Ekuxilongweni nasekwelapheni izifo zenyongo, ukuthuthukiswa kobuchwepheshe be-endoscopic kuye kwagxila njalo emigomweni yokunemba okukhulu, ukungenelela okuncane, kanye nokuphepha okukhulu. I-Endoscopic retrograde cholangiopancreatography (ERCP), ihhashi elisebenzayo lokuxilonga nokwelapha izifo zenyongo, sekuyisikhathi eside lamukelwa kabanzi ngenxa yokungabi nokuhlinzwa kanye nokungena kwayo kakhulu. Kodwa-ke, lapho ibhekene nezilonda zenyongo eziyinkimbinkimbi, inqubo eyodwa ivame ukwehluleka. Yilapho i-percutaneous transhepatic cholangioscopy (PTCS) iba khona ukwengeza okubalulekile ku-ERCP. Le ndlela ehlanganisiwe "ye-dual-scope" idlula imikhawulo yokwelashwa kwendabuko futhi inikeza iziguli inketho entsha yokuxilonga nokwelapha.
I-ERCP kanye ne-PTCS ngayinye inamakhono ayo ahlukile.
Ukuze uqonde amandla okusetshenziswa okuhlangene kwe-dual-scope, umuntu kumele aqale aqonde ngokucacile amakhono ahlukile alezi zinsimbi ezimbili. Nakuba zombili zingamathuluzi okuxilonga nokwelapha i-biliary, zisebenzisa izindlela ezihlukile, zakha ukuhambisana okuphelele.
I-ERCP: Ubuchwepheshe be-Endoscopic obungena endleleni yokugaya ukudla
I-ERCP imele i-Endoscopic Retrograde Cholangiopancreatography. Ukusebenza kwayo kufana nendlela ejikelezayo yokwenza izinto. Udokotela ufaka i-duodenoscope ngomlomo, emhubheni, nasesiswini, ekugcineni afinyelele e-duodenum ehlayo. Udokotela uthola izikhala zamathumbu ze-bile kanye ne-pancreatic ducts (i-duodenal papilla). I-catheter ibe isifakwa nge-endoscopic biopsy port. Ngemva kokujova i-contrast agent, kwenziwa ukuhlolwa kwe-X-ray noma kwe-ultrasound, okuvumela ukuxilongwa okubonakalayo kwe-bile kanye ne-pancreatic ducts.
Ngalesi sisekelo,I-ERCPIngenza nezinqubo zokwelapha ezahlukahlukene: isibonelo, ukukhulisa imigudu ye-bile encishisiwe ngebhaluni, ukuvula imigudu evalekile ene-stents, ukususa amatshe emgudwini we-bile ngebhasikidi lokususa itshe, kanye nokuthola izicubu ezigulayo ukuze kuhlaziywe nge-pathological besebenzisa i-biopsy forceps. Inzuzo yayo eyinhloko itholakala eqinisweni lokuthi isebenza ngokuphelele ngomgodi wemvelo, isusa isidingo sokusikwa kobuso. Lokhu kuvumela ukululama okusheshayo ngemva kokuhlinzwa kanye nokuphazamiseka okuncane emzimbeni wesiguli. Ifaneleka kakhulu ekwelapheni izinkinga zemigudu ye-bile eduze kwamathumbu, njengamatshe emgudwini we-bile ophakathi nendawo ophansi, ukuqina kwemigudu ye-bile ephansi, kanye nezilonda emgudwini we-pancreatic kanye ne-bile duct.
Kodwa-ke, i-ERCP nayo "inobuthakathaka" bayo: uma ukuvinjelwa kwe-bile duct kukhulu futhi i-bile ingakwazi ukukhishwa kahle, i-contrast agent izoba nobunzima bokugcwalisa yonke i-bile duct, okuzothinta ukunemba kokuxilongwa; ngamatshe e-bile duct angaphakathi kwesibindi (ikakhulukazi amatshe atholakala ekujuleni kwesibindi) kanye ne-bile duct stenosis ephezulu (eduze kwe-hilum yesibindi nangaphezulu), umphumela wokwelashwa uvame ukwehla kakhulu ngoba i-endoscope "ayikwazi ukufinyelela" noma indawo yokusebenza ilinganiselwe.
I-PTCS: I-Percutaneous Pioneer Edabula Ubuso Besibindi
I-PTCS, noma i-percutaneous transhepatic choledochoscopy, isebenzisa indlela "yangaphandle-ngaphakathi", ngokungafani nendlela "yangaphakathi-ngaphandle" ye-ERCP. Ngaphansi kwesiqondiso se-ultrasound noma se-CT, udokotela ohlinzayo ubhoboza isikhumba esifubeni noma esiswini sesiguli sokunene, edlula ngqo ezicutshini zesibindi futhi efinyelela emgudwini we-bile duct ovulekile, edala umhubhe wokwenziwa "we-skin-liver-bile duct". I-choledochoscope ibe isifakwa ngalo mhubhe ukuze ibone ngqo umhubhe we-bile duct wangaphakathi kwesibindi ngenkathi ngesikhathi esifanayo yenza ukwelashwa okufana nokususwa kwamatshe, i-lithotripsy, ukwandiswa kwezicucu, kanye nokubekwa kwe-stent.
“Isikhali esibulalayo” se-PTCS sisekukwazini kwayo ukufinyelela ngqo izilonda ze-bile duct ngaphakathi kwesibindi. Inekhono elikhulu ekubhekaneni “nezinkinga ezijulile” okunzima ukuzifinyelela nge-ERCP: isibonelo, amatshe amakhulu e-bile duct angaphezu kuka-2 cm ububanzi, “amatshe amaningi” asakazeke emagatsheni amaningi e-bile duct ngaphakathi kwesibindi, ukuqina kwe-bile duct okubekwe phezulu okubangelwa izimila noma ukuvuvukala, kanye nezinkinga eziyinkimbinkimbi ezifana ne-anastomotic stenosis kanye ne-bile fistula ezenzeka ngemva kokuhlinzwa kwe-bile. Ngaphezu kwalokho, lapho iziguli zingakwazi ukwenza i-ERCP ngenxa yezizathu ezifana nokukhubazeka kwe-duodenal papillary kanye nokuvinjelwa kwamathumbu, i-PTCS ingasebenza njengenye indlela, ikhipha i-bile ngokushesha futhi inciphise i-jaundice, ngaleyo ndlela ithenge isikhathi sokwelashwa okulandelayo.
Kodwa-ke, i-PTCS ayiphelele: njengoba idinga ukubhobozwa ebusweni bomzimba, izinkinga ezifana nokopha, ukuvuza kwenyongo, kanye nokutheleleka zingase zenzeke. Isikhathi sokululama ngemva kokuhlinzwa side kancane kune-ERCP, futhi ubuchwepheshe bukadokotela bokubhoboza kanye nokunemba kwesiqondiso sesithombe kuphezulu kakhulu.
Inhlanganisela Enamandla: I-Logic ye-"Synergistic Operation" ne-Dual-Scope Combination
Uma “izinzuzo ze-endovascular” ze-ERCP zihlangabezana “nezinzuzo ze-percutaneous” ze-PTCS, lokhu kokubili akusagcini endleleni eyodwa, kodwa kunalokho kwakha uhlaka lokuxilonga nokwelapha “oluthinta kokubili ngaphakathi nangaphandle komzimba.” Lokhu kuhlanganiswa akulona ukwengeza okulula kobuchwepheshe, kodwa kunalokho uhlelo “olwenzelwe wena” “1+1>2” oluqondiswe esimweni sesiguli. Ngokuyinhloko luqukethe amamodeli amabili: “okuhlanganisiwe ngokulandelana” kanye “nokuhlanganisiwe ngasikhathi sinye.”
Inhlanganisela Elandelanayo: “Vula Indlela Kuqala, Bese Ukwelashwa Okunembile”
Lena indlela evame kakhulu yokuhlanganisa, ngokuvamile elandela isimiso esithi “ukukhipha amanzi kuqala, ukwelashwa kamuva.” Isibonelo, ezigulini ezine-jaundice evimbelayo ebangelwa amatshe e-bile duct angaphakathi kwesibindi, isinyathelo sokuqala ukusungula umzila wokukhipha amanzi e-bile ngokusebenzisa i-PTCS puncture ukuze kukhishwe i-bile eqongelelekile, kuncishiswe ukucindezeleka kwesibindi, kuncishiswe ingozi yokutheleleka, futhi kubuyiselwe kancane kancane ukusebenza kwesibindi sesiguli kanye nesimo somzimba. Uma isimo sesiguli sesizinzile, i-ERCP yenziwa kusukela ohlangothini lwamathumbu ukuze kususwe amatshe e-bile duct engezansi, kwelashwe izilonda ku-duodenal papilla, futhi kwandiswe kakhulu ukuqina kwe-bile duct kusetshenziswa ibhaluni noma i-stent.
Ngakolunye uhlangothi, uma isiguli sithola i-ERCP futhi kutholakale ukuthi sinamatshe esibindi asele noma i-stenosis ephezulu engelapheki, i-PTCS ingasetshenziswa ukuqedela "umsebenzi wokuqeda" kamuva. Lo modeli unikeza inzuzo "yendlela yesinyathelo ngesinyathelo enezingozi ezingalawuleki," okwenza ifaneleke kakhulu ezigulini ezinezimo eziyinkimbinkimbi nezimo zempilo ezikhona ngaphambilini.
Ukusebenza Okuhlanganisiwe Ngesikhathi Esifanayo: “Ukusebenza Kwe-Dual-scope Ngesikhathi Esifanayo,
Isixazululo Sokuma Kodwa”
Ezigulini ezinezifo ezicacile kanye nokubekezelelana okuhle ngokomzimba, odokotela bangakhetha inqubo "ehlanganisiwe ngesikhathi esisodwa". Ngesikhathi sokuhlinzwa okufanayo, amaqembu e-ERCP kanye ne-PTCS asebenza ndawonye. Udokotela ohlinzayo we-ERCP usebenzisa i-endoscope ohlangothini lwamathumbu, evula i-duodenal papilla bese ebeka ucingo lokuqondisa. Udokotela ohlinzayo we-PTCS, eqondiswa yi-imaging, ubhoboza isibindi futhi asebenzise i-choledochoscope ukuthola ucingo lokuqondisa olubekwe yi-ERCP, efinyelela ukuhambisana okunembile "kweziteshi zangaphakathi nezangaphandle." Amaqembu amabili abe esebambisana ukwenza i-lithotripsy, ukususa amatshe, kanye nokubeka i-stent.
Inzuzo enkulu yalolu hlobo ukuthi lubhekana nezinkinga eziningi ngenqubo eyodwa, luqeda isidingo sokubulala izinzwa eziningi kanye nokuhlinzwa, lufinyeze kakhulu umjikelezo wokwelashwa. Isibonelo, ezigulini ezinamatshe e-bile duct intrahepatic kanye namatshe e-common bile duct, i-PTCS ingasetshenziswa ngesikhathi esisodwa ukususa amatshe e-intrahepatic kanye ne-ERCP ukubhekana namatshe e-common bile duct, kuqedwe isidingo sokuba iziguli zenze izivivinyo eziningi zokubulala izinzwa kanye nokuhlinzwa, okuthuthukisa kakhulu ukusebenza kahle kokwelashwa.
Isimo Esisebenzayo: Yiziphi Iziguli Ezidinga Ukuhlanganiswa Okubili?
Akuzona zonke izifo zenyongo ezidinga ukuthwebula izithombe ezihlanganisiwe ze-dual-scope. Ukuthwebula izithombe ezihlanganisiwe ze-dual-scope kufaneleka kakhulu ezimweni eziyinkimbinkimbi ezingenakuxazululwa ngendlela eyodwa, ikakhulukazi okuhlanganisa okulandelayo:
Amatshe e-bile duct ayinkimbinkimbi: Lesi yisimo esiyinhloko sokusetshenziswa kwe-CT ehlanganisiwe ye-dual-scope. Isibonelo, iziguli ezinamatshe e-bile duct angaphakathi kwesibindi (ikakhulukazi lawo atholakala ezindaweni ezikude njenge-left lateral lobe noma i-right posterior lobe yesibindi) kanye namatshe e-bile duct avamile; iziguli ezinamatshe aqinile angaphezu kuka-2 cm ububanzi angenakususwa yi-ERCP yodwa; kanye neziguli ezinamatshe afakwe emigudwini ye-bile emincane, okuvimbela ukudlula kwezinsimbi ze-ERCP. Isebenzisa i-CTCS ehlanganisiwe ye-dual-scope, i-CTCS "iphula" amatshe amakhulu futhi isuse amatshe aqhamuka esibindini, kuyilapho i-ERCP "isula" izindlela ezingezansi ezivela emathunjini ukuze ivimbele amatshe asele, ifinyelele "ekususweni kwamatshe okuphelele."
Ukuqina kwe-bile duct ephezulu: Uma ukuqina kwe-bile duct kutholakala ngaphezu kwe-hepatic hilum (lapho kuhlangana khona i-hepatic ducts yesobunxele nesokudla), ama-endoscope e-ERCP kunzima ukuwafinyelela, okwenza kube nzima ukuhlola ngokunembile ubukhali kanye nembangela yokuqina. Kulezi zimo, i-PTCS ivumela ukubona ngqo ukuqina ngeziteshi zangaphakathi kwesibindi, okuvumela ama-biopsies ukuqinisekisa uhlobo lwesilonda (njengokuvuvukala noma isimila) ngesikhathi esifanayo enza ukunwebeka kwebhaluni noma ukubeka i-stent. I-ERCP, ngakolunye uhlangothi, ivumela ukubekwa kwe-stent ngezansi, esebenza njenge-relay ye-PTCS stent, iqinisekisa ukuphuma kwamanzi kwe-bile duct yonke ngaphandle kokuphazamiseka.
Izinkinga zokuhlinzwa kwe-biliary ngemva kokuhlinzwa: I-anastomotic stenosis, i-bile fistula, kanye namatshe asele angase avele ngemva kokuhlinzwa kwe-biliary. Uma isiguli sinamatheli aqinile emathunjini ngemva kokuhlinzwa futhi i-ERCP ingenzeki, i-PTCS ingasetshenziswa ukukhipha amanzi nokwelapha. Uma i-anastomotic stenosis iphezulu futhi i-ERCP ingakwazi ukukhulisa ngokugcwele, i-PTCS ingahlanganiswa nokukhulisa ama-bilateral ukuze kuthuthukiswe izinga lempumelelo lokwelashwa.
Iziguli ezingakwazi ukubekezelela ukuhlinzwa okukodwa: Isibonelo, iziguli esezikhulile noma iziguli ezinezifo ezinzima zenhliziyo namaphaphu azikwazi ukumelana nokuhlinzwa okukodwa okude. Ukuhlanganiswa kwezibuko ezimbili kungahlukanisa ukuhlinzwa okuyinkimbinkimbi kube "okungenangozi kakhulu + okungenangozi kakhulu", kunciphisa izingozi zokuhlinzwa kanye nomthwalo ongokomzimba.
Umbono Wesikhathi Esizayo: "Isiqondiso Sokuthuthukisa" Sokuhlanganiswa Kwe-Dual-Scope
Ngokuthuthuka kwezobuchwepheshe, inhlanganisela ye-ERCP kanye ne-PTCS iyaqhubeka nokukhula. Ngakolunye uhlangothi, intuthuko kwezobuchwepheshe bokuthwebula izithombe ivumela ukubhoboza nezinqubo ezinembile kakhulu. Isibonelo, inhlanganisela ye-intraoperative endoscopic ultrasound (EUS) kanye ne-PTCS ingabona ngeso lengqondo isakhiwo sangaphakathi se-bile duct ngesikhathi sangempela, kunciphisa izinkinga zokubhoboza. Ngakolunye uhlangothi, ukusungula izinto ezintsha ezinsimbini kwenza ukwelashwa kube ngcono kakhulu. Isibonelo, ama-choledochoscope aguquguqukayo, ama-lithotripsy probes ahlala isikhathi eside, kanye nama-bioresorbable stents kuvumela inhlanganisela ye-dual-scope ukubhekana nezilonda eziyinkimbinkimbi kakhulu.
Ngaphezu kwalokho, "i-robot-assisted dual-scope combined" ivele njengesiqondiso esisha socwaningo: ngokusebenzisa izinhlelo ze-robotic ukulawula ama-endoscope kanye nezinsimbi zokubhoboza, odokotela bangenza izinqubo ezibucayi endaweni ekhululekile, okuzothuthukisa ukunemba nokuphepha kokuhlinzwa. Esikhathini esizayo, ngokwamukelwa okwandayo kokubambisana kwemikhakha eminingi (MDT), i-ERCP kanye ne-PTCS zizohlanganiswa kakhulu ne-laparoscopy kanye nokwelashwa okungenelelayo, okuhlinzeka ngezinketho zokuxilongwa ezenzelwe wena kanye nekhwalithi ephezulu kanye nezinketho zokwelapha iziguli ezinezifo ze-biliary.
Inhlanganisela ye-ERCP kanye ne-PTCS enezici ezimbili iphula imikhawulo yendlela eyodwa yokuxilonga nokwelapha i-biliary, ibhekana nezifo eziningi eziyinkimbinkimbi ze-biliary ngendlela engangenisi kakhulu futhi enembile. Ukubambisana kwale "two enekhono" akubonisi nje kuphela intuthuko yobuchwepheshe bezokwelapha kodwa futhi kuhlanganisa indlela yokuxilonga nokwelapha egxile esigulini. Iguqula lokho okwakudinga i-laparotomy enkulu kube ukwelashwa okungangenisi kakhulu okunokuhlukumezeka okuncane kanye nokululama okusheshayo, okuvumela iziguli eziningi ukuba zinqobe izifo zazo ngenkathi zigcina impilo yazo isezingeni eliphezulu. Sikholelwa ukuthi ngokuqhubeka kwentuthuko kwezobuchwepheshe, inhlanganisela ye-billion-scope izovula amakhono engeziwe, ilethe amathuba amasha ekuxilongweni nasekwelapheni izifo ze-biliary.
Thina, iJiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumkhiqizi eShayina ogxile ezintweni ezisetshenziswayo ze-endoscopic, sifaka umugqa we-GI ofana noi-biopsy forceps, i-hemoclip, ugibe lwe-polyp, inaliti ye-sclerotherapy, i-catheter yokufafaza, amabhulashi e-cytology, ucingo lokuqondisa, ubhasikidi wokuthola amatshe, i-catheter yokukhipha amanzi ekhaleni, futhiI-Sphincterotome njll.ezisetshenziswa kabanzi ku-I-EMR, I-ESD, I-ERCP.
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Isikhathi sokuthunyelwe: Novemba-14-2025