Ekuxilongeni nasekwelapheni izifo ze-biliary, ukuthuthukiswa kobuchwepheshe be-endoscopic kuye kwagxila ngokuqhubekayo emigomeni yokunemba okukhulu, ukuhlasela okuncane, nokuphepha okukhulu. I-Endoscopic retrograde cholangiopancreatography (ERCP), ihhashi lomsebenzi lokuxilongwa nokwelashwa kwesifo se-biliary, sekuyisikhathi eside yamukelwa kabanzi ngenxa yesimo sayo esingahlinzeki futhi esihlasela kancane. Kodwa-ke, lapho ubhekene nezilonda eziyinkimbinkimbi ze-biliary, inqubo eyodwa ngokuvamile iyahluleka. Yilapho i-percutaneous transhepatic cholangioscopy (PTCS) iba umphelelisi obalulekile we-ERCP. Le ndlela ehlanganisiwe “ye-double-scope” yeqa imikhawulo yokwelashwa kwendabuko futhi inikeza iziguli indlela entsha ngokuphelele yokuhlonza nokwelashwa.
I-ERCP ne-PTCS ngayinye inamakhono ayo ahlukile.
Ukuze uqonde amandla okusetshenziswa okuhlanganisiwe kobubanzi obukabili, umuntu kufanele aqale aqonde ngokucacile amakhono ayingqayizivele alawa mathuluzi amabili. Nakuba zombili zingamathuluzi okuxilongwa nokwelashwa kwe-biliary, zisebenzisa izindlela ezihlukene, zakha umphelelisi ophelele.
I-ERCP: Isazi se-Endoscopic Singena Epheshaneni Lokugaya
I-ERCP imele i-Endoscopic Retrograde Cholangiopancreatography. Ukusebenza kwayo kufana nendlela ezungezayo yokwenza izinto. Udokotela ufaka i-duodenoscope ngomlomo, umminzo, nesisu, ekugcineni ifike ku-duodenum eyehlayo. Udokotela uthola ukuvuleka kwamathumbu e-bile kanye ne-pancreatic ducts (i-duodenal papilla). I-catheter ibe isifakwa ngembobo ye-endoscopic biopsy. Ngemuva kokujova i-ejenti ehlukile, kwenziwa ukuhlolwa kwe-X-ray noma i-ultrasound, okuvumela ukuxilongwa okubonakalayo kwe-bile kanye ne-pancreatic ducts.
Ngalesi sisekelo,I-ERCPingakwazi futhi ukwenza uhla lwezinqubo zokwelapha: isibonelo, ukunweba imigudu ye-bile ewumngcingo ngebhaluni, ukuvula imigudu evinjiwe ngama-stents, ukususa amatshe emgudwini we-bile ngobhasikidi wokukhipha itshe, nokuthola izicubu ezigulayo zokuhlaziywa kwe-pathological kusetshenziswa i-biopsy forceps. Inzuzo yayo eyinhloko isekutheni isebenza ngokuphelele ngembobo yemvelo, iqeda isidingo sokusikwa kwendawo. Lokhu kuvumela ukululama ngokushesha ngemva kokuhlinzwa kanye nokuphazamiseka okuncane emzimbeni wesiguli. Ilungele kakhulu ukwelapha izinkinga zemigudu yenyongo eduze namathumbu, njengamatshe phakathi naphansi komgudu wenyongo ovamile, ukuqina kwemigudu yenyongo ephansi, nezilonda kumgudu we-pancreatic kanye ne-bile.
Kodwa-ke, i-ERCP iphinde ibe "nobuthakathaka" bayo: uma ukuvinjelwa kwe-bile duct kunzima futhi i-bile ayikwazi ukukhishwa kahle, i-agent ehlukile izoba nobunzima bokugcwalisa yonke i-bile duct, okuzothinta ukunemba kokuxilongwa; ngamatshe e-intrahepatic bile duct (ikakhulukazi amatshe atholakala ekujuleni kwesibindi) kanye ne-bile duct stenosis ephezulu (eduze kwesibindi i-hilum nangaphezulu), umphumela wokwelapha uvame ukuncishiswa kakhulu ngoba i-endoscope "ayikwazi ukufinyelela" noma indawo yokusebenza ilinganiselwe.
I-PTCS: Iphayona Elingenasici Linqamula Ubuso Besibindi
I-PTCS, noma i-percutaneous transhepatic choledochoscopy, isebenzisa indlela “yangaphandle,” ngokungafani nendlela “yangaphakathi-ngaphandle” ye-ERCP. Ngaphansi kokuqondisa kwe-ultrasound noma kwe-CT, udokotela ohlinzayo ubhoboza isikhumba esifubeni esingakwesokudla sesiguli noma esiswini, enqamula kahle izicubu zesibindi futhi afinyelele embotsheni enwetshiwe ye-intrahepatic, enze umhubhe wokwenziwa “wesikhumba-isibindi-bile”. Kube sekufakwa i-choledochoscope ngalo mhubhe ukuze kubhekwe ngqo i-intrahepatic bile duct ngenkathi ngesikhathi esifanayo kwenziwa ukwelapha okufana nokukhipha amatshe, i-lithotripsy, ukunwetshwa kokuqina, nokubekwa kwe-stent.
“Isikhali sokubulala” se-PTCS sisemandleni ayo okufinyelela ngokuqondile izilonda ze-intrahepatic bile duct. Ihlakaniphile ikakhulukazi ekubhekaneni "nezinkinga ezijulile" okunzima ukufinyelela kuzo nge-ERCP: isibonelo, amatshe amakhulu e-bile duct angaphezu kuka-2 cm ububanzi, "amatshe amaningi" ahlakazeke emagatsheni amaningi e-intrahepatic bile duct, ukuqina kwe-bile duct okubangelwa izimila noma ukuvuvukala, kanye nezinkinga eziyinkimbinkimbi ezifana ne-anastomotic stenosis eyenzeka ngemva kokuhlinzwa kwe-bile fibilis. Ngaphezu kwalokho, lapho iziguli zingakwazi ukuthola i-ERCP ngenxa yezizathu ezinjengokukhubazeka kwe-duodenal papillary nokuvinjelwa kwamathumbu, i-PTCS ingasebenza njengenye indlela, ikhiphe i-bile ngokushesha futhi inciphise i-jaundice, ngaleyo ndlela ithenge isikhathi sokwelashwa okulandelayo.
Kodwa-ke, i-PTCS ayiphelele: njengoba idinga ukubhoboza ebusweni bomzimba, izinkinga ezinjengokopha, ukuvuza kwenyongo, kanye nokutheleleka kungenzeka. Isikhathi sokululama sangemva kokuhlinzwa side kancane kune-ERCP, futhi ubuchwepheshe bokubhoboza bodokotela nokunemba kokuqondisa kwesithombe kuphakeme kakhulu.
Inhlanganisela Enamandla: I-Logic "Yokusebenza Okusebenzisanayo" nge-Dual-Scope Combination
Lapho "izinzuzo ze-endovascular" ze-ERCP zihlangabezana "nezinzuzo ze-percutaneous" ze-PTCS, lezi ezimbili azisanqunyelwe endleleni eyodwa, kodwa kunalokho zakha uhlaka lokuxilonga nokwelashwa "oluhlasela ngaphakathi nangaphandle komzimba." Le nhlanganisela ayikona ukungezwa okulula kobuchwepheshe, kodwa iwuhlelo lomuntu siqu lwe-“1+1>2″ oluklanyelwe isimo sesiguli. Ngokuyinhloko iqukethe amamodeli amabili: “okulandelanayo kuhlanganisiwe” “nokuhlangene ngasikhathi sinye.”
Inhlanganisela Elandelanayo: “Vula Indlela Okokuqala, Bese Ubelashwa Ngokunembayo”
Lena indlela ejwayeleke kakhulu yokuhlanganisa, elandela isimiso “sokukhipha amanzi kuqala, Ukwelapha Kamuva.” Isibonelo, ezigulini ezine-jaundice evimbela kakhulu ebangelwa amatshe e-intrahepatic bile duct, isinyathelo sokuqala ukusungula umzila we-biliary drainage ngokusebenzisa i-PTCS ukubhoboza ukukhipha i-bile eqoqiwe, ukukhulula ukucindezeleka kwesibindi, ukunciphisa ingozi yokutheleleka, futhi kancane kancane ukubuyisela ukusebenza kwesibindi sesiguli nesimo somzimba. Uma isimo sesiguli sesizinzile, i-ERCP ibe seyenziwa kusukela ohlangothini lwamathumbu ukuze kukhishwe amatshe embotsheni yenyongo evamile, kwelaphe izilonda ku-duodenal papilla, futhi kunwetshwe ngokwengeziwe ukuqina komgudu wenyongo kusetshenziswa ibhaluni noma i-stent.
Ngokuphambene, uma isiguli senza i-ERCP futhi sitholakala sinezinsalela zamatshe esibindi noma i-stenosis yezinga eliphezulu engakwazi ukwelashwa, i-PTCS ingasetshenziswa ukuqedela "umsebenzi wokuqeda" kamuva. Lo modeli unikeza inzuzo "yendlela yesinyathelo ngesinyathelo enezingozi ezilawulekayo," okwenza ifaneleke ikakhulukazi iziguli ezinezimo eziyinkimbinkimbi nezimo zempilo ezivele zikhona ngaphambili.
Ukusebenza Okuhlanganisiwe Ngasikhathi sinye: “Ukusebenza Okukabili Ngasikhathi sinye,
I-Single-Stop Solution”
Ezigulini ezinokuxilongwa okucacile nokubekezelelana okuhle ngokomzimba, odokotela bangase bakhethe inqubo "ehlangene ngesikhathi esisodwa". Ngesikhathi sokuhlinzwa okufanayo, amaqembu e-ERCP nawe-PTCS asebenza ndawonye. Udokotela ohlinzayo we-ERCP usebenzisa i-endoscope esuka ohlangothini lwamathumbu, evula i-duodenal papilla futhi abeke i-guidewire. Udokotela ohlinzayo we-PTCS, eholwa ngokuthwebula izithombe, ubhoboza isibindi futhi asebenzise i-choledochoscope ukuze athole i-guidewire ebekwe yi-ERCP, azuze ukuqondana okunembayo “kwemigudu yangaphakathi neyangaphandle.” La maqembu womabili abe esesebenzisana ukwenza i-lithotripsy, ukususa amatshe, nokubeka ama-stent.
Inzuzo enkulu yale modeli ukuthi ibhekana nezinkinga eziningi ngenqubo eyodwa, isusa isidingo sezinzwa eziningi nokuhlinzwa, okufinyeza kakhulu umjikelezo wokwelapha. Isibonelo, ezigulini ezinawo womabili amatshe e-intrahepatic bile duct kanye namatshe ajwayelekile e-bile duct, i-PTCS ingasetshenziswa ngesikhathi esisodwa ukusula amatshe e-intrahepatic kanye ne-ERCP ukubhekana namatshe avamile we-bile duct, kuqedwe isidingo sokuthi iziguli zithole imizuliswano eminingi ye-anesthesia nokuhlinzwa, ukuthuthukisa kakhulu ukusebenza kahle kokwelashwa.
Isimo Esisebenzayo: Yiziphi Iziguli Ezidinga Inhlanganisela Ye-Double-Scope?
Akuzona zonke izifo ze-biliary ezidinga isithombe esihlanganisiwe se-double-scope. Ukuthwebula okuhlanganisiwe kobubanzi obukabili kulungele ngokuyinhloko amacala ayinkimbinkimbi angakwazi ukusingathwa ngendlela eyodwa, okuhlanganisa kakhulu lokhu okulandelayo:
Amatshe ayinkimbinkimbi we-bile duct: Lesi yisimo esiyinhloko sokusetshenziswa kwe-CT ehlanganisiwe ene-double-scope. Isibonelo, iziguli ezinawo womabili amatshe e-intrahepatic bile duct (ikakhulukazi lawo atholakala ezindaweni ezikude njenge-left lateral lobe noma i-posterior lobe yesibindi kwesokudla) kanye namatshe avamile we-bile duct; iziguli ezinamatshe aqinile angaphezu kuka-2 cm ububanzi angakwazi ukususwa yi-ERCP kuphela; kanye neziguli ezinamatshe afakwe emiseleni yenyongo emincane, evimbela ukudlula kwamathuluzi e-ERCP. Isebenzisa i-CTCS ehlanganisiwe ene-double-scope, i-CTCS "ibhidliza" amatshe amakhulu futhi isusa amatshe amagatsha ngaphakathi kwesibindi, kuyilapho i-ERCP "isula" imigudu engezansi emathunjini ukuze ivimbele amatshe asele, ifinyelele "imvume ephelele yamatshe."
Izinga eliphezulu lokuqina kwemigudu yenyongo: Uma ukuqina kwemigudu yenyongo kutholakala ngaphezu kwe-hepatic hilum (lapho kuhlangana khona imigudu yesibindi kwesokunxele nesokudla), kunzima ukufinyelela ama-endoscope e-ERCP, okwenza kube nzima ukuhlola ngokunembile ukuqina kanye nembangela ye-stricture. Kulezi zimo, i-PTCS ivumela ukubonwa okuqondile kwe-stricture ngokusebenzisa iziteshi ze-intrahepatic, okuvumela ama-biopsies ukuthi aqinisekise imvelo yesilonda (njengokuvuvukala noma isimila) ngenkathi ngesikhathi esifanayo yenza ukunwetshwa kwebhaluni noma ukubekwa kwe-stent. I-ERCP, ngakolunye uhlangothi, ivumela ukubekwa kwe-stent ngezansi, esebenza njenge-relay ye-stent ye-PTCS, iqinisekisa ukugeleza okungavimbeki kwawo wonke umgudu we-bile.
Izinkinga ze-postoperative yokuhlinzwa kwe-biliary: I-Anastomotic stenosis, i-bile fistula, namatshe ayinsalela angase avele ngemva kokuhlinzwa kwe-biliary. Uma isiguli sinokunamathela okunzima emathunjini ngemva kokuhlinzwa futhi i-ERCP ingenakwenzeka, i-PTCS ingasetshenziselwa ukukhipha nokwelashwa. Uma i-anastomotic stenosis iphezulu futhi i-ERCP ingakwazi ukunwebeka ngokugcwele, i-PTCS ingahlanganiswa nokunwetshwa kwamazwe amabili ukuze kuthuthukiswe izinga lokuphumelela lokwelashwa.
Iziguli ezingakwazi ukubekezelela ukuhlinzwa okukodwa: Isibonelo, iziguli esezikhulile noma iziguli ezinezifo ezinzima ze-cardiopulmonary azikwazi ukumelana nokuhlinzwa okukodwa okude. Inhlanganisela yezibuko ezikabili ingahlukanisa ukusebenza okuyinkimbinkimbi kube "okungajwayelekile + okuncane kakhulu", ukunciphisa izingozi zokuhlinzwa kanye nomthwalo ongokwenyama.
I-future Outlook: “Indlela Yokuthuthukisa” Yenhlanganisela Ye-Dual-Scope
Ngokuthuthuka kwezobuchwepheshe, inhlanganisela ye-ERCP ne-PTCS iyaqhubeka nokuvela. Ngakolunye uhlangothi, ukuthuthuka kobuchwepheshe bezithombe kunika amandla ama-puncture nezinqubo ezinembe kakhudlwana. Isibonelo, inhlanganisela ye-intraoperative endoscopic ultrasound (EUS) ne-PTCS ingakwazi ukubona ngeso lengqondo isakhiwo sangaphakathi se-bile duct ngesikhathi sangempela, ukunciphisa izinkinga zokubhoboza. Ngakolunye uhlangothi, izinto ezintsha ezisetshenziswayo zenza ukwelashwa kusebenze kangcono. Isibonelo, ama-choledochoscopes aguquguqukayo, ama-lithotripsy probe ahlala isikhathi eside, nama-bioresorbable stents anika amandla inhlanganisela ye-dual-scope ukubhekana nezilonda eziyinkimbinkimbi.
Ngaphezu kwalokho, "i-robot-assist dual-scope ehlangene" ivele njengendlela entsha yocwaningo: ngokusebenzisa amasistimu we-robotic ukulawula ama-endoscopes nezinsimbi zokubhoboza, odokotela bangenza izinqubo ezibucayi endaweni enethezekile, bathuthukise ukunemba nokuphepha kokuhlinzwa. Esikhathini esizayo, ngokwanda kokwamukelwa kokubambisana kwe-multidisciplinary (MDT), i-ERCP ne-PTCS izophinde ihlanganiswe ne-laparoscopy kanye nemithi yokwelapha yokungenelela, inikeze ukuxilongwa komuntu siqu kanye nekhwalithi ephezulu kanye nezinketho zokwelashwa kweziguli ezinezifo ze-biliary.
Inhlanganisela ye-double-scope ye-ERCP ne-PTCS yephula imikhawulo yendlela eyodwa yokuxilongwa nokwelashwa kwe-biliary, ukubhekana nezifo eziningi eziyinkimbinkimbi ze-biliary ngendlela engavamile futhi enembile. Ukusebenzisana kwaleli “duo elinekhono” akubonisi nje kuphela intuthuko yobuchwepheshe bezokwelapha kodwa kuhlanganisa nendlela egxile esigulini yokuxilongwa nokwelashwa. Iguqula lokho okwake kwadinga i-laparotomy enkulu ibe yimithi yokwelapha ehlasela kancane enokuhlukumezeka okuncane kanye nokululama ngokushesha, okuvumela iziguli eziningi ukuthi zinqobe izifo zazo kuyilapho zigcina izinga eliphezulu lempilo. Sikholelwa ukuthi ngokuthuthuka okuqhubekayo kwezobuchwepheshe, inhlanganisela ye-dual-scope izovula amakhono engeziwe, ilethe amathuba amasha ekuxilongweni nasekwelapheni izifo ze-biliary.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., singumkhiqizi wase-China ogxile ezintweni ezisetshenziswayo ze-endoscopic, sifaka ulayini we-GI njengokuthii-biopsy forceps, i-hemoclip, polyp ugibe, inaliti ye-sclerotherapy, fafaza i-catheter, amabhulashi e-cytology, guidewire, ubhasikidi wokubuyisa amatshe, i-catheter ye-nasal biliary drainage, futhiI-Sphincterotome njll. ezisetshenziswa kakhulu kuI-EMR, ESD, I-ERCP.
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Isikhathi sokuthumela: Nov-14-2025