Ibikoresho bya ERCP - Igikapu cyo gukuramo amabuye
Igitebo cyo gukuramo amabuye ni ikintu gikoreshwa cyane mu gukuramo amabuye mu bikoresho bya ERCP. Ku baganga benshi bashya muri ERCP, igitebo cy'amabuye gishobora kuba kigikoreshwa gusa mu gitekerezo cy' "ibikoresho byo gutoragura amabuye", kandi ntibihagije mu guhangana n'ikibazo kigoye cya ERCP. Uyu munsi, ndavuga muri make kandi nige ubumenyi bujyanye n'udutebo tw'amabuye twa ERCP nkurikije amakuru nabonye.
Icyiciro rusange
Agasanduku ko gukuramo amabuye gagabanyijemo agasanduku gakoresha insinga ziyobora, agasanduku kadakoresha insinga ziyobora, n'agasanduku ko gukuramo amabuye gahuza. Muri byo, agasanduku ko gukuramo amabuye gahuza ni agasanduku gasanzwe ko gukuramo amabuye gahagarariwe na Micro-Tech na Rapid Exchange (RX) gahuza udusanduku du ...
Dukurikije imiterere y'agaseke, gashobora kugabanywamo "hexagonal", "diamond" na "spiral", ari byo diyama, Dormia na spiral, muri byo uduseke twa Dormia dukoreshwa cyane. Uduseke twavuzwe haruguru dufite ibyiza n'ibibi byatwo, kandi tugomba gutoranywa mu buryo bworoshye bitewe n'imimerere nyayo n'uburyo umuntu akoresha.
Kubera ko agaseke kameze nk'ibuye n'agaseke ka Dormia ari agaseke gafite "inyuma yagutse n'inyuma yagabanutse", bishobora korohereza agaseke kugarura amabuye. Iyo ibuye ridashobora gukurwamo nyuma yo gufatwa kubera ko ibuye ari rinini cyane, agaseke gashobora kurekurwa neza, kugira ngo hirindwe impanuka ziteye isoni.
Agaseke gasanzwe ka "diyama"
Uduseke dusanzwe twa "hexagon-rhombus" dukoreshwa gake cyane, cyangwa gusa mu duseke two gusya amabuye. Bitewe n'umwanya munini w'agaseke ka "diyama", biroroshye ko amabuye mato asohoka mu gaseke. Agaseke gafite ishusho y'uruziga gafite imiterere yo "kworoshye kwambaraho ariko ntibyoroshye gupfundura". Gukoresha agaseke gafite ishusho y'uruziga bisaba gusobanukirwa neza ibuye n'imikorere iteganyijwe kugira ngo hirindwe ko ibuye rifatirwamo uko bishoboka kose.
Agaseke ko mu ruziga
Agaseke ko guhinduranya vuba gahujwe no gusya no gusya gakoreshwa mu gihe cyo gukuramo amabuye manini, bishobora kugabanya igihe cyo gukora no kunoza umuvuduko wo gusya. Byongeye kandi, niba agaseke gakeneye gukoreshwa mu gushushanya, igikoresho cyo gutandukanya ibintu gishobora gusukurwa mbere no gukurwamo amazi mbere yuko agaseke kinjira mu muyoboro w'inkondo y'umura.
Icya kabiri, inzira yo gukora
Imiterere y'ingenzi y'agaseke k'amabuye igizwe n'umutima w'agaseke, icyuma cyo hanze n'umukingo. Umugongo w'agaseke ugizwe n'insinga z'agaseke (titanium-nickel alloy) n'insinga zikurura (304 steel stainless steel 304). Insinga z'agaseke ni imiterere y'insinga ziboshye, isa n'imiterere y'umutego, ifasha gufata intego, gukumira kunyerera, no kugumana imbaraga nyinshi kandi ntibyoroshye gucika. Insinga zikurura ni insinga zidasanzwe z'ubuvuzi zifite imbaraga zikomeye zo gukurura no gukomera, bityo rero ntabwo nzavuga birambuye hano.
Ingingo y'ingenzi yo kuvugaho ni imiterere yo gusudira hagati y'insinga ikurura n'insinga y'igikapu, insinga y'igikapu n'umutwe w'icyuma w'igikapu. By'umwihariko, aho gusudira hagati y'insinga ikurura n'insinga y'igikapu ni ingenzi cyane. Hashingiwe ku gishushanyo nk'iki, ibisabwa mu gikorwa cyo gusudira ni byinshi cyane. Igikapu gifite ubuziranenge buke gishobora kudatsinda gusa ibuye ahubwo kinatuma aho gusudira hagati y'insinga ikurura n'insinga y'igikapu cy'urushundura hacika mu gihe cyo gusya amabuye nyuma yo gukuraho ibuye, bigatuma igikapu n'ibuye bisigara mu muyoboro w'inkondo y'umura, hanyuma bigakurwaho. Ingorane (ubusanzwe zishobora kuboneka hakoreshejwe ikindi gikapu) ndetse bishobora no gusaba kubagwa.
Uburyo bubi bwo gusudira insinga n'umutwe w'icyuma by'uduseke dusanzwe bushobora gutuma agaseke gacika byoroshye. Ariko, uduseke twa Boston Scientific twashyizeho imbaraga nyinshi muri urwo rwego kandi twashyizeho uburyo bwo kurinda umutekano. Ni ukuvuga ko niba amabuye atarabasha gucika hakoreshejwe amabuye asya afite umuvuduko mwinshi, agaseke gakomeza amabuye gashobora kurinda umutwe w'icyuma uri ku mpera y'agaseke kugira ngo insinga y'agaseke n'insinga ikurura bihuzwe. Ubuziranenge, bityo birinda uduseke n'amabuye bisigara mu muyoboro w'inda.
Sinzavuga birambuye ku muyoboro w'inyuma n'umukingo. Byongeye kandi, abakora ibikoresho bitandukanye byo gusya amabuye bazagira ibikoresho bitandukanye byo gusya amabuye, kandi nzagira amahirwe yo kumenya byinshi nyuma.
Uburyo bwo gukoresha
Gukuraho amabuye mu nzu y’imbohe ni ikintu kigoye cyane. Ibi bishobora kuba ari ukudaha agaciro uburwayi bw’umurwayi n’ibindi bikoresho bye, cyangwa bikaba ari ikimenyetso cy’utubuye tw’imiyoboro y’amaraso. Uko byagenda kose, tugomba kubanza kumenya uburyo bwo kwirinda gufungwa, hanyuma tukamenya icyo twakora mu gihe habayeho gufungwa.
Kugira ngo hirindwe gufungirwa mu gikapu, hagomba gukoreshwa agapira k'inkingi kugira ngo kaguke umwobo w'inkeri mbere yo gukuramo amabuye. Ubundi buryo bushobora gukoreshwa mu gukuraho agapira k'inkoni burimo: gukoresha agapira ka kabiri (agasanduku kajya mu gikapu) no kubagwa, kandi inkuru iherutse gutangazwa nayo yavuze ko kimwe cya kabiri (2 cyangwa 3) cy'insinga gishobora gutwikwa hakoreshejwe APC. kumenagura, no kurekura agapira k'inkoni.
Icya kane, uburyo bwo kuvura abantu bafungirwa mu gasanduku k'amabuye
Ikoreshwa ry'agaseke rikubiyemo ahanini: guhitamo agaseke n'ibiri mu gaseke byo gufata ibuye. Mu bijyanye no guhitamo agaseke, ahanini biterwa n'imiterere y'agaseke, uburebure bw'agaseke, ndetse no gukoresha cyangwa kugabanya ubukana bwa lithotripsy (muri rusange, ikigo cya endoscopy gitegurwa buri gihe).
Muri iki gihe, agaseke ka "diyama" gakoreshwa buri gihe, ni ukuvuga agaseke ka Dormia. Mu mabwiriza ya ERCP, ubwoko bw'agaseke buvugwa neza mu gice cyo gukuramo amabuye ku mabuye asanzwe y'imiyoboro y'amaraso. Gafite igipimo cyo gukuramo amabuye neza cyane kandi biroroshye gukuramo. Ni amahitamo yo ku murongo wa mbere ku mabuye menshi. Ku bijyanye n'umurambararo w'agaseke, agaseke kajyanye nako kagomba gutoranywa hakurikijwe ingano y'amabuye. Ntibyoroshye kuvuga byinshi ku mahitamo y'ibirango by'agaseke, nyamuneka hitamo ukurikije ingeso zawe bwite.
Ubuhanga bwo gukuraho ibuye: Agasanduku gashyirwa hejuru y'ibuye, maze ibuye rigapimwa hifashishijwe uburyo bwo gusuzuma indwara ya angiografiya. Birumvikana ko EST cyangwa EPBD bigomba gukorwa hakurikijwe ingano y'ibuye mbere yo gufata ibuye. Iyo umuyoboro w'inyongo wakomeretse cyangwa ugacika, hashobora kubura umwanya uhagije wo gufungura agasanduku. Gakwiye gukurwa hakurikijwe uko ibintu bimeze. Ndetse ni amahitamo yo gushaka uburyo bwo kohereza ibuye ku muyoboro w'inyongo munini kugira ngo rigarurwe. Ku mabuye y'inyongo ya hilar, ni ngombwa kumenya ko ayo mabuye azasunikwa mu mwijima kandi ntashobora gukurwamo iyo agasanduku kavanywe mu gasanduku cyangwa hakozwe ikizamini.
Hari ibintu bibiri bisabwa kugira ngo uvane amabuye mu gitebo cy'amabuye: kimwe ni uko hari umwanya uhagije hejuru y'ibuye cyangwa iruhande rw'ibuye kugira ngo igitebo gifunguke; ikindi ni ukwirinda gufata amabuye manini cyane, nubwo igitebo cyaba cyafunguwe burundu, ntushobora kukivanamo. Twahuye kandi n'amabuye ya cm 3 yakuweho nyuma yo gukorerwa isuzuma rya endoscopic lithotripsy, yose agomba kuba ari lithotripsy. Ariko, iki kibazo kiracyari ikibazo gikomeye kandi gisaba umuganga w'inararibonye kubaga.
Igihe cyo kohereza: Gicurasi-13-2022