Mu gusuzuma no kuvura indwara zifata biliary, iterambere rya tekinoroji ya endoskopi ryibanze ku ntego zisobanutse neza, kudatera, ndetse n’umutekano mwinshi. Endoscopic retrograde cholangiopancreatography (ERCP), ifarashi ikoreramo yo gusuzuma no kuvura indwara ya biliary, imaze igihe kinini yemerwa cyane kubera imiterere yayo yo kubaga no kwibasirwa na gato. Ariko, iyo uhuye nibisebe bigoye bya biliary, tekinike imwe ikunze kuba mugufi. Aha niho perlangane transhepatique cholangioscopy (PTCS) ihinduka ikintu cyingenzi kuri ERCP. Ubu buryo bwa "dual-range" burenze imipaka yubuvuzi gakondo kandi butanga abarwayi uburyo bushya bwo gusuzuma no kuvura.
ERCP na PTCS buriwese afite ubuhanga bwe bwihariye.
Kugirango wumve imbaraga zuburyo bubiri zikoreshwa, umuntu agomba kubanza kumva neza ubushobozi budasanzwe bwibi bikoresho byombi. Nubwo byombi ari ibikoresho byo gusuzuma no kuvura biliary, bakoresha uburyo butandukanye, bakora ibintu byuzuye.
ERCP: Ubuhanga bwa Endoskopique Yinjiza Inzira Yigifu
ERCP isobanura Endoscopic Retrograde Cholangiopancreatography. Imikorere yacyo isa nuburyo bwo kuzenguruka bwo gukora ibintu. Muganga yinjiza duodenoskopi mu kanwa, esofagusi, ninda, amaherezo igera kuri duodenum imanuka. Muganga amenya gufungura amara yumuyoboro wa pisine na pancreatic (papilla duodenal). Catheter noneho yinjizwa binyuze ku cyambu cya endoscopique. Nyuma yo gutera inshinge zinyuranye, hakorwa isuzuma rya X-ray cyangwa ultrasound, bigafasha kwisuzumisha mu buryo bworoshye bwo kubona imiyoboro ya pansreatic.
Hashingiwe kuri,ERCPIrashobora kandi gukora uburyo butandukanye bwo kuvura: kurugero, kwagura imiyoboro yagabanutse hamwe na ballon, gufungura inzira zifunze hamwe na stent, kuvana amabuye kumuyoboro wa bile hamwe nigitebo cyo kuvanaho amabuye, no kubona tissue irwaye kugirango isesengurwe rya pathologiya ukoresheje ingufu za biopsy. Inyungu yibanze yibanze kuba ikora rwose binyuze mumyanya karemano, ikuraho ibikenewe byo gutemwa hejuru. Ibi bituma umuntu yakira vuba nyuma yo kubagwa no guhungabana gake kumubiri wumurwayi. Irakwiriye cyane cyane kuvura ibibazo byumuyoboro wegereye amara, nkamabuye yo hagati hamwe nu munsi wo hasi wumuyoboro wa bili, gukomera kwimyanda yo hepfo, hamwe no gukomeretsa kumuyoboro wa pancreatic na bile.
Nyamara, ERCP ifite kandi "intege nke" zayo: niba inzitizi zumubyimba zikomeye kandi umwanda ntushobora gusohoka neza, umukozi utandukanye azagira ikibazo cyo kuzuza umuyoboro wose, bizagira ingaruka kumpamvu yo gusuzuma; kuri intrahepatic bile duct amabuye (cyane cyane amabuye aherereye mu mwijima) hamwe na sitasiyo yo mu kirere ihagaze neza (hafi y'umwijima hilum no hejuru), ingaruka zo kuvura akenshi ziragabanuka cyane kuko endoskopi “idashobora kugera” cyangwa umwanya wo gukorera ni muto.
PTCS: Umupayiniya utandukanijwe unyuze hejuru yumwijima
PTCS, cyangwa transhepatic transhepatic choledochoscopy, ikoresha uburyo bwa "hanze-in", bitandukanye nuburyo bwa "imbere-hanze" bwa ERCP. Ku buyobozi bwa ultrasound cyangwa CT, umuganga abaga atobora uruhu ku gituza cy’iburyo cy’umurwayi cyangwa mu nda, bikanyura mu mwijima w’umwijima no kugera ku muyoboro w’imitsi wagutse, ugakora umuyoboro w’ubukorikori “uruhu-umwijima-bile”. Choledochoscope noneho yinjizwa muri uyu muyoboro kugira ngo yitegereze neza umuyoboro wa intrahepatic mu gihe icyarimwe ikora imiti nko kuvanaho amabuye, lithotripsy, kwaguka gukomeye, no gushyira stent.
“Intwaro yica” ya PTCS iri mu bushobozi bwayo bwo kugera mu mitsi itagaragara. Ni umuhanga cyane mugukemura "ibibazo byimbitse" bigoye kugera kuri ERCP: kurugero, amabuye manini yimyanda irenze cm 2 z'umurambararo, "amabuye menshi" akwirakwira mumashami menshi yimyanda yo mu nda, imyanya ndangagitsina ihanamye cyane iterwa nibibyimba cyangwa umuriro, hamwe nibibazo bigoye nka stastose ya anastomotic na fistulas iba nyuma ya biliary. Byongeye kandi, iyo abarwayi badashoboye kwandura ERCP kubera impamvu nka malodal duodenal papillary malformation no guhagarika amara, PTCS irashobora kuba ubundi buryo, bwihuta bwumuyaga kandi bikagabanya indwara ya jaundice, bityo bikagura igihe cyo kuvurwa nyuma.
Nyamara, PTCS ntabwo itunganye: kubera ko isaba gucumita hejuru yumubiri, ingorane nko kuva amaraso, kumeneka, no kwandura bishobora kubaho. Igihe cyo gukira nyuma yo gukira ni kirekire cyane ugereranije na ERCP, kandi tekinoroji ya muganga yo gutobora no kuyobora amashusho ni ndende cyane.
Gukomatanya Gukomeye: Logic ya "Gukora Synergistic Operation" hamwe na Dual-Scope Combination
Iyo "ibyiza bya endovaskulaire" ya ERCP ihuye n "" inyungu zidasanzwe "za PTCS, byombi ntibikigarukira ku buryo bumwe, ahubwo bigira uburyo bwo gusuzuma no kuvura" bwibasira imbere ndetse no hanze yumubiri. " Uku guhuriza hamwe ntabwo byongeweho byoroheje byikoranabuhanga, ahubwo ni gahunda yihariye "1 + 1> 2 ″ gahunda ijyanye nuburwayi bwumurwayi. Igizwe ahanini nuburyo bubiri:" bikurikiranye hamwe "na" icyarimwe bihujwe. "
Gukurikirana bikurikiranye: “Banza ufungure inzira, hanyuma uvure neza”
Ubu ni bwo buryo bukunze gukoreshwa, bukurikiza ihame rya “Kuvoma mbere, Kuvura Nyuma.” Kurugero, kubarwayi bafite jaundice ikumira cyane iterwa namabuye yimyanda ya intrahepatic, intambwe yambere ni ugushiraho umuyoboro w’amazi wa biliary unyuze mu cyuho cya PTCS kugirango ukureho umwanda wuzuye, kugabanya umuvuduko wumwijima, kugabanya ibyago byo kwandura, kandi buhoro buhoro ugarura imikorere yumwijima numurwayi. Iyo umurwayi amaze kumera neza, ERCP noneho ikorwa uhereye kumara kugirango ikureho amabuye mumiyoboro yo hepfo isanzwe, ivure ibikomere muri papila duodenal, hanyuma irusheho kwaguka imiyoboro y'amara ikoresheje ballon cyangwa stent.
Ku rundi ruhande, niba umurwayi ahuye na ERCP ugasanga afite amabuye y'umwijima asigaye cyangwa stenosis yo mu rwego rwo hejuru idashobora kuvurwa, PTCS irashobora gukoreshwa mu kurangiza “umurimo wo kurangiza” nyuma. Iyi moderi itanga ibyiza by "inzira-ku-ntambwe hamwe n’ingaruka zishobora gukemurwa," bigatuma bikenerwa cyane cyane ku barwayi bafite ibibazo bitoroshye ndetse n’ubuzima bwabayeho mbere;
Gukorera hamwe icyarimwe: “Icyarimwe Dual-range Operation,
Igisubizo kimwe ”
Ku barwayi bafite isuzumabumenyi risobanutse kandi bihanganira umubiri, abaganga barashobora guhitamo uburyo "icyarimwe". Mugihe kimwe cyo kubaga, amakipe ya ERCP na PTCS akorana. Umuganga ubaga ERCP akoresha endoskopi kuva mu mara, yagura papila duodenal no gushyira umurongo ngenderwaho. Umuganga ubaga PTCS, ayobowe no gufata amashusho, atobora umwijima kandi akoresha choledochoscope kugira ngo amenye icyerekezo cyashyizweho na ERCP, agere ku guhuza neza “imiyoboro y'imbere n'inyuma.” Amakipe yombi noneho arafatanya gukora lithotripsy, gukuraho amabuye, no gushyira stent.
Inyungu nini yiyi moderi nuko ikemura ibibazo byinshi hamwe nuburyo bumwe, ikuraho ibikenewe byinshi byo gutera anesteziya no kubagwa, bigabanya cyane uburyo bwo kuvura. Kurugero, kubarwayi bafite amabuye yimyanya ndangagitsina hamwe namabuye asanzwe, PTCS irashobora gukoreshwa icyarimwe mugukuraho amabuye yo munda hamwe na ERCP kugirango bakemure amabuye asanzwe, bikuraho ko abarwayi bakeneye inshuro nyinshi zatewe anesteziya no kubagwa, bikazamura neza uburyo bwo kuvura.
Ikintu gikurikizwa: Ni abahe barwayi bakeneye guhuza ibice bibiri?
Indwara zose za biliary ntizisaba amashusho abiri. Ibice bibiri bifatanyirijwe hamwe bikwiranye cyane cyane kubibazo bigoye bidashobora gukemurwa nubuhanga bumwe, cyane cyane harimo ibi bikurikira:
Amabuye y'amazi akomeye: Nibintu byambere byokoreshwa muburyo bubiri bwa CT. Kurugero, abarwayi bafite amabuye yombi yimbere yimbere (cyane cyane aherereye ahantu hitaruye nko kuruhande rwibumoso cyangwa iburyo bwinyuma yumwijima) hamwe namabuye asanzwe; abarwayi bafite amabuye akomeye arenga cm 2 z'umurambararo udashobora gukurwaho na ERCP wenyine; n'abarwayi bafite amabuye bacumbikiwe mu miyoboro migari yagabanutse, bikabuza kunyura mu bikoresho bya ERCP. Ukoresheje uburyo bubiri bwahujwe na CTCS, CTCS "isenya" amabuye manini kandi ikuraho amabuye yishami imbere yumwijima, mugihe ERCP "ikuraho" ibice byo hasi biva mu mara kugirango ikumire amabuye asigaye, igere ku "gukuraho amabuye yuzuye."
Umuyoboro wo mu rwego rwohejuru: Iyo imiyoboro ihanamye iri hejuru ya hepatike ya hepatike (aho imiyoboro y’ibumoso n’iburyo ihurira), endoskopi ya ERCP iragoye kuyigeraho, ku buryo bigoye gusuzuma neza uburemere n’impamvu zitera gukomera. Muri ibi bihe, PTCS yemerera kwerekanwa muburyo butaziguye binyuze mumiyoboro ya intrahepatique, ituma biopsies yemeza imiterere yindwara (nko gutwika cyangwa kubyimba) mugihe icyarimwe ikora kwaguka kwa ballon cyangwa gushyira stent. Ku rundi ruhande, ERCP, yemerera gushyira stent hepfo, ikora nk'icyerekezo cya stent ya PTCS, ikemeza ko amazi atabangamiwe numuyoboro wose.
Ingorane nyuma yo kubagwa kwa biliary: Anastomotic stenosis, fistula bile, hamwe namabuye asigaye bishobora kubaho nyuma yo kubagwa biliary. Niba umurwayi afite amara akomeye nyuma yo kubagwa kandi ERCP ntibishoboka, PTCS irashobora gukoreshwa mumazi no kuvura. Niba anastomotic stenosis iherereye hejuru kandi ERCP ntishobora kwaguka byuzuye, PTCS irashobora guhuzwa no kwaguka byombi kugirango bitezimbere intsinzi yubuvuzi.
Abarwayi badashobora kwihanganira kubagwa kamwe: Urugero, abarwayi bageze mu zabukuru cyangwa abarwayi bafite indwara zikomeye z'umutima n'umutima ntibashobora kwihanganira kubagwa igihe kirekire. Gukomatanya indorerwamo ebyiri birashobora kugabanya imikorere igoye muri "minimally invasive + minimally invasive", bigabanya ingaruka zo kubaga hamwe nuburemere bwumubiri.
Ibihe bizaza: "Kuzamura Icyerekezo" cyo Guhuza Ibice bibiri
Hamwe niterambere ryikoranabuhanga, guhuza ERCP na PTCS bikomeje gutera imbere. Ku ruhande rumwe, iterambere mu buhanga bwo gufata amashusho rifasha gutobora neza nuburyo bukoreshwa. Kurugero, guhuza ultrasound endoscopic intraoperative (EUS) na PTCS birashobora kwiyumvisha imiterere yimbere yumuyoboro wa bili mugihe nyacyo, bikagabanya ibibazo byacumita. Kurundi ruhande, udushya mubikoresho bituma kuvura neza. Kurugero, byoroshye choledochoscopes, lithotripsy iramba iramba, hamwe na bioresorbable stent zifasha guhuza ibice bibiri kugirango bikemure ibikomere byinshi.
Byongeye kandi, "robot-ifashwa na dual-range ebyiri ihuriweho" yagaragaye nkicyerekezo gishya cyubushakashatsi: ukoresheje sisitemu ya robo kugirango igenzure endoskopi nibikoresho byacumita, abaganga barashobora gukora inzira zoroshye muburyo bwiza, bikarushaho kunoza uburyo bwo kubaga n'umutekano. Mu bihe biri imbere, hamwe no kwiyongera kw’ubufatanye butandukanye (MDT), ERCP na PTCS bizarushaho guhuzwa na laparoskopi hamwe n’ubuvuzi bwa interineti, bizatanga uburyo bwihariye bwo gusuzuma no kuvura abarwayi bafite uburwayi bwa biliary.
Ihuriro ryibice bibiri bya ERCP na PTCS bivanaho imipaka yuburyo bumwe bwo gusuzuma no kuvura biliary, bikemura indwara nyinshi zifata biliary hamwe nuburyo bworoshye kandi bworoshye. Ubufatanye bw'aba “bombi bafite impano” ntibugaragaza gusa iterambere ry'ikoranabuhanga ry'ubuvuzi ahubwo binagaragaza uburyo bushingiye ku barwayi bwo gusuzuma no kuvura. Ihindura icyigeze gisabwa laparotomie ikomeye mubuvuzi bwibasiwe cyane no guhahamuka gake no gukira vuba, bigatuma abarwayi benshi bashobora gutsinda indwara zabo mugihe bakomeza ubuzima bwiza. Twizera ko hamwe nogukomeza gutera imbere mu ikoranabuhanga, guhuza ibice byombi bizafungura ubundi bushobozi, bizana uburyo bushya bwo gusuzuma no kuvura indwara ya biliary.
Twe, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., Ni uruganda mu Bushinwa ruzobereye mu gukoresha endoskopi, harimo umurongo wa GI nkabiopsy imbaraga, hemoclip, umutego, inshinge, spray catheter, cytology, kuyobora, igitebo cyo kugarura amabuye, izuru rya biliary drainage catheter, naSphincterotome nibindi. zikoreshwa cyane muriEMR, ESD, ERCP.
Ibicuruzwa byacu byemewe na CE kandi byemewe na FDA 510K, kandi ibihingwa byacu byemewe na ISO. Ibicuruzwa byacu byoherejwe mu Burayi, Amerika y'Amajyaruguru, Uburasirazuba bwo hagati ndetse no muri Aziya, kandi bigera ku bakiriya bamenyekana kandi bashimwe!
Igihe cyo kohereza: Ugushyingo-14-2025