Amatshe e-bile duct ahlukaniswe ngamatshe ajwayelekile kanye namatshe anzima. Namuhla sizofunda kakhulu ukuthi singawasusa kanjani amatshe e-bile duct okunzima ukuwasebenzisa.I-ERCP.
"Ubunzima" bamatshe anzima bubangelwa kakhulu ukuma kwawo okuyinkimbinkimbi, indawo engavamile, ubunzima kanye nengozi yokususwa. Uma kuqhathaniswaI-ERCPngezimila ze-bile duct, ingozi ilingana noma iphakeme kakhulu. Uma ubhekene nobunzima nsuku zonkeI-ERCPsisebenza, sidinga ukuhlomisa izingqondo zethu ngolwazi futhi sivumele indlela yethu yokucabanga iguqule amakhono ethu ukuze sibhekane nezinselele.
01 Ukuhlukaniswa kwemvelaphi "kwamatshe anzima"
Amatshe aqinile angahlukaniswa ngamaqembu amatshe, amaqembu okungajwayelekile komzimba, amaqembu ezifo ezikhethekile kanye namanye ngokusekelwe ezimbangela zawo.
① Iqembu lamatshe
Eziyinhloko zifaka phakathi amatshe amakhulu e-bile duct, amatshe amaningi (amatshe aqinile), amatshe angaphakathi kwesibindi, kanye namatshe athintekile (ayinkimbinkimbi yi-AOSC). Lezi yizimo lapho kunzima ukususa amatshe futhi kudinga isixwayiso kusenesikhathi.
·Itshe likhulu kakhulu (ububanzi >1.5 cm). Ubunzima bokuqala ekususeni itshe ukuthi itshe alikwazi ukususwa noma ukuphulwa yizinto ezisetshenziswayo. Ubunzima besibili ukuthi itshe alikwazi ukususwa noma ukuphulwa ngemva kokususwa. Kudingeka i-gravel ephuthumayo ngalesi sikhathi.
· Amatshe amancane kakhulu akufanele athathwe kalula. Ikakhulukazi amatshe amancane angagudluka noma agijimele esibindini kalula, kanti amatshe amancane kunzima ukuwathola nokuwamboza, okwenza kube nzima ukuwaphatha ngokwelashwa nge-endoscopic.
·Ngamatshe agcwele imisele yenyongo evamile,I-ERCPUkususwa kwamatshe kuthatha isikhathi eside kakhulu futhi kulula ukuboshwa. Ngokuvamile kudingeka ukuhlinzwa ukuze kususwe amatshe.
②Ukukhubazeka komzimba
Ukukhubazeka kokwakheka komzimba kufaka phakathi ukuphambuka komgudu we-bile, i-Mirrizi syndrome, kanye nokukhubazeka kwesakhiwo engxenyeni engezansi kanye nokuphuma komgudu we-bile. I-Peripapillary diverticula nayo iyisimo esingavamile sokwakheka komzimba esivamile.
Ngemva kokuhlinzwa kwe-LC, isakhiwo se-bile duct asivamile futhi i-bile duct iyasonteka.I-ERCPUma isetshenziswa, ucingo oluqondisayo "kulula ukulubeka phansi kodwa akulula ukulufaka" (luyawa ngengozi ngemva kokwenyuka ekugcineni), ngakho-ke uma ucingo oluqondisayo selubekwe, kumele lugcinwe ukuze kuvinjelwe ukuthi ucingo oluqondisayo luwe ngaphandle komsele wenyongo.
·I-Mirizz syndrome iwukukhubazeka komzimba okungatholakali kalula futhi kunganakwa. Ucwaningo lwecala: Ngemva kokuhlinzwa kwe-LC, isiguli esinamatshe e-cystic duct sacindezela i-common bile duct, okwabangela i-Mirrizz syndrome. Amatshe awakwazanga ukususwa ngaphansi kokubhekwa kwe-X-ray. Ekugcineni, inkinga yaxazululwa ngemva kokuxilongwa nokususwa ngaphansi kokubona ngqo nge-eyeMAX.
·NgenxaI-ERCPUkususwa kwamatshe e-bile duct ezigulini zesisu ngemuva kokuhlinzwa kwe-Bi II, isihluthulelo ukufinyelela ingono nge-scope. Ngezinye izikhathi kuthatha isikhathi eside (okudinga ingqondo eqinile) ukufinyelela ingono, futhi uma ucingo oluqondisayo lungagcinwanga kahle, lungaphuma kalula.
③Ezinye izimo
I-peripapillary diverticulum ehlanganiswe namatshe e-bile duct ivame kakhulu. Ubunzima bokuhlinzwa ngalesi sikhathi ingozi yokusikwa kwe-nipple kanye nokukhula kwayo. Le ngozi inkulu kakhulu kuma-nipple ngaphakathi kwe-diverticulum, kanti ingozi yama-nipple eduze kwe-diverticulum incane.
Ngalesi sikhathi, kubalulekile futhi ukuqonda izinga lokukhula. Isimiso esijwayelekile sokukhulisa ukunciphisa umonakalo odingekayo ukuze kususwe amatshe. Umonakalo omncane usho izingozi ezincane. Namuhla, ukwanda kwebhaluni (CRE) kwe-nipple ezungeze i-diverticula kuvame ukusetshenziswa ukugwema i-EST.
Iziguli ezinezifo zegazi, ukusebenza kwenhliziyo namaphaphu ezingakwazi ukubekezelelaI-ERCP, noma izifo zamalunga omgogodla ezingakwazi ukubekezelela ukuma kwesobunxele isikhathi eside kufanele zinakwe futhi zihlolwe lapho zibhekene namatshe anzima.
02 Ingqondo yokubhekana "namatshe anzima"
Umqondo ongalungile lapho ubhekene "namatshe anzima": ukuhaha nempumelelo, ukunganaki, ukwedelela ngaphambi kokuhlinzwa, njll.
·Ubugovu nothando lwempumelelo enkulu
Uma sibhekene namatshe e-bile duct, ikakhulukazi lawo anamatshe amaningi, sifuna njalo ukususa wonke amatshe. Lolu uhlobo "lobugovu" nempumelelo enkulu.
Eqinisweni, kulungile ukuthatha yonke into kanye nehlanzekile, kodwa ukuthatha okuhlanzekile ngazo zonke izindleko "kulungile kakhulu", okuyinto engaphephile futhi ezoletha ubunzima nobunzima obuningi. Amatshe amaningi e-bile duct kufanele anqunywe ngokuphelele ngokusekelwe esimweni sesiguli. Ezimweni ezikhethekile, ithubhu kufanele ibekwe noma isuswe kuphela ngamaqoqo.
Uma amatshe amakhulu e-bile duct kunzima ukuwasusa okwesikhashana, "ukuncibilika kwe-stent" kungacatshangwa. Ungaphoqi ukususwa kwamatshe amakhulu, futhi ungazifaki esimweni esiyingozi kakhulu.
·ukunganaki
Okusho ukuthi, ukuhlinzwa okungaboni ngaphandle kokuhlaziywa okuphelele nocwaningo kuvame ukuholela ekuhlulekeni kokususwa kwamatshe. Ngakho-ke, amacala amatshe e-bile duct kufanele ahlolwe ngokugcwele ngaphambi kokuhlinzwa, ahlolwe ngobuqotho (kudinga ikhonoI-ERCPodokotela ukuze bafunde izithombe), kufanele kwenziwe izinqumo ngokucophelela kanye nezinhlelo eziphuthumayo ukuze kuvinjelwe ukususwa kwamatshe okungalindelekile.
II-ERCPUhlelo lokukhipha amatshe kumele lube nolwesayensi, olungenaphutha, oluphelele, futhi olukwazi ukumelana nokuhlaziywa nokucatshangelwa. Kumelwe sinamathele esimisweni sokukhulisa inzuzo yesiguli futhi singabi ngabangenasisekelo.
·ukudelela
Amatshe amancane engxenyeni engezansi yomsele wenyongo kulula ukuwashalazela. Uma amatshe amancane ehlangabezana nezinkinga zesakhiwo engxenyeni engezansi yomsele wenyongo kanye nendawo ephuma kuyo, kuzoba nzima kakhulu ukususa itshe.
I-ERCPUkwelashwa kwamatshe e-bile duct kunezindlela eziningi kanye nezingozi eziphezulu. Kunzima futhi kuyingozi njengokungathi noma kuphakeme kakhulu kunalokhoI-ERCPukwelashwa kwezimila ze-bile duct. Ngakho-ke, uma ungakuthathi kalula, uzozishiyela indlela efanele yokubaleka.
03 Indlela yokubhekana "namatshe anzima"
Uma ubhekene namatshe anzima, kufanele kwenziwe ukuhlolwa okuphelele kwesiguli, kufanele kwenziwe ukwanda okwanele,ubhasikidi wokubuyisa itshekufanele kukhethwe futhi kulungiswe i-lithotripter, futhi kufanele kuklanywe uhlelo olusetshenziselwe kusengaphambili kanye nohlelo lokwelapha.
Ngaphandle kwalokho, izinzuzo nezingozi kufanele zihlolwe ngokusekelwe esimweni sesiguli ngaphambi kokuqhubeka.
·Ukucubungula kokuvula
Ubukhulu bomgodi busekelwe esimweni setshe eliqondiwe kanye nomsele we-bile. Ngokuvamile, ukuchezuka okuncane + ukuvuleka okukhulu (okuphakathi) kusetshenziswa ukwandisa umgodi. Ngesikhathi se-EST, kubalulekile ukugwema omkhulu ngaphandle kanye nomkhulu ngaphakathi.
Uma ungenalwazi, kulula ukwenza i-incision "enkulu ngaphandle kodwa encane ngaphakathi", okungukuthi, i-nipple ibukeka inkulu ngaphandle, kodwa akukho i-incision ngaphakathi. Lokhu kuzokwenza ukuthi ukususwa kwetshe kungaphumeleli.
Uma kwenziwa i-EST incision, kufanele kusetshenziswe "umnsalo ongajulile kanye ne-slow incision" ukuvimbela i-zipper incision. I-incision kufanele isheshe njenge-incision ngayinye. Ummese akufanele "uhlale unganyakazi" ngesikhathi sokusika ukuze kuvinjelwe ukuphazamiseka kwe-nipple futhi kubangele i-pancreatitis.
·Ukucubungula ukuhlolwa kwengxenye engezansi kanye nokuthumela ngaphandle
Amatshe e-common bile duct adinga ukuhlolwa kwengxenye engezansi kanye nendawo yokuphuma kwe-common bile duct. Zombili izindawo kumele zihlolwe. Ukuhlanganiswa kwazo zombili kunquma ingozi kanye nobunzima benqubo yokusikwa kwe-nipple.
·I-lithotripsy ephuthumayo
Amatshe amakhulu kakhulu futhi aqinile kanye namatshe angenakususwa amagilavu adinga ukwelashwa nge-emergency lithotripter (emergency lithotripter).
Amatshe e-Bile pigment angaqhekeka abe yizicucu, futhi iningi lamatshe e-cholesterol aqinile lingaxazululwa ngale ndlela. Uma idivayisi ingenakudedelwa ngemva kokutholwa, futhi i-lithotripter ingakwazi ukuphula amatshe, "kuyinkinga enkulu". Ngalesi sikhathi, i-eyeMAX ingadingeka ukuze kuhlolwe futhi kwelashwe amatshe ngqo.
Qaphela: Ungayisebenzisi i-lithotripsy engxenyeni engezansi kanye nokuphuma kwe-common bile duct. Ungayisebenzisi i-lithotripsy egcwele ngesikhathi se-lithotripsy, kodwa shiya isikhala sayo. I-Emergency lithotripsy iyingozi. Ngesikhathi se-emergency lithotripsy, i-end axis ingase ingahambisani ne-bile duct axis, futhi ukucindezeleka kungaba kukhulu kakhulu ukuba kubangele ukubhoboka.
·Itshe elincibilikisayo elinamandla
Uma itshe likhulu kakhulu futhi kunzima ukulisusa, ungacabanga ngokulincibilikisa - okungukuthi, ukufaka i-stent yepulasitiki. Linda kuze kube yilapho itshe lincipha ngaphambi kokususa itshe, khona-ke amathuba okuphumelela azoba makhulu kakhulu.
· Amatshe angaphakathi kwemithambo yegazi
Odokotela abasebasha abanolwazi oluncane kungcono bangenzi ukwelashwa kwe-endoscopic kwamatshe e-bile duct ngaphakathi kwesibindi. Ngenxa yokuthi amatshe akule ndawo angase angakwazi ukubanjwa noma angase agijime ajule futhi avimbele ukuqhubeka kokusebenza, umgwaqo uyingozi kakhulu futhi umncane.
· Amatshe emisele yenyongo ahlanganiswe ne-peripapillary diverticulum
Kuyadingeka ukuhlola ingozi kanye nokulindela kokwanda. Ingozi yokubhoboza kwe-EST iphezulu kakhulu, ngakho-ke njengamanje indlela yokwandisa ibhaluni ikhethiwe ngokuyisisekelo. Usayizi wokukhulisa kufanele ube owanele ukususa itshe. Inqubo yokukhulisa kufanele ibe kancane futhi igxathu negxathu, futhi akukho ukwanda okunamandla noma ukwanda okuvunyelwe. Isirinji iyakhula ngokuthanda kwayo. Uma kukhona ukopha ngemva kokukhula, kudingeka ukwelashwa okufanele.
Thina, iJiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumkhiqizi eShayina ogxile ezintweni ezisetshenziswayo ze-endoscopic, njengei-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 njll.ezisetshenziswa kabanzi ku-I-EMR,I-ESD,I-ERCPImikhiqizo yethu inesitifiketi se-CE, kanti izitshalo zethu zinesitifiketi se-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi kanye nengxenye ye-Asia, futhi zithola ukuqashelwa nokunconywa kakhulu ngamakhasimende!
Isikhathi sokuthunyelwe: Julayi-26-2024