I-ERCP Accessories-Stone Extraction Basket
Ubhasikidi wokubuyiswa kwamatshe umsizi ovame ukusetshenziswa wokubuyisa amatshe kuzisekeli ze-ERCP.Kodokotela abaningi abasanda kuthola i-ERCP, ubhasikidi wamatshe usengakhawulelwa kumqondo "wamathuluzi okucosha amatshe", futhi akwanele ukubhekana nesimo esiyinkimbinkimbi se-ERCP.Namuhla, ngizofingqa futhi ngifunde ulwazi olufanele lobhasikidi bamatshe be-ERCP ngokusekelwe kulwazi olufanele engiluxoxile.
Ukuhlukaniswa okujwayelekile
Ubhasikidi wokubuyisa amatshe uhlukaniswe waba ubhasikidi oqondiswa ngocingo, ubhasikidi ongenawo umhlahlandlela ohamba ngocingo, kanye nobhasikidi ohlanganisiwe wokubuyisa amatshe.Phakathi kwabo, obhasikidi abahlanganisiwe bokubuyisa-crush obhasikidi abajwayelekile bokubuyisa abamelelwe i-Micro-Tech kanye ne-Rapid Exchange (RX) obhasikidi ababuyiswayo abamelelwe i-Boston Scientifi.Ngenxa yokuthi ubhasikidi ohlanganisiwe wokubuyiswa kwe-crush kanye nobhasikidi oshintsha ngokushesha kubiza kakhulu kunobhasikidi abavamile, amanye amayunithi nodokotela abahlinzayo bangase banciphise ukusetshenziswa kwabo ngenxa yezinkinga zezindleko.Kodwa-ke, kungakhathaliseki ukuthi kubiza malini ukuvele uyilahle, odokotela abaningi abahlinzayo bazimisele kakhulu ukusebenzisa ubhasikidi (onocingo oluqondisayo) ukuze uhlukanise, ikakhulukazi amatshe ama-bile duct amakhudlwana.
Ngokusho kokuma kwebhasikidi, ingahlukaniswa ngokuthi "i-hexagonal", "idayimane" kanye "ne-spiral", okuyi-diamond, i-Dormia ne-spiral, okuvame ukusetshenziswa kuyo amabhasikidi e-Dormia.Obhasikidi abangenhla banezinzuzo zabo kanye nokubi, futhi badinga ukukhethwa ngokuguquguqukayo ngokuya ngesimo sangempela kanye nemikhuba yokuyisebenzisa komuntu siqu.
Ngenxa yokuthi ubhasikidi omise okwedayimane kanye nobhasikidi we-Dormia kuyisakhiwo sikabhasikidi esiguquguqukayo "esibanzi esingaphambili nesiphetho esincishisiwe", kungenza kube lula kubhasikidi ukubuyisa amatshe.Uma itshe lingakhishwa ngemva kokuba livalelekile ngenxa yokuthi itshe likhulu kakhulu, ubhasikidi ungadedelwa kahle, ukuze kugwenywe izingozi ezibangela amahloni.
Ubhasikidi ojwayelekile "wedayimane".
Obhasikidi abajwayelekile be-"hexagon-rhombus" basetshenziswa ngokweqabukela, noma kuphela kumabhasikidi okugaya amatshe.Ngenxa yesikhala esikhulu sikabhasikidi "wedayimane", kulula ukuthi amatshe amancane abaleke kubhasikidi.Ubhasikidi omise okwe-spiral unezici zokuthi "ukugqoka okulula kodwa akulula ukukuqaqa".Ukusetshenziswa kukabhasikidi omise okwe-spiral kudinga ukuqonda okugcwele kwetshe kanye nokusebenza okulinganiselwe ukugwema ukuthi itshe libhajwe ngangokunokwenzeka.
Ubhasikidi ovunguzayo
Ubhasikidi oshintshisana ngokushesha ohlanganiswe nokuchotshozwa nokuchotshozwa usetshenziswa ngesikhathi sokukhishwa kwamatshe amakhulu, okunganciphisa isikhathi sokusebenza futhi kuthuthukise izinga lokuphumelela lokuchotshozwa.Ukwengeza, uma ubhasikidi udinga ukusetshenziselwa ukuthwebula izithombe, i-ejenti yokuqhathanisa ingasuswa ngaphambili futhi iphele ngaphambi kokuba ubhasikidi ungene emgodini we-bile.
Okwesibili, inqubo yokukhiqiza
Isakhiwo esiyinhloko sikabhasikidi wamatshe sakhiwe umgogodla webhasikidi, i-sheath yangaphandle nesibambo.Ingqikithi kabhasikidi yakhiwe ngocingo lukabhasikidi (ingxubevange ye-titanium-nickel) kanye nocingo oludonsayo (304 insimbi yezokwelapha engagqwali).Ucingo lwebhasikidi luyisakhiwo esilukiwe se-alloy, esifana nesakhiwo esiboshwe sogibe, esiza ukubamba okuhlosiwe, ukuvimbela ukushelela, nokugcina ukungezwani okuphezulu futhi akulula ukuphuka.Intambo edonsayo iwucingo lwezokwelapha olukhethekile olunamandla aqinile okuqina nokuqina, ngakho-ke ngeke ngingene emininingwaneni lapha.
Iphuzu elibalulekile okufanele sikhulume ngalo yisakhiwo sokushisela phakathi kwentambo yokudonsa kanye nocingo lukabhasikidi, ucingo lukabhasikidi kanye nekhanda lensimbi likabhasikidi.Ikakhulukazi, iphuzu lokushisela phakathi kwentambo yokudonsa kanye nocingo lwebhasikidi libaluleke kakhulu.Ngokusekelwe kumklamo onjalo, izidingo zenqubo ye-welding ziphezulu kakhulu.Ubhasikidi onezinga eliphansi kancane ngeke nje wehluleke ukuchoboza itshe kodwa futhi ubangele ukuthi indawo yokushisela phakathi kwentambo edonsayo kanye nocingo lukabhasikidi lwemesh luphuke ngesikhathi sokugaywa kwamatshe ngemva kokususwa kwetshe, okuholela ekutheni ubhasikidi kanye itshe elisele ku-bile duct, nokususwa okulandelayo.Ubunzima (imvamisa bungatholwa ngobhasikidi wesibili) futhi bungadinga nokuhlinzwa.
Inqubo embi yokushisela yocingo kanye nekhanda lensimbi lobhasikidi abaningi abavamile kungabangela kalula ukuthi ubhasikidi uphuke.Nokho, obhasikidi be-Boston Scientific benze imizamo eyengeziwe mayelana nalokhu futhi baklama indlela yokuvikela ukuphepha.Okusho ukuthi, uma amatshe engakakwazi ukuphulwa ngamatshe acindezelayo aphezulu, ubhasikidi oqinisa amatshe angavikela ikhanda lensimbi ekugcineni kwebhasikidi ukuze kuqinisekiswe ukuhlanganiswa kocingo lwebhasikidi kanye nocingo oludonsayo.Ubuqotho, ngaleyo ndlela ugwema obhasikidi namatshe asele ku-bile duct.
Ngeke ngingene emininingwaneni mayelana neshubhu nesibambo sangaphandle.Ngaphezu kwalokho, abakhiqizi abahlukahlukene be-crusher bazoba nama-crushers amatshe ahlukene, futhi ngizoba nethuba lokufunda kabanzi kamuva.
Isetshenziswa kanjani
Ukususwa kwamatshe aboshiwe kuyinto enzima kakhulu.Lokhu kungase kube ukubukelwa phansi komsebenzisi kwesimo sesiguli kanye nezinsiza, noma kungase kube isici samatshe e-bile duct ngokwawo.Kunoma yikuphi, kufanele siqale sazi ukuthi singakugwema kanjani ukuboshwa, bese sazi ukuthi yini okufanele siyenze uma ukuboshwa kwenzeka.
Ukuze ugweme ukuboshwa kukabhasikidi, ibhaluni yekholomu kufanele isetshenziselwe ukunweba ukuvuleka kwengono ngaphambi kokukhipha itshe.Ezinye izindlela ezingasetshenziswa ukususa ubhasikidi oboshiwe zihlanganisa: ukusetshenziswa kwebhasikidi yesibili (ubhasikidi ukuya kubhasikidi) nokususwa ngokuhlinzwa, futhi isihloko sakamuva sibike ukuthi ingxenye (2 noma 3) yezintambo ingashiswa kusetshenziswa. I-APC.aphule, futhi akhulule ubhasikidi oboshiwe.
Okwesine, ukwelashwa kokuboshwa kukabhasikidi wamatshe
Ukusetshenziswa kwebhasikidi kuhlanganisa ikakhulukazi: ukukhethwa kwebhasikidi kanye nokuqukethwe okubili kubhasikidi ukuthatha itshe.Mayelana nokukhethwa kukabhasikidi, kuncike kakhulu ekubunjweni kukabhasikidi, ububanzi bukabhasikidi, kanye nokuthi kufanele kusetshenziswe noma kugcinwe i-lithotripsy ephuthumayo (imvamisa, isikhungo se-endoscopy silungiswa ngokujwayelekile).
Njengamanje, ubhasikidi "wedayimane" usetshenziswa njalo, okungukuthi, ubhasikidi we-Dormia.Kumhlahlandlela we-ERCP, lolu hlobo lukabhasikidi lushiwo ngokucacile esigabeni sokukhipha amatshe amatshe avamile epayipi lenyongo.Inezinga eliphezulu lempumelelo yokukhishwa kwamatshe futhi kulula ukuyisusa.Kuwumugqa wokuqala wokukhetha kokukhipha amatshe amaningi.Ngobubanzi bebhasikidi, ibhasikidi elihambisanayo kufanele likhethwe ngokusho kobukhulu betshe.Kuyaphazamisa ukusho okwengeziwe mayelana nokukhethwa kwemikhiqizo yebhasikidi, sicela ukhethe ngokuvumelana nemikhuba yakho siqu.
Amakhono okususa amatshe: Ubhasikidi ubekwe ngaphezu kwetshe, futhi itshe lihlolwa ngaphansi kokubhekwa kwe-angiographic.Yiqiniso, i-EST noma i-EPBD kufanele yenziwe ngokuhambisana nobukhulu betshe ngaphambi kokuthatha itshe.Lapho i-bile duct ilimala noma incishisiwe, kungase kungabi nendawo eyanele yokuvula ubhasikidi.Kufanele ilandwe ngokwesimo esithile.Kuyinketho yokuthola indlela yokuthumela itshe kumbhobho wenyongo ovulekile ukuze ulandwe.Ngamatshe e-hilar bile duct, kufanele kuqashelwe ukuthi amatshe azophonswa esibindini futhi awakwazi ukubuyiswa lapho ubhasikidi ukhishwa kubhasikidi noma ukuhlolwa kwenziwa.
Kunemibandela emibili yokukhipha amatshe kubhasikidi wamatshe: enye iwukuthi kunesikhala esanele ngaphezu kwetshe noma eceleni kwetshe ukuvumela ubhasikidi ukuba uvule;enye iwukugwema ukuthatha amatshe amakhulu kakhulu, ngisho noma ubhasikidi uvuliwe ngokuphelele, awukwazi ukukhishwa.Siphinde sabhekana namatshe angama-3 cm akhishwe ngemuva kwe-endoscopic lithotripsy, wonke okumele abe yi-lithotripsy.Nokho, lesi simo sisenobungozi futhi sidinga udokotela onolwazi ukuthi asihlinze.
Isikhathi sokuthumela: May-13-2022