Amatshe e-bile duct ahlukaniswe ngamatshe ajwayelekile namatshe anzima. Namuhla sizofunda ikakhulukazi ukuthi singawasusa kanjani amatshe we-bile duct okunzima ukwenzaI-ERCPP.
"Ubunzima" bamatshe anzima ikakhulukazi ngenxa yokwakheka okuyinkimbinkimbi, indawo engajwayelekile, ubunzima kanye nobungozi bokususwa. Qhathanisa neI-ERCPPOkwe-bile ductor tumors, ubungozi bulingana noma buphakeme kakhulu. Lapho uhlangabezana nobunzima nsuku zonkeI-ERCPPSebenza, sidinga ukuhlomisa izingqondo zethu ngolwazi futhi sivumele imfihlakalo yethu iguqule amakhono ethu ukubhekana nezinselelo.
Ukuhlukaniswa okungu-0
Amatshe anzima angahlukaniswa ngamaqembu amatshe, amaqembu angejwayelekile angejwayelekile, amaqembu akhethekile wesifo nabanye ngokuya ngezimbangela zabo.
① Iqembu lamatshe
Okusemqoka kufaka phakathi amatshe amakhulu we-bile duct, amatshe amaningi (amatshe aslayida), amatshe angaphakathi namatshe athintekayo, namatshe athintekile (ankimbinkimbi yi-AOSC). Zonke lezi zimo lapho kunzima ukususa amatshe futhi kudinga isexwayiso sokuqala.
· Itshe likhulu ikakhulukazi (ububanzi> 1.5 cm). Ubunzima bokuqala ekususeni itshe ukuthi itshe alikwazi ukususwa noma liphulwe yizesekeli. Ubunzima besibili ukuthi itshe alikwazi ukususwa noma liphule ngemuva kokususwa. Amatshe aphuthumayo adingekayo ngalesi sikhathi.
Ngaphandle kwamatshe amancane akufanele kuthathwe kalula. Ikakhulu amatshe amancane angashintsha kalula noma agijime esibindini, futhi kunzima ukuthola amatshe amancane, okwenza kube nzima ukwelapha ngokwelashwa kwe-endoscopic.
Amatshe agcwele amatshe agcwele ama-bile,I-ERCPPUkususwa kwamatshe kuthatha isikhathi eside futhi kulula ukuboshwa. Ukuhlinzwa kuvame ukudingeka ukususa amatshe.
Ukuhlukunyezwa Kwezimpawu
Ukuhlukunyezwa kwe-anatomical kufaka phakathi ukuhlukunyezwa kwe-bile duct, Mirrizi Syndrome, kanye nokuhlukunyezwa kwesakhiwo engxenyeni engezansi kanye nokuphuma kwe-bile duct. I-Peripapillary Diverticula nayo iyinto ejwayelekile ye-anatomic.
· Ngemuva kokuhlinzwa kwe-LC, ukwakheka kwe-bile duct kuyinto engajwayelekile futhi i-bile duct ibilisiwe. NgesikhathiI-ERCPPUkusebenza, ucingo lomhlahlandlela "kulula ukulubeka phansi kepha akulula ukulufaka" (liwe ngengozi ngemuva kokukhuphuka ekugcineni, ngakho-ke uma ucingo lwe-PROUD luphakanyiswe, ngakho-ke uma ucingo lwe-PRALIDIO luphakanyiswa, kufanele lugcinwe ukuvikela i-terle duct.
· Mirizz Syndrome ukuhlukunyezwa kwe-anatomical okuphuthelwa kalula futhi kunganakwa. Isifundo secala: Ngemuva kokuhlinzwa kwe-LC, isiguli esinamatshe e-cystic duct amatshe acindezelwe i-duct evamile ye-bile, okwenza iMirrizz Syndrome. Amatshe awakwazanga ukususwa ngaphansi kokubonwa kwe-X-ray. Ekugcineni, le nkinga yaxazululeka ngemuva kokuxilongwa kanye nokususwa ngaphansi kombono oqondile nge-eyphax.
· ForI-ERCPPI-Bile Duct Stone Ukususwa kweziguli zesisu ngemuva kokuhlinzwa kwe-BI II, ukhiye ukufinyelela ingono ngobubanzi. Kwesinye isikhathi kuthatha isikhathi eside (okudinga isimo sengqondo esiqinile) ukufinyelela ingono, futhi uma umhlahlandlela ungagcinwa kahle, ungaphuma kalula.
Izimo ze-PORTER
I-Peripapillary Diverticulum ehlanganiswe namatshe e-bile duct ajwayelekile. Ubunzima ekusebenzeni ngalesi sikhathi busengozini yokuncipha kwengono nokwanda. Le ngozi inkulu kakhulu ngezingono ngaphakathi kwe-diverticulum, futhi ubungozi bezingono eziseduze ne-diverticulum incane.
Ngalesi sikhathi, kuyadingeka futhi ukuqonda izinga lokunweba. Umgomo ojwayelekile wokunweba ukunciphisa umonakalo odingekayo ukuze ususe amatshe. Umonakalo omncane usho ubungozi obuncane. Namuhla, ukunwetshwa kwe-balloon (cre) yengono ezungeze i-dilerticula ngokuvamile kusetshenziselwa ukugwema est.
Iziguli ezinezifo ze-hematological, umsebenzi we-cardiopulmonary ongakwazi ukubekezelelaI-ERCPP, noma izifo ezihlanganyelwe ezihlanganayo ezihlangene ezingakwazi ukubekezelela ukuma kwesikhathi eside kwesobunxele kufanele zinake futhi zihlolwe lapho zihlangabezana namatshe anzima.m
02 I-Psychology yokubhekana "namatshe anzima"
Isimo sengqondo esingalungile lapho sibhekene "namatshe anzima": ukuhaha nempumelelo, ukunganaki, ukwedelelwa kwangaphambi kokusebenza, njll.
· Ukuhaha nothando ngempumelelo enkulu
Lapho ubhekene namatshe e-bile duct, ikakhulukazi labo abanamatshe amaningi, sihlala sifuna ukususa wonke amatshe. Lolu uhlobo lokuhaha "ukuhaha" nempumelelo enkulu.
Eqinisweni, kunembile ukuthatha konke futhi okumsulwa, kepha ukuthatha izindleko ezimsulwa nakho "kuhle", okungaphephile, okungaphephile futhi kuzoletha ubunzima nobunzima obuningi futhi kuzoletha ubunzima obuningi nobunzima. Amatshe amaningi we-bile amaningi kufanele anqunywe ngokuphelele ngokusekelwe esimweni sesiguli. Kumacala akhethekile, ishubhu kufanele libekwe noma lisuswe kuma-batches kuphela.
Lapho kunzima ukususa amatshe amakhulu okususa okwesikhashana, "ukuchithwa kwe-STENT" kungabhekwa. Musa ukuphoqa ukususwa kwamatshe amakhulu, futhi ungazibekezeleli esimweni esiyingozi kakhulu.
· I-RECKLELELE
Okungukuthi, ukusebenza okungaboni ngaphandle kokuhlaziywa okugcwele futhi ucwaningo luvame ukuholela ekwehlulekeni kwamatshe. Ngakho-ke, amacala amatshe e-bile duct amatshe kufanele ahlolwe ngokugcwele ngaphambi kokuhlinzwa, ahlolwe kahle (edinga amandlaI-ERCPPOdokotela ukufunda izithombe), kufanele kwenziwe izinqumo ngokucophelela izinqumo nezinhlelo eziphuthumayo ukuvimbela ukususwa kwamatshe okungalindelekile.
Le khasiI-ERCPPUhlelo lokukhishwa kwamatshe kumele lube yisayensi, inhloso, oluphelele, futhi lukwazi ukumelana nokuhlaziya nokucatshangelwa. Kufanele silandele umgomo wokukhulisa umhlomulo weziguli futhi ungabi nomphikisi.
· Ukwedelela
Amatshe amancane engxenyeni engezansi ye-bile duct kulula ukuyishaya indiva. Uma amatshe amancane ahlangabezana nezinkinga ezihlelekile engxenyeni engezansi ye-bile duct kanye nokuphuma kwayo, kuzoba nzima kakhulu ukususa itshe.
I-ERCPPUkwelashwa kwamatshe e-bile duct ahlukahlukene kanye nezingozi eziphakeme. Kunzima futhi kuyingozi njengokuphakeme noma okuphakeme kakhulu kunokubaI-ERCPPukwelashwa kwama-bile ductor. Ngakho-ke, uma ungakuthathi kalula, uzozishiya umzila ofanele wokuphunyuka.
03 ukubhekana "namatshe anzima"
Lapho uhlangabezana namatshe anzima, ukuhlolwa okuphelele kwesiguli kufanele kwenziwe, kwakhiwa ngokwanele, aIbhasikidi leRando ReastKufanele kukhethwe futhi i-lithotripter elungiselelwe, futhi uhlelo oluhlanganisiwe nohlelo lokwelashwa kufanele lwenziwe.
Njengenye indlela, izinzuzo nezingcebe kufanele zihlolwe ngokusekelwe esimweni sesiguli ngaphambi kokuqhubeka.
· Ukucubungula ukucubungula
Ubukhulu bokuvulwa bususelwa esimweni setshe eliqondiwe ne-bile duct. Ngokuvamile, incision encane + enkulu (ephakathi) isetshenziselwa ukwandisa ukuvulwa. Ngesikhathi sokubhala, kuyadingeka ukugwema ngaphandle kwangaphandle nangaphakathi ngaphakathi.
Uma ungenalwazi, kulula ukwenza ukuvela okuthi "Kukhulu ngaphandle kodwa okuncane ngaphakathi", okungukuthi, ingono ingono ibukeka inkulu ngaphandle, kepha akukho ukuvela ngaphakathi. Lokhu kuzodala ukuthi ukususwa kwamatshe kwehluleke.
Lapho wenza incision est, "umnsalo ongajulile nokukhanya kancane" kufanele kusetshenziselwe ukuvikela ukuvela kwe-zipper. Ukuvela kufanele kube ngokushesha njengokukhanya ngakunye. Ummese akufanele 'uhlasele' ngesikhathi sokuvuselelwa ukuvikela ukuphazanyiswa kwe-Ingono futhi kubangele i-pancreatitis. .
Ukuhlolwa kokuhlola kwesigaba esiphansi kanye nokuthumela ngaphandle
Amatshe we-bile duct ejwayelekile adinga ukuhlolwa kwengxenye engezansi kanye nokuphuma kwe-duct evamile ye-ntahi. Zombili lezi zindawo kumele zihlolwe. Inhlanganisela yazo zombili inquma ubungozi nobunzima benqubo ye-Nice Incion.
· Echazar Lithodripsy
Amatshe amakhulu amakhulu futhi anzima namatshe angenakuzithoba adinga ukwelashwa nge-lithotrip ephuthumayo (ephuthumayo ye-lithotripter).
Amatshe we-bile we-pigment angaphulwa ngokuyisisekelo abe yizicucu, futhi iningi lamatshe e-cholesterol kanzima angaxazululwa ngale ndlela. Uma idivaysi ingakhishwa ngemuva kokubuyisa, futhi i-lithotripter ayikwazi ukuphula amatshe, kungukuthi "ubunzima" bangempela. Ngalesi sikhathi, kungenzeka ukuthi i-Eyphax ingadingeka ukuxilonga ngokuqondile nokwelapha amatshe.
Qaphela: Ungasebenzisi i-LithoTripsy esigabeni esingezansi kanye nokuphuma kwe-duct evamile ye-ntahi. Musa ukusebenzisa i-lithodripsy egcwele ngesikhathi se-lithodripsy, kepha yishiye indawo. I-Lithodripsy ephuthumayo iyingozi. Ngesikhathi esiphuthumayo se-Lithodripsy, i-eksisi yokugcina ingahle ingahambisani ne-axis ye-bile duct, futhi ukungezwani kungahle kube kuhle kakhulu ukubangela ukuba yize.
Itshe elichithekile
Uma itshe likhulu kakhulu futhi kunzima ukususa, ungacabanga ukuqondiswa okuqinile - okungukuthi, ukubeka ipulasitiki. Linda kuze kube yilapho itshe lincipha ngaphambi kokususa itshe, khona-ke ithuba lempumelelo lizoba liphezulu kakhulu.
· Amatshe we-Intraepatic
Odokotela abasebasha abanokuhlangenwe nakho okuncane kungcono ukuthi benze ukwelashwa kwe-endoscopic kwamatshe we-intraepatic bile. Ngoba amatshe akule ndawo angeke akwazi ukubanjiswa noma angahle ajule futhi avikele ukusebenza okwengeziwe, umgwaqo uyingozi kakhulu futhi umncane.
Amatshe we-bile duct ahlanganiswe ne-reverticululum ye-peripapillary
Kuyadingeka ukuhlola ubungozi nokulindela kokunwetshwa. Ingozi yokugcwala kwe-EST iphakeme kakhulu, manje indlela yokunwetshwa kwe-balloon ekhethiwe. Usayizi wokwanda kufanele ube ngokwanele ukususa itshe. Inqubo yokwanda kufanele ihambe kancane futhi igxathu negxathu, futhi akukho ukwanda okunodlame noma ukwanda okuvunyelwe. Isirinji siyanda ngentando. Uma kukhona ukopha ngemuva kokudinwa, kudingeka ukwelashwa okufanele.
We, Jiangxi Zhuoruihui Medical Incument Co, Ltd, umenzi waseChina ochwepheshe kokudla kwe-endoscopic, njengeI-Biopsy Forceps,hemoclip,I-PolyP Snare,inaliti ye-sclerotherapy,fafaza i-catheter,ama-cytolology amabhulashi,Umhlahlandlela,I-Stone Retrieval Basket,I-Catheter ye-NASAL BILY CHATHETER njll. asetshenziswa kabanzi kuEMR,Ivi,I-ERCPP. Imikhiqizo yethu iqinisekisiwe, futhi izitshalo zethu ziqinisekisiwe ze-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi nendawo nengxenye ye-Asia, futhi zithola amakhasimende wokuqashelwa nokudumisa!
Isikhathi Sokuposa: Jul-26-2024