Ibikoresho bya ErCp-Igitebo cyo gukuramo amabuye
Igitebo cyongeye kugarura ibuye ni umufasha usanzwe wakoresheje ibuye mubikoresho bya Ercp. Kubaganga benshi bashya kuri ercp, igitebo cyamabuye gishobora kugarukira ku gitekerezo cya "Ibikoresho byo gutora amabuye", kandi ntibihagije guhangana n'ibibazo bitoroshye. Uyu munsi, nzavuga muri make kandi niga ubumenyi bujyanye n'ibihano by'amabuye ya ErCP bishingiye ku makuru ajyanye nabyo nagishije inama.
Ibyiciro rusange
Igitebo kimaze kugarura amabuye kigabanijwemo igitebo kiyobora Wire wirebire, igitebo kidayobora Witwa Wire wirebire, hamwe nigitebo cyinjijwemo cyamabuye. Muri bo, ibiseke byinjijwemo - ibiseke bisenyutse ni ibiseke bisanzwe bigaragazwa na micro-tekinoroji kandi ihanagura vuba (RX) basubiye inyuma (RX) basubiyeho ibiseke bya Boston bihagarariwe na siyansi ya Boston ihagarariwe na siyansi. Kuberako igitebo cyinjijwemo-clush agaseke hamwe nigitebo cyihuse bihenze kuruta ibiseke bisanzwe, ibice bimwe nibikorwa byakazi birashobora kugabanya imikoreshereze yabo kubera ibibazo byayo bitewe nibibazo byateganijwe. Ariko, tutitaye ku kiguzi cyo kuwureka gusa, abaganga benshi bakora barushijeho gukoresha igitebo (hamwe ninsinga) yo gucamo ibice, cyane cyane kumabuye ya gile gato.
Dukurikije imiterere yigitebo, irashobora kugabanywamo "hexagonal" na "spiral" na "spiral", aribyo diyama, dormia na spiral, mubiseke bya dormia bikunze gukoreshwa. Ibitebo byavuzwe haruguru bifite ibyiza byabo nibibi, kandi bigomba gutorwa muburyo bworoshye ukurikije uko ibintu bimeze hamwe ningeso zumuntu.
Kuberako igitebo kimeze nka diyama hamwe nigitebo cya dormia nigitebo cyoroshye hamwe na "kwaguka imbere kandi bigabanya iherezo", birashobora korohereza igitebo kugirango ugarure amabuye. Niba ibuye ridashobora gusohoka nyuma yo kugwa mu mutego kuko ibuye rinini cyane, igitebo kirashobora kurekurwa neza, kugirango wirinde impanuka ziterwa isoni.
Igitebo gisanzwe "diyama"
Ibiseke byayo bya buri gihe "Hhombus" bikoreshwa gake cyane, cyangwa mu biseke byamabuye gusa. Kubera umwanya munini wa "Diamond" igitebo "cyoroshye, biroroshye kumabuye mato guhunga igitebo. Igitebo kimeze gutenguzi gifite ibiranga "byoroshye kubyambara ariko ntibyoroshye guhambura". Gukoresha igitebo kimeze gutenguzi gisaba gusobanukirwa byuzuye ibuye nigikorwa cyagereranijwe kugirango wirinde ibuye ryatsimbaraye bishoboka.
Agaseke
Igitebo-cyo guhana byihuse hamwe no guhonyora no guhonyora bikoreshwa mugihe cyo gukuramo amabuye manini, bishobora kugabanya igihe cyo gukora no kunoza igipimo cyo gutsinda cyo guhonyora. Byongeye kandi, niba igitebo kigomba gukoreshwa mugushushanya, umukozi utandukanye arashobora kubanza guhumeka no kunanirwa imbere yigitebo cyinjira mu gikari.
Icya kabiri, inzira yo gukora
Imiterere nyamukuru yigitebo cyamabuye kigizwe nigitebo cyibanze, umutsima winyuma nintoki. Igitebo cyibanze kigizwe nicyire za pakeke (Titanium-nikel-nikel Inkongo yigitebo ni inkubi y'umuyaga imiterere, isa n'inzego ihagaze y'umutego, ifasha gufata intego, irinde kunyerera, no gukomeza impagarara nyinshi kandi ntabwo byoroshye kumena. Insinga yo gukurura ni insinga yihariye yubuvuzi ifite imbaraga nubuhanga bukomeye, kuburyo ntazajya mubisobanuro birambuye hano.
Ingingo y'ingenzi yo kuvuga ni imiterere yo gusudira hagati yinsinga ya gukurura hamwe niyiti yinteke, insinga nigitebo cyumutwe wigitebo. By'umwihariko, ingingo yo gusudira hagati yinsinga ya gukurura insinga ni ngombwa cyane. Ukurikije igishushanyo nkicyo, ibisabwa kugirango inzira yo gusudira iri hejuru cyane. Igitebo gifite ubuziranenge buto gato ntibushobora kunanirwa gusa kumenagura ibuye gusa ahubwo bitera ingingo isuye insinga ya gukurura amabuye, bikava mu gitebo n'amabuye asigaye mu gihimbano, kandi kuvanaho. Ingorane (mubisanzwe irashobora kugarurwa nigitebo cya kabiri) kandi gishobora kuba cyabaga.
Inzira yo gusudira isuzugura insinga numutwe wicyuma wibitebo byinshi bisanzwe birashobora gutuma byoroshye igitebo. Nyamara, ibitebo bya siyansi ya Boston byagize imbaraga muri urwo rwego kandi byateguye uburyo bwo kurinda umutekano. Nukuvuga ngo, Niba amabuye adashobora gucika amabuye yo hejuru ajanjagura, igitebo kimurika amabuye kirashobora kurinda icyuma cyerekana imbere yigitebo kugirango yinjize. Ubunyangamugayo, bityo birinda ibitebo n'amabuye bisigaye mu gihimbano.
Ntabwo nzajya mubisobanuro birambuye kuri shiti yo hanze no gukora. Byongeye kandi, abakora amabuye atandukanye basenya amabuye bazagira abagizi ba nabi bamabuye, kandi nzagira amahirwe yo kwiga nyuma.
Uburyo bwo Gukoresha
Gukuramo amabuye byafunzwe nikintu gikomeye. Ibi birashobora kuba umukoresha adaha agaciro imiterere yumurwayi nibikoresho, cyangwa birashobora kuba ikintu kiranga amabuye yintoki ubwabo. Ibyo ari byo byose, dukwiye kubanza kumenya kwirinda gufungwa, hanyuma tugamenya icyo gukora niba gufungwa bibaye.
Kugira ngo wirinde gufungwa, hagomba gukoreshwa na Columnar Inkoko zigomba gukoreshwa mugukingura amatongo mbere yo gukuramo amabuye. Ubundi buryo bushobora gukoreshwa kugirango dukureho igitebo cyafunzwe harimo: Gukoresha igitebo cya kabiri (igitebo-gitekeri) no gukuraho, hamwe nibyiciro biherutse kandi byatangaje ko igice (2 cyangwa 3) cy'insinga zishobora gutwikwa hakoreshejwe APC. Kumena, no kurekura igitebo cyafunzwe.
Icya kane, kuvura amabuye ateket
Gukoresha igitebo ahanini birimo: guhitamo igitebo hamwe nibice bibiri byigitebo kugirango ufate ibuye. Kubijyanye no gutoranya ibitebo, ahanini biterwa nuburyo bwigitebo, diameter yigitebo, kandi niba ugomba gukoresha cyangwa kuzimya logotrishy (muri rusange, ikigo cya Endoscopy cyateguwe).
Kugeza ubu, igitebo "cya diyama cyakoreshejwe gikoreshwa cyane, ni ukuvuga igitebo cya dormia. Mu kabwiriza ka ercp, iki gitebo kivugwa neza mu gice cyo gukuramo amabuye ku mabuye yo mu bigo. Ifite igipimo kinini cyo gutsinda cyo gukuramo amabuye kandi biroroshye gukuraho. Numurongo wambere-guhitamo gutukura cyane. Kuri diameter yigitebo, igitebo gihuye kigomba gutoranywa ukurikije ingano yibuye. Ntabwo ari ukuvuga kuvuga byinshi kubyerekeye guhitamo ibirango bya gitebo, nyamuneka hitamo ukurikije ingeso zawe bwite.
Ubuhanga bwo gukuraho amabuye: Igitebo gishyizwe hejuru yibuye, kandi ibuye rigeragezwa ryakozwe mubihe bya angiographic. Birumvikana, est cyangwa EPBD igomba gukorwa hakurikijwe ubunini bw'ibuye mbere yo gufata ibuye. Iyo umuyoboro wibinini ukomeretse cyangwa ugabanijwe, hashobora kubaho umwanya uhagije wo gufungura igitebo. Bikwiye kugarurwa hakurikijwe ibintu byihariye. Ndetse nuburyo bwo gushaka uburyo bwo kohereza ibuye kuri bile binini binini byibindi byo kugarura. Kubwamabuye ya hular bicyuma, twakagombye gutwarwa numwijima kandi ntibishobora kuboneka mugihe igitebo cyakuwe mu gitebo cyangwa ikizamini gikorwa.
Hariho ibintu bibiri byo gufata amabuye mu gitebo cyamabuye: imwe nuko hariho umwanya uhagije hejuru yibuye cyangwa iruhande rwamabuye kugirango wemere igitebo gufungura; Ibindi nukwirinda gufata amabuye manini, nubwo igitebo cyarafunguwe rwose, ntigishobora gusohoka. Twahuye kandi n'amabuye 3 ya CM yakuweho nyuma yo lithotric yo lithotric, byose bigomba kuba lithotripsy. Ariko, ibi bihe biracyafite ibyago kandi bisaba umuganga w'inararibonye gukora.
Igihe cya nyuma: Gicurasi-13-2022