Ibikoresho bya ERCP-Igiseke cyo gukuramo amabuye
Igitebo cyo kugarura amabuye nikintu gikunze gukoreshwa gifasha kugarura ibikoresho mubikoresho bya ERCP.Ku baganga benshi bashya kuri ERCP, igitebo cyamabuye gishobora kuba kigarukira gusa ku gitekerezo cy "ibikoresho byo gutora amabuye", kandi ntibihagije guhangana n’ibibazo bitoroshye bya ERCP.Uyu munsi, nzavuga muri make kandi nige ubumenyi bujyanye nibiseke bya ERCP byamabuye nkurikije amakuru ajyanye nabajije.
Ibyiciro rusange
Igitebo cyo kugarura amabuye kigabanyijemo igitebo kiyobora insinga ziyobowe, igitebo kiyobora insinga, hamwe nigitebo cyahujwe no kugarura amabuye.Muri byo, ibitebo byahujwe no kugarura ibitebo ni ibisanzwe bisanzwe byo kugarura-guhonyora uhagarariwe na Micro-Tech hamwe na Rapid Exchange (RX) kugarura-gusya ibiseke bihagarariwe na Boston Scientifi.Kuberako guhuriza hamwe kugarura-gusya hamwe nigitebo cyihuse cyo guhindura ibintu bihenze kuruta ibiseke bisanzwe, ibice bimwe nabaganga bakora barashobora kugabanya imikoreshereze yabyo kubera ibibazo byigiciro.Nubwo, hatitawe ku kiguzi cyo kubireka gusa, abaganga benshi babaga bafite ubushake bwo gukoresha igitebo (hamwe ninsinga iyobora) kugirango bagabanye, cyane cyane kumabuye manini manini.
Ukurikije imiterere y'agaseke, irashobora kugabanywamo "impande esheshatu", "diyama" na "spiral", aribyo diyama, Dormia na spiral, muri byo ibitebo bya Dormia bikunze gukoreshwa.Ibitebo byavuzwe haruguru bifite ibyiza byabyo nibibi, kandi bigomba guhitamo byoroshye ukurikije uko ibintu bimeze hamwe nuburyo bwo gukoresha.
Kuberako igitebo kimeze nka diyama hamwe nigitebo cya Dormia nuburyo bworoshye bwigitebo gifite "kwagura impera yimbere no kugabanya impera", birashobora korohereza igitebo kubona amabuye.Niba ibuye ridashobora gusohoka nyuma yo gufatwa kubera ko ibuye ari rinini, igitebo gishobora kurekurwa neza, kugirango wirinde impanuka ziteye isoni.
Igitebo gisanzwe "diyama"
Ibiseke bisanzwe "hexagon-rhombus" bikoreshwa gake cyane, cyangwa mubiseke byamabuye.Bitewe n'umwanya munini w'igitebo cya "diyama", biroroshye ko amabuye mato ashobora guhunga igitebo.Igitebo kimeze nka spiral gifite ibiranga "byoroshye kwambara ariko ntibyoroshye guhambura".Gukoresha igitebo kimeze nka spiral bisaba gusobanukirwa neza ibuye nigikorwa cyagereranijwe kugirango wirinde ibuye gukomera uko bishoboka.
Igitebo
Igiseke cyihuse cyo guhinduranya hamwe no kumenagura no kumenagura bikoreshwa mugihe cyo gukuramo amabuye manini, ashobora kugabanya igihe cyo gukora no kuzamura igipimo cyo gutsinda.Byongeye kandi, niba igitebo gikeneye gukoreshwa mugushushanya, agent itandukanye irashobora kubanza gukaraba no kunanirwa mbere yuko igitebo cyinjira mumiyoboro.
Icya kabiri, inzira yo gukora
Imiterere nyamukuru yigitebo cyamabuye igizwe ninturusu, igishishwa cyo hanze hamwe nigitoki.Igitebo cyibiseke bigizwe ninsinga (titanium-nikel alloy) hamwe no gukurura insinga (ibyuma 304 byubuvuzi bidafite ibyuma).Umugozi wigitebo nububiko buvanze, busa nuburyo bwubatswe bwumutego, bufasha gufata intego, kwirinda kunyerera, no gukomeza impagarara nyinshi kandi ntibyoroshye kumeneka.Gukurura insinga ni umugozi wihariye wubuvuzi ufite imbaraga zikomeye kandi zikomeye, ntabwo rero nzajya muburyo burambuye hano.
Ingingo y'ingenzi yo kuganiraho ni imiterere yo gusudira hagati y'insinga zikurura n'insinga, agaseke hamwe n'umutwe w'icyuma cy'igitebo.By'umwihariko, ingingo yo gusudira hagati yo gukurura insinga ninsinga ya basket ni ngombwa.Ukurikije igishushanyo mbonera, ibisabwa muburyo bwo gusudira ni byinshi cyane.Igitebo gifite ubuziranenge buke ntigishobora kunanirwa kumenagura ibuye gusa ahubwo gishobora no gutuma aho gusudira hagati yinsinga zikurura ninsinga ya mesh yamenetse mugihe cyo kumenagura amabuye nyuma yo gukuramo ibuye, bikavamo igitebo na ibuye risigaye mu muyoboro wa bile, no gukuraho nyuma.Ingorane (mubisanzwe zishobora kugarurwa nigitebo cya kabiri) kandi birashobora no kubagwa.
Uburyo bubi bwo gusudira bwinsinga hamwe nicyuma cyumutwe wibiseke byinshi bisanzwe birashobora gutuma igitebo kimeneka.Nyamara, ibiseke bya Boston Scientific byashyize ingufu muri urwo rwego kandi bitegura uburyo bwo kurinda umutekano.Nukuvuga ko, niba amabuye atagishobora kumeneka hamwe nigitutu cyinshi cyo kumenagura amabuye, igitebo gishimangira amabuye kirashobora kurinda umutwe wicyuma kumpera yimbere yigitebo kugirango harebwe guhuza umugozi wigitebo hamwe ninsinga zikurura.Ubunyangamugayo, bityo wirinde ibitebo namabuye asigaye mumiyoboro.
Ntabwo nzajya muburyo burambuye kubyerekeranye nicyuma cyo hanze.Mubyongeyeho, uruganda rutandukanye rwamabuye ruzagira amabuye atandukanye, kandi nzagira amahirwe yo kwiga byinshi nyuma.
Uburyo bwo gukoresha
Gukuraho amabuye afunzwe nikintu kirenze ibibazo.Ibi birashobora kuba umukoresha adaha agaciro imiterere yumurwayi hamwe nibindi bikoresho, cyangwa birashobora kuba ibiranga amabuye yumuyoboro ubwayo.Ibyo ari byo byose, dukwiye kubanza kumenya uko twakwirinda gufungwa, hanyuma tugomba kumenya icyo gukora mugihe habaye gufungwa.
Kugira ngo wirinde gufungwa kwagaseke, umupira winkingi ugomba gukoreshwa kugirango ugure amabere mbere yo gukuramo amabuye.Ubundi buryo bushobora gukoreshwa mugukuraho igitebo gifunzwe harimo: gukoresha igitebo cya kabiri (agaseke-ku-gatebo) no kuvanaho kubaga, kandi ingingo iherutse kandi yatangaje ko kimwe cya kabiri (2 cyangwa 3) cyinsinga zishobora gutwikwa ukoresheje APC.kumena, no kurekura igitebo gifunzwe.
Icya kane, kuvura gufunga igitebo cyamabuye
Gukoresha igitebo birimo ahanini: guhitamo igitebo nibiri mubiseke gufata ibuye.Kubijyanye no gutoranya igitebo, biterwa ahanini nuburyo bwigitebo, diameter yigitebo, hamwe nogukoresha cyangwa kubika lithotripsy yihutirwa (muri rusange, ikigo cya endoskopi gitegurwa bisanzwe).
Kugeza ubu, igitebo cya "diyama" gikoreshwa bisanzwe, ni ukuvuga agaseke ka Dormia.Mu murongo ngenderwaho wa ERCP, ubu bwoko bwigitebo buvugwa neza mugice cyo gukuramo amabuye kumyanda isanzwe.Ifite igipimo kinini cyo gukuramo amabuye kandi byoroshye kuyakuraho.Numurongo wambere uhitamo kubikuramo amabuye menshi.Kuri diametre yigitebo, igitebo kijyanye nacyo kigomba gutoranywa ukurikije ubunini bwibuye.Ntibyoroshye kuvuga byinshi kubyerekeye guhitamo ibirango byigitebo, nyamuneka hitamo ukurikije ingeso zawe bwite.
Ubuhanga bwo kuvanaho amabuye: Igitebo gishyirwa hejuru yibuye, kandi ibuye ryageragejwe munsi yo kureba.Nibyo, EST cyangwa EPBD bigomba gukorwa ukurikije ubunini bwibuye mbere yo gufata ibuye.Iyo umuyoboro wa bili wakomeretse cyangwa ugabanijwe, ntihashobora kuba umwanya uhagije wo gufungura igitebo.Igomba kuboneka ukurikije ibihe byihariye.Ndetse nuburyo bwo gushakisha uburyo bwo kohereza ibuye kumuyoboro mugari ugereranije kugirango ugarure.Ku mabuye ya hilar bile, twakagombye kumenya ko amabuye azasunikwa mu mwijima kandi ntashobora kugarurwa mugihe igitebo cyakuwe mu gitebo cyangwa ikizamini.
Hariho ibintu bibiri byo gukuramo amabuye mu gitebo cyamabuye: kimwe nuko hari umwanya uhagije hejuru yibuye cyangwa kuruhande rwibuye kugirango igitebo gikingure;ikindi ni ukwirinda gufata amabuye manini cyane, nubwo igitebo cyafunguwe rwose, ntigishobora gusohoka.Twahuye kandi namabuye ya cm 3 yakuweho nyuma ya lithotripsy ya endoskopi, yose igomba kuba lithotripsy.Nubwo bimeze bityo ariko, ibi biracyafite ibyago kandi bisaba umuganga w'inararibonye kubaga.
Igihe cyo kohereza: Gicurasi-13-2022