Izesekeli ze-ERCP-Ibhasikidi Lokukhipha Amatshe
Ibhasikidi lokubuyisa amatshe liyisisetshenziswa esivame ukusetshenziswa ekutholeni amatshe kwizesekeli ze-ERCP. Kwabaningi odokotela abasanda kuqala i-ERCP, ibhasikidi lamatshe lingase lilinganiselwe emcabangweni "wamathuluzi okuqoqa amatshe", futhi akwanele ukubhekana nesimo esiyinkimbinkimbi se-ERCP. Namuhla, ngizofingqa futhi ngifunde ulwazi olufanele lwamabhasikidi amatshe e-ERCP ngokusekelwe olwazini olufanele engilubonisile.
Ukuhlukaniswa okuvamile
Ibhasikidi lokubuyisa itshe lihlukaniswe libe yibhasikidi eliqondiswa ngocingo oluqondisayo, ibhasikidi elingaqondiswa ngocingo oluqondisayo, kanye nebhasikidi elihlanganisiwe lokubuyisa itshe. Phakathi kwazo, amabhasikidi okubuyisa ahlanganisiwe amabhasikidi ajwayelekile okubuyisa amelwe yi-Micro-Tech kanye namabhasikidi okubuyisa i-Rapid Exchange (RX) amelwe yi-Boston Scientifi. Ngenxa yokuthi ibhasikidi elihlanganisiwe lokubuyisa ahlanganisiwe kanye nebhasikidi lokushintsha okusheshayo kubiza kakhulu kunamabhasikidi avamile, amanye amayunithi nodokotela abasebenzayo banganciphisa ukusetshenziswa kwawo ngenxa yezinkinga zezindleko. Kodwa-ke, kungakhathaliseki ukuthi izindleko zokumane bawushiye, odokotela abaningi abasebenzayo bazimisele kakhulu ukusebenzisa ibhasikidi (enocingo oluqondisayo) ukuze baqhekeke, ikakhulukazi ngamatshe amakhulu kancane e-bile duct.
Ngokuma kwebhasikidi, lingahlukaniswa libe "yi-hexagonal", "idayimane" kanye "ne-spiral", okungukuthi idayimane, i-Dormia kanye ne-spiral, lapho kusetshenziswa khona kakhulu amabhasikidi e-Dormia. Amabhasikidi angenhla anezinzuzo zawo kanye nokungalungi kwawo, futhi adinga ukukhethwa ngendlela eguquguqukayo ngokwesimo sangempela kanye nemikhuba yokusebenzisa yomuntu siqu.
Ngenxa yokuthi ubhasikidi omise okwedayimane kanye nobhasikidi weDormia kuyisakhiwo sebhasikidi esiguquguqukayo "esingaphambili esinwetshiwe kanye nesiphetho esincishisiwe", kungenza kube lula ukuthi ubhasikidi ulande amatshe. Uma itshe lingenakukwazi ukukhishwa ngemva kokubanjwa ngoba itshe likhulu kakhulu, ubhasikidi ungakhululwa kahle, ukuze kugwenywe izingozi ezihlazisayo.
Ibhasikidi "ledayimane" elivamile
Amabhasikidi avamile "e-hexagon-rhombus" asetshenziswa kaningi, noma kuphela kumabhasikidi okuchoboza amatshe. Ngenxa yesikhala esikhulu sebhasikidi "yedayimane", kulula ngamatshe amancane ukubaleka ebhasikidini. Ibhasikidi elinomumo ojikelezayo linezici "zokulula ukulifaka kodwa akulula ukulikhulula". Ukusetshenziswa kwebhasikidi elinomumo ojikelezayo kudinga ukuqonda okugcwele itshe kanye nomsebenzi olinganisiwe wokugwema itshe ukubambeka ngangokunokwenzeka.
Ibhasikidi elijikelezayo
Ibhasikidi lokushintshana okusheshayo elihlanganiswe nokuchoboza nokuchoboza lisetshenziswa ngesikhathi sokukhipha amatshe amakhulu, okunganciphisa isikhathi sokusebenza futhi kuthuthukise izinga lempumelelo yokuchoboza. Ngaphezu kwalokho, uma ibhasikidi lidinga ukusetshenziselwa izithombe, i-contrast agent ingahlanzwa kusengaphambili futhi ikhishwe ngaphambi kokuba ibhasikidi ingene emgudwini we-bile.
Okwesibili, inqubo yokukhiqiza
Isakhiwo esiyinhloko sebhasikidi lamatshe sakhiwe yinhloko yebhasikidi, igobolondo langaphandle kanye nesibambo. Inhloko yebhasikidi yakhiwe ngcingo yebhasikidi (i-titanium-nickel alloy) kanye nentambo yokudonsa (insimbi engagqwali yezokwelapha engu-304). Intambo yebhasikidi iyisakhiwo esilukiwe nge-alloy, esifana nesakhiwo esilukiwe se-snare, esiza ukubamba okuqondiwe, ukuvimbela ukushelela, nokugcina ukucindezeleka okuphezulu futhi akulula ukuphuka. Intambo yokudonsa iyintambo ekhethekile yezokwelapha enamandla amakhulu okudonsa nokuqina, ngakho-ke ngeke ngingene emininingwaneni lapha.
Iphuzu elibalulekile okufanele sikhulume ngalo isakhiwo sokushisela phakathi kwentambo yokudonsa kanye nentambo yebhasikidi, ucingo lwebhasikidi kanye nekhanda lensimbi lebhasikidi. Ikakhulukazi, iphuzu lokushisela phakathi kwentambo yokudonsa kanye nentambo yebhasikidi libaluleke kakhulu. Ngokusekelwe kumklamo onjalo, izidingo zenqubo yokushisela ziphakeme kakhulu. Ibhasikidi elinekhwalithi ephansi kancane lingase lingagcini nje ngokwehluleka ukuchoboza itshe kodwa futhi libangele iphuzu lokushisela phakathi kwentambo yokudonsa kanye nentambo yebhasikidi enemeshi ukuthi liphuke ngesikhathi senqubo yokuchoboza itshe ngemva kokususwa kwetshe, okuholela ekutheni ibhasikidi kanye netshe kusele emgudwini we-bile, kanye nokususwa okulandelayo. Ubunzima (ngokuvamile bungatholakala ngebhasikidi lesibili) futhi kungadinga nokuhlinzwa.
Inqubo embi yokushisela ucingo kanye nekhanda lensimbi lamabhasikidi amaningi avamile ingabangela kalula ukuthi ibhasikidi liphuke. Kodwa-ke, amabhasikidi eBoston Scientific enze imizamo eminingi kulokhu futhi aklama indlela yokuvikela ukuphepha. Okusho ukuthi, uma amatshe engasakwazi ukuphulwa ngamatshe acindezelayo aphezulu, ibhasikidi eliqinisa amatshe lingavikela ikhanda lensimbi ekugcineni kwebhasikidi ukuqinisekisa ukuhlanganiswa kocingo lwebhasikidi kanye nentambo yokudonsa. Ubuqotho, ngaleyo ndlela kugwenywe amabhasikidi namatshe asele emgudwini we-bile.
Ngeke ngingene emininingwaneni mayelana nethubhu nesibambo sangaphandle se-sheath. Ngaphezu kwalokho, abakhiqizi abahlukahlukene be-crusher yamatshe bazoba ne-crusher yamatshe ehlukene, futhi ngizothola ithuba lokufunda kabanzi kamuva.
Isetshenziswa kanjani
Ukususwa kwamatshe aboshwe kuyinto eyinkinga kakhulu. Lokhu kungaba ukunganaki komuntu oqhuba lesi simo sesiguli kanye nezinto ezihambisana naso, noma kungaba yisici samatshe e-bile duct uqobo. Kunoma ikuphi, kufanele sazi kuqala ukuthi singakugwema kanjani ukuboshwa, bese sazi ukuthi senzeni uma kwenzeka ukuboshwa.
Ukuze kugwenywe ukuboshwa kwebhasikidi, kufanele kusetshenziswe ibhaluni eliyikholomu ukuze kwandiswe imbobo yengono ngaphambi kokukhishwa kwamatshe. Ezinye izindlela ezingasetshenziswa ukususa ibhasikidi eliboshiwe zifaka: ukusebenzisa ibhasikidi lesibili (ukusuka kubhasikidi uye kubhasikidi) kanye nokususwa ngokuhlinzwa, futhi isihloko samuva sibike nokuthi ingxenye (2 noma 3) yezintambo ingashiswa kusetshenziswa i-APC. phula, bese ukhulula ibhasikidi eliboshiwe.
Okwesine, ukwelashwa kokuboshwa kwebhasikidi lamatshe
Ukusetshenziswa kwebhasikidi kuhlanganisa kakhulu: ukukhetha ibhasikidi kanye nokuqukethwe okubili kwebhasikidi okufanele kuthathwe itshe. Ngokuphathelene nokukhethwa kwebhasikidi, kuncike kakhulu ekubunjweni kwebhasikidi, ububanzi bebhasikidi, nokuthi ngabe kufanele kusetshenziswe noma kugcinwe i-lithotripsy ephuthumayo (ngokuvamile, isikhungo se-endoscopy silungiswa njalo).
Njengamanje, ibhasikidi "ledayimane" lisetshenziswa njalo, okungukuthi, ibhasikidi leDormia. Esiqondisweni se-ERCP, lolu hlobo lwebhasikidi lukhulunywa ngalo ngokucacile esigabeni sokukhishwa kwamatshe amatshe avamile e-bile duct. Lunezinga eliphezulu lempumelelo yokukhishwa kwamatshe futhi kulula ukulususa. Luyindlela yokuqala yokukhetha iningi lamatshe akhishwayo. Ngobubanzi bebhasikidi, ibhasikidi elihambisanayo kufanele likhethwe ngokuya ngosayizi wetshe. Akulula ukusho okwengeziwe ngokukhetha izinhlobo zebhasikidi, sicela ukhethe ngokwemikhuba yakho.
Amakhono okususa itshe: Ibhasikidi libekwa ngaphezu kwetshe, bese itshe lihlolwa ngaphansi kokuhlolwa kwe-angiographic. Yiqiniso, i-EST noma i-EPBD kufanele yenziwe ngokobukhulu betshe ngaphambi kokuthatha itshe. Uma i-bile duct ilimele noma incishisiwe, kungase kungabi nendawo eyanele yokuvula ibhasikidi. Kufanele ilandwe ngokwesimo esithile. Kuyindlela yokuthola indlela yokuthumela itshe emgudwini we-bile obanzi ukuze lilandwe. Kumatshe e-bile duct e-hilar, kufanele kuqashelwe ukuthi amatshe azocindezelwa esibindini futhi awakwazi ukutholwa lapho ibhasikidi likhishwa ebhasikidini noma kwenziwa ukuhlolwa.
Kunemibandela emibili yokukhipha amatshe ebhasikidini lamatshe: eyodwa ukuthi kunesikhala esanele ngaphezu kwetshe noma eceleni kwetshe ukuvumela ibhasikidi ukuthi livuleke; enye ukugwema ukuthatha amatshe amakhulu kakhulu, noma ngabe ibhasikidi livuliwe ngokuphelele, alikwazi ukukhishwa. Siphinde sahlangana namatshe angama-3 cm asuswa ngemuva kwe-endoscopic lithotripsy, wonke okumele abe yi-lithotripsy. Kodwa-ke, lesi simo siseyingozi kakhulu futhi sidinga udokotela onolwazi ukuthi ahlinze.
Isikhathi sokuthunyelwe: Meyi-13-2022