ubuwula be-opharetha ngesimo sesiguli nezesekeli, noma kungaba yisici samatshe e-bile duct ngokwawo. Kunoma ikuphi, kufanele sazi kuqala ukuthi singakugwema kanjani ukuboshwa, bese kufanele sazi ukuthi yini okufanele siyenze uma ukuboshwa kwenzeke.
Ukugwema ukuboshwa kwebhasikidi, ibhaluni le-columnar kufanele lisetshenziselwe ukunciphisa ukuvula ingono ngaphambi kokukhishwa ngamatshe. Ezinye izindlela ezingasetshenziswa ukususa ubhasikidi ovalelwe zifaka phakathi: Ukusetshenziswa kwebhasikidi lesibili (ubhasikidi-to-basket) nokususwa okuhlotshelwe, futhi i-athikili yakamuva ibuye yashabalala leyo hora (2 noma 3) yezintambo zingashiswa zisebenzisa i-APC. Phula, bese udedela ubhasikidi oboshwe.
Okwesine, ukwelashwa kwe-Stone Basket Desingcondation
Ukusetshenziswa kwebhasikidi kuhlanganisa ikakhulukazi: Ukukhethwa kwebhasikidi kanye nokuqukethwe okubili kwebhasikidi ukuthatha itshe. Ngokuya kokukhethwa kwebhasikidi, ikakhulukazi kuya ngesimo sebhasikidi, ububanzi bamabhasikidi, nokuthi basebenzise noma basebenzise i-lithotripsy ephuthumayo (ngokuvamile, isikhungo se-endoscopy silungiselelwe njalo).
Njengamanje, ibhasikidi ledayimane elisetshenziswe njalo, okungukuthi, ubhasikidi wase-Dormia. In the Imihlahlandlela ye-ECRP, lolu hlobo lwebhasikidi lukhulunywa ngokucacile engxenyeni yokukhishwa ngamatshe ngamatshe ajwayelekile e-bile duct. Inesilinganiso esiphezulu sempumelelo yokukhishwa ngamatshe futhi kulula ukuyikhipha. Kungukukhetha komugqa wokuqala wokukhishwa kwamatshe amaningi. Okwesigaba sebhasikidi, ubhasikidi ohambisanayo kufanele akhethwe ngokosayizi wetshe. Akulona iqiniso ukusho okuningi ngokukhethwa kwemikhiqizo yebhasikidi, sicela ukhethe ngokuya ngemikhuba yakho yangasese.
Amakhono okususa amatshe: Ibhasikidi libekwa ngaphezulu kwetshe, futhi itshe lihlolwe ngaphansi kokubonwa kwe-angiographic. Vele, kufanele noma i-EST noma i-ESP kufanele yenziwe ngokosayizi wetshe ngaphambi kokuthatha itshe. Lapho i-bile duct ilimele noma incishisiwe, kungahle kungabi yindawo eyanele yokuvula ubhasikidi. Kufanele itholakale ngokuya ngesimo esithile. Kuyindlela yokuthola indlela yokuthola indlela yokuthumela itshe kwi-bile duct ebanzi yokubuyisa. Kumatshe e-hilar bile duct amatshe, kufanele kuqashelwe ukuthi amatshe azodonswa esibindini futhi awatholakali lapho kwenziwa ubhasikidi ukuphuma kubhasikidi noma kuhlolwa.
Kunezimo ezimbili zokuthatha amatshe kubhasikidi wamatshe: ukuthi kukhona isikhala esanele ngaphezulu kwetshe noma eceleni kwetshe lokuvumela ubhasikidi ukuba uvule; Okunye ukugwema ukuthatha amatshe amakhulu kakhulu, noma ngabe ubhasikidi uvulwa ngokuphelele, awukwazi ukususwa. Siphinde sahlangane namatshe ama-3 cm asuswe ngemuva kwe-endoscopic lithodripsy, konke okumele kube yi-lithorripsy. Kodwa-ke, lesi simo sisayingozi futhi sidinga udokotela onolwazi ukuthi asebenze.
Isikhathi Seposi: Meyi-13-2022