Ibikoresho bya ERCP-Igiseke cyo gukuramo amabuye
Igitebo cyo kugarura amabuye nikisanzwe gikoreshwa mumabuye yo kugarura ibikoresho bya ERCP.Kubaganga benshi bashya kuri ERCP, igitebo cyamabuye kirashobora kugarukira kumyumvire y "ibikoresho byo gutora amabuye", kandi ntibihagije guhangana nikibazo gikomeye cya ERCP.Uyu munsi, nzavuga muri make kandi nige ubumenyi bujyanye nibiseke bya ERCP nkurikije amakuru ajyanye nabajije.
Ibyiciro rusange
Igitebo cyo kugarura amabuye kigabanyijemo igitebo kiyobora umugozi, igitebo kiyobora insinga, hamwe nigitebo cyo kugarura amabuye.Muri byo, ibitebo byahujwe no kugarura ibiseke ni ibisanzwe bisanzwe byo kugarura-gusya bigaragazwa na Micro-Tech hamwe na Rapid Exchange (RX) kugarura-gusya ibiseke bihagarariwe na Boston Scientifi.Kuberako igiteranyo cyo kugarura-gusya hamwe nigiseke-gihinduka byihuse bihenze kuruta ibitebo bisanzwe, ibice bimwe nabaganga bakora birashobora kugabanya imikoreshereze yabyo kubera ibibazo byigiciro.Nyamara, tutitaye 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 inyungu zabyo nibibi, kandi bigomba guhitamo byoroshye ukurikije uko ibintu bimeze hamwe nuburyo bwo gukoresha.
Kuberako agaseke kameze nka diyama hamwe nigitebo cya Dormia nuburyo bworoshye bwigitebo gifite "kwagura impera yimbere no kugabanya impera", birashobora korohereza igitebo kubona amabuye.Niba ibuye ridashobora gukurwaho nyuma yo gufatwa kuko ibuye rinini cyane, 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 cya spiral
Igiseke cyihuta 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 guhanagurwa mbere no kunanirwa mbere yuko igitebo cyinjira mumiyoboro.
Icya kabiri, inzira yo gukora
Imiterere nyamukuru yigitebo cyamabuye igizwe nintoki, igishishwa cyinyuma hamwe nigitoki.Igitebo cyibiseke bigizwe ninsinga (titanium-nikel alloy) hamwe no gukurura insinga (ibyuma 304 byubuvuzi bidafite ibyuma).Umugozi wigitebo nuburyo 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 nuburyo bwo gusudira hagati yo gukurura insinga ninsinga, umugozi wigitebo hamwe nicyuma cyigitebo.By'umwihariko, gusudira hagati yo gukurura insinga hamwe ninsinga ya basket ni ngombwa.Ukurikije igishushanyo mbonera, ibisabwa muburyo bwo gusudira ni byinshi.Igitebo gifite ubuziranenge buke ntibishobora kunanirwa kumenagura ibuye gusa ahubwo binatera 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 bili, no gukuraho nyuma.Ingorabahizi (mubisanzwe irashobora 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 byashyizeho ingufu muriki kibazo kandi bitegura uburyo bwo kurinda umutekano.Nukuvuga ko, niba amabuye atagishobora kumeneka hamwe nigitutu kinini cyo kumenagura amabuye, igitebo gikomera amabuye kirashobora kurinda umutwe wicyuma kumpera yimbere yigitebo kugirango harebwe guhuza insinga nigitereko.Ubunyangamugayo, bityo wirinde ibitebo n'amabuye asigaye mumiyoboro.
Ntabwo nzajya muburyo burambuye kubyerekeranye na sheath yo hanze.Mubyongeyeho, uruganda rutandukanye rwamabuye ruzagira amabuye atandukanye, kandi nzagira amahirwe yo kwiga byinshi nyuma.
Uburyo bwo gukoresha
Gukuraho amabuye afunzwe nikintu gikomeye.Ibi birashobora kuba umukoresha adaha agaciro imiterere yumurwayi nibikoresho bye, cyangwa birashobora kuba ibiranga amabuye yumuyoboro ubwayo.Ibyo ari byo byose, dukwiye kubanza kumenya uburyo bwo kwirinda gufungwa, hanyuma tugomba kumenya icyo gukora niba gufunga bibaye.
Kugira ngo wirinde gufunga igitebo, hagomba gukoreshwa umupira winkingi kugirango ugure ibere mbere yo gukuramo amabuye.Ubundi buryo bushobora gukoreshwa mugukuraho igitebo gifunzwe harimo: gukoresha igitebo cya kabiri (agaseke-ku-kebo) no kuvanaho kubagwa, kandi ingingo iherutse kandi ivuga 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 cyane cyane: guhitamo igitebo nibiri mubiseke gufata ibuye.Kubijyanye no gutoranya igitebo, biterwa ahanini nuburyo bwigitebo, diameter yigitebo, ndetse no gukoresha cyangwa kubika lithotripsy yihutirwa (muri rusange, ikigo cya endoskopi cyateguwe 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 kuyakuramo.Numurongo wambere uhitamo gukuramo amabuye menshi.Kuri diametre yigitebo, igitebo kijyanye nacyo kigomba gutoranywa ukurikije ubunini bwibuye.Ntibyoroshye kuvuga byinshi kubyerekeye guhitamo ibirango byigiseke, nyamuneka hitamo ukurikije ingeso zawe bwite.
Ubuhanga bwo gukuraho amabuye: Igitebo gishyirwa hejuru yibuye, kandi ibuye ryageragejwe munsi ya angiographic.Birumvikana ko 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 no kugarura.Ku mabuye ya hilar bile, twakagombye kumenya ko amabuye azasunikwa mumwijima kandi ntashobora kugarurwa mugihe igitebo cyakuwe mubiseke cyangwa ikizamini.
Hariho ibintu bibiri byo gukuramo amabuye mu gatebo k'amabuye: kimwe nuko hari umwanya uhagije hejuru yibuye cyangwa kuruhande rwibuye kugirango igitebo gikingure;ikindi nukwirinda 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 cyoherejwe: Gicurasi-13-2022