Mu gusuzuma no kuvura indwara z’inkari, iterambere ry’ikoranabuhanga rya endoscopic ryakomeje kwibanda ku ntego zo gukora neza cyane, kudatera indwara nyinshi, no kugira umutekano mwinshi. Endoscopic retrograde cholangiopancreatography (ERCP), uburyo bwo gusuzuma no kuvura indwara z’inkari, bumaze igihe kinini bwemerwa cyane kubera ko butabagwa kandi butatera indwara nyinshi. Ariko, iyo uhuye n’ibisebe bikomeye by’inkari, uburyo bumwe bukunze kubura. Aha niho percutaneous transhepatic cholangioscopy (PTCS) iba ingenzi cyane kuri ERCP. Ubu buryo buhuriweho bwa "double-scope" burenze imbogamizi z’ubuvuzi gakondo kandi buha abarwayi uburyo bushya bwo gusuzuma no kuvura.
ERCP na PTCS buri imwe ifite ubuhanga bwayo bwihariye.
Kugira ngo umuntu asobanukirwe imbaraga zo gukoresha uburyo bubiri buvanze, agomba kubanza gusobanukirwa neza ubushobozi bwihariye bw'ibi bikoresho byombi. Nubwo byombi ari ibikoresho byo gusuzuma no kuvura ikibyimba cy'inda, bikoresha uburyo butandukanye, bigatuma habaho ubwuzuzanye butunganye.
ERCP: Ubuhanga bwo gupima imikorere y'igogora mu nzira y'igifu
ERCP isobanura Endoscopic Retrograde Cholangiopancreatography. Umurimo wayo usa n'uburyo bwo gukora ibintu buzenguruka. Muganga ashyiramo duodenoscope anyuze mu kanwa, mu muhogo no mu gifu, amaherezo akagera kuri duodenum imanuka. Muganga areba aho amara yegereye imiyoboro y'inkondo y'umura n'iy'inkondo y'umura (duodenal papilla). Hanyuma hashyirwamo catheter inyuze mu gice cya biopsy cya endoscopic. Nyuma yo gutera contrast agent, hakorwa isuzuma rya X-ray cyangwa ultrasound, bigatuma habaho gusuzuma mu maso imiyoboro y'inkondo y'umura n'iy'inkondo y'umura.
Hashingiwe kuri ibi,ERCPishobora kandi gukora uburyo butandukanye bwo kuvura: urugero, kwagura imiyoboro y'inyongo ifunganye ukoresheje agapira, gufungura inzira zifunze zifite stent, gukura amabuye mu muyoboro w'inyongo ukoresheje agasanduku ko gukuramo amabuye, no kubona ingingo zirwaye kugira ngo zisesengurwe hakoreshejwe uburyo bwa biopsy forceps. Akamaro kayo k'ingenzi ni uko ikora neza mu mwobo karemano, ikuraho gukata ku buso. Ibi bituma umurwayi akira vuba kandi umubiri we ntugire ikibazo kinini. Irakwiriye cyane cyane kuvura ibibazo by'imiyoboro y'inyongo hafi y'amara, nk'amabuye ari mu miyoboro y'inyongo yo hagati n'iyo hasi, imiyoboro y'inyongo yo hasi, n'ibisebe ku ihuriro ry'imiyoboro y'inyongo n'inyongo.
Ariko, ERCP ifite kandi "intege nke" zayo: iyo umuyoboro w'indyo ufunganye cyane kandi inyo idashobora gusohoka neza, umuti ugabanya imiterere y'amaraso uzagira ingorane zo kuzuza umuyoboro wose w'indyo, ibyo bizagira ingaruka ku buryo bwo gusuzuma neza; ku mabuye y'indyo yo mu mwijima (cyane cyane amabuye ari mu mwijima) na stenosis y'indyo yo mu mwijima iri hejuru (hafi y'umwijima n'inyuma), ingaruka zo kuvura zikunze kugabanuka cyane kuko endoscope "idashobora kugera" cyangwa umwanya wo kubaga ukaba muto.
PTCS: Umuvuduko w'umubiri unyura mu mwijima
PTCS, cyangwa percutaneous transhepatic choledochoscopy, ikoresha uburyo bwo "kunyura hanze", bitandukanye n'uburyo bwo "kunyura imbere" bwa ERCP. Mu gihe umuganga agenzurwa na ultrasound cyangwa CT, ashyira uruhu ku gituza cy'iburyo cy'umurwayi cyangwa ku nda, anyura neza mu mubiri w'umwijima maze akagera ku muyoboro w'inyongobe mu mwijima, agashyiraho umuyoboro w'inyongobe w'umwimerere "uruhu-umwijima-inyongobe". Hanyuma, choledochoscope inyuzwa muri uyu muyoboro kugira ngo irebe neza umuyoboro w'inyongobe mu mwijima mu gihe icyarimwe ikora uburyo bwo kuvura nko gukuraho amabuye, lithotripsy, kwagura strictures, no gushyira stent.
"Intwaro yica" ya PTCS ishingiye ku bushobozi bwayo bwo kugera ku bisebe byo mu miyoboro y'inkondo y'umura mu mwijima. Ifite ubuhanga cyane mu gukemura "ibibazo bikomeye" bigoye kugerwaho na ERCP: urugero, amabuye manini y'imiyoboro y'inkondo y'umura arengeje cm 2 z'umurambararo, "amabuye menshi" akwirakwiriye ku mashami menshi y'imiyoboro y'inkondo y'umura mu mwijima, imitsi y'inkondo y'umura ihagaze hejuru iterwa n'ibibyimba cyangwa kubyimba, hamwe n'ingorane zikomeye nka stenosis ya anastomotic na fistula y'inkondo y'umura bibaho nyuma yo kubagwa inkondo y'umura. Byongeye kandi, iyo abarwayi badashoboye gukora ERCP bitewe n'impamvu nko kumererwa nabi kwa duodenal papillary no kuziba amara, PTCS ishobora kuba ubundi buryo, ikura inkondo y'umura vuba kandi ikagabanya umuhondo, bityo ikagura igihe cyo kuvurwa nyuma yaho.
Ariko, PTCS ntabwo ari nziza cyane: kubera ko isaba gutobora ku mubiri, ingorane nko kuva amaraso, kuva amaraso mu nda, no kwandura zishobora kubaho. Igihe cyo gukira nyuma yo kubagwa ni kirekire gato ugereranyije na ERCP, kandi ikoranabuhanga rya muganga ryo gutobora no kuyobora amashusho ni byinshi cyane.
Uruvange Rukomeye: Ishingiro ry'"Ibikorwa Bihuza" hamwe n'Uruvange Rubiri
Iyo "inyungu z'imitsi yo mu nda" za ERCP zihuye n' "inyungu z'imitsi yo mu nda" za PTCS, byombi ntibiba bikiri uburyo bumwe gusa, ahubwo bishyiraho uburyo bwo gusuzuma no kuvura "bugaragara imbere no hanze y'umubiri." Ubu buryo si uburyo bworoshye bwo kongeramo ikoranabuhanga, ahubwo ni gahunda yihariye ya "1+1>2" ijyanye n'imiterere y'umurwayi. Igizwe ahanini n'uburyo bubiri: "buvanze mu buryo bukurikiranye" na "buvanze icyarimwe."
Uruhurirane rw'ibice: "Banza ufungure inzira, hanyuma uvure neza"
Ubu ni bwo buryo bukunze gukoreshwa cyane, akenshi bukurikiza ihame rya "gutanga amazi mbere, kuvurwa nyuma." Urugero, ku barwayi bafite indwara ikomeye yo kubyimba umuhogo iterwa n'utubuye tw'imiyoboro y'amaraso mu mwijima, intambwe ya mbere ni ugushyiraho umuyoboro w'amazi unyura muri PTCS kugira ngo uvane amaraso menshi, ugabanye umuvuduko w'umwijima, ugabanye ibyago byo kwandura, kandi buhoro buhoro usubize imikorere y'umwijima n'imiterere y'umubiri w'umurwayi. Iyo umurwayi amaze guhagarara neza, ERCP ikorwa mu mara kugira ngo ikureho amabuye mu miyoboro y'amaraso yo hasi, ivure ibisebe mu duodenal papilla, kandi yongere yagure imiyoboro y'amaraso hakoreshejwe icyuma cyangwa stent.
Ku rundi ruhande, iyo umurwayi akorewe ERCP maze agasanga afite amabuye y’umwijima asigaye cyangwa stenosis yo ku rwego rwo hejuru idashobora kuvurwa, PTCS ishobora gukoreshwa mu kurangiza "akazi ko kurangiza" nyuma. Ubu buryo butanga inyungu yo "gukora intambwe ku yindi hamwe n'ingaruka zishobora gukemuka," bigatuma ikwiriye cyane cyane abarwayi bafite indwara zikomeye n'indwara zari zisanzweho.
Igikorwa gihuriweho icyarimwe: “Umurimo uhuriweho n'ibipimo bibiri icyarimwe,
Igisubizo cyo Guhagarara Rimwe”
Ku barwayi bafite indwara igaragara kandi bafite ubushobozi bwo kwihanganira indwara, abaganga bashobora guhitamo uburyo bwo "gukora icyarimwe". Mu gihe cyo kubagwa kimwe, amakipe ya ERCP na PTCS akora hamwe. Umuganga wa ERCP akoresha endoscope yo ku ruhande rw'amara, agakura papilla y'igifu hanyuma agashyiraho insinga ziyobora. Umuganga wa PTCS, ayobowe n'amashusho, acisha umwijima agakoresha choledochoscope kugira ngo amenye insinga ziyobora indwara za ERCP, bityo agere ku murongo mwiza w' "imiyoboro y'imbere n'iy'inyuma." Hanyuma ayo makipe yombi afatanya gukora lithotripsy, gukuraho amabuye, no gushyira stent.
Akamaro gakomeye k'ubu buryo ni uko bukemura ibibazo byinshi hakoreshejwe uburyo bumwe, bukuraho gukenera ikinya n'ububaji bwinshi, bigabanya cyane ukwezi k'ubuvuzi. Urugero, ku barwayi bafite amabuye y'imiyoboro y'amaraso yo mu mwijima n'amabuye y'imiyoboro y'amaraso yo mu bwoko bwa common bile, PTCS ishobora gukoreshwa icyarimwe mu gukuraho amabuye y'amaraso yo mu mwijima na ERCP mu gukemura amabuye y'imiyoboro y'amaraso yo mu bwoko bwa common bile, bikuraho gukenera ko abarwayi bakorerwa anesthesia no kubagwa inshuro nyinshi, binongera cyane imikorere myiza yo kuvura.
Urugero rufatika: Ni abahe barwayi bakeneye gupimwa inshuro ebyiri?
Si indwara zose zo mu nda zisaba gufotora hakoreshejwe ikoranabuhanga rya "dual-scope combined imaging". Gufotora hakoreshejwe ikoranabuhanga rya "dual-scope combined imaging" bibereye cyane cyane mu bibazo bigoye bidashobora gukemurwa hakoreshejwe uburyo bumwe, cyane cyane harimo ibi bikurikira:
Amabuye y’imiyoboro y’inkondo y’umura: Iyi ni yo ngingo y’ibanze ikoreshwa kuri CT ivanze n’ibice bibiri. Urugero, abarwayi bafite amabuye y’imiyoboro y’inkondo y’umura mu mwijima (cyane cyane aherereye ahantu kure nko mu gice cy’ibumoso cyangwa igice cy’inyuma cy’umwijima) n’amabuye y’imiyoboro y’inkondo y’umura; abarwayi bafite amabuye akomeye arengeje cm 2 z’umurambararo adashobora gukurwaho na ERCP yonyine; n’abarwayi bafite amabuye afungiye mu miyoboro y’inkondo y’umura ifunganye, bigatuma ibikoresho bya ERCP bitanyura. Ikoresheje CTCS ivanze n’ibice bibiri, CTCS “imenagura” amabuye manini kandi igakuraho amabuye ari mu mwijima, mu gihe ERCP “ikuraho” inzira zo hasi zituruka mu mara kugira ngo hirindwe ko amabuye asigara, bityo “igere ku gice cy’ibuye cyuzuye.”
Imiterere y'imiyoboro y'inkondo y'umura yo ku rwego rwo hejuru: Iyo imiterere y'imiyoboro y'inkondo y'umura iherereye hejuru y'umugongo w'umwijima (aho imiyoboro y'umwijima y'ibumoso n'iburyo ihurira), endoscope za ERCP ziragoye kuzibona, bigatuma bigorana gusuzuma neza ubukana n'impamvu y'imiterere y'inkondo y'umura. Muri ibi bihe, PTCS yemerera kureba neza imiterere y'inkondo y'umura binyuze mu nzira zo mu mwijima, bigatuma biopsies zemeza imiterere y'igisebe (nk'ububyimba cyangwa ikibyimba) mu gihe icyarimwe bikura cyangwa bigashyira stent. ERCP, ku rundi ruhande, yemerera gushyira stent hepfo, ikora nk'aho stent ya PTCS inyura, igenzura ko imiyoboro yose y'inkondo y'umura idakingiye.
Ingorane zo kubagwa ikinyabutabire nyuma yo kubagwa: Gutera ikinyabutabire mu mara, gutera ikinyabutabire mu mara, n'utubuye dusigaye bishobora kubaho nyuma yo kubagwa ikinyabutabire. Iyo umurwayi afite ibibazo bikomeye byo gufatana mu mara nyuma yo kubagwa kandi ERCP idashoboka, PTCS ishobora gukoreshwa mu kuvura no kuvura. Iyo stenosis ya anastomotic iboneka hejuru kandi ERCP idashobora kwaguka neza, PTCS ishobora guhuzwa no kwaguka kw'imitsi yombi kugira ngo hongerwe uburyo bwo kuvura.
Abarwayi badashobora kwihanganira kubagwa rimwe: Urugero, abarwayi bageze mu zabukuru cyangwa abarwayi bafite indwara zikomeye z’umutima n’ibihaha ntibashobora kwihanganira kubagwa igihe kirekire. Guhuza indorerwamo ebyiri bishobora kugabanya igikorwa gikomeye cyo kubagwa mo "kidatera cyane + kidatera cyane", bigabanya ibyago byo kubagwa n’umutwaro w’umubiri.
Icyerekezo cy'ejo hazaza: "Icyerekezo cyo kuvugurura" cy'ihuza ry'ibice bibiri
Hamwe n'iterambere ry'ikoranabuhanga, uruhurirane rwa ERCP na PTCS rukomeje gutera imbere. Ku ruhande rumwe, iterambere mu ikoranabuhanga ryo gufata amashusho riri gutuma habaho gutobora no gukora neza. Urugero, uruhurirane rwa ultrasound ya endoscopic intraoperative (EUS) na PTCS rushobora kubona imiterere y'imbere y'umuyoboro w'inkondo y'umura mu gihe nyacyo, bigabanya ingorane zo gutobora. Ku rundi ruhande, udushya mu bikoresho birimo gutuma ubuvuzi burushaho kuba bwiza. Urugero, choledoscopes zoroshye, probe za lithotripsy ziramba, na stent zishobora gutobora umubiri biri gutuma habaho guhuza kwa dual-scope kugira ngo birwanye ibisebe bigoye cyane.
Byongeye kandi, "robot-assisted dual-scope combined" yagaragaye nk'icyerekezo gishya cy'ubushakashatsi: hakoreshejwe sisitemu za roboti mu kugenzura endoscopes n'ibikoresho byo gutobora, abaganga bashobora gukora ibikorwa byoroshye ahantu heza, birushaho kunoza imikorere myiza n'umutekano wo kubaga. Mu gihe kizaza, hamwe no kwiyongera k'ubufatanye mu nzego zitandukanye (MDT), ERCP na PTCS bizahuzwa cyane na laparoscopy na interventional treatments, bitanga uburyo bwo gusuzuma no kuvura abarwayi bafite indwara z'inda ziterwa n'imiyoboro y'amaraso ku buryo bwihariye kandi bufite ireme.
Uburyo bwo gupima no kuvura indwara y’inkari bugizwe n’ibice bibiri (dual-scope) bwa ERCP na PTCS bugabanya imbogamizi z’uburyo bumwe bwo gusuzuma no kuvura indwara y’inkari, bugakemura indwara nyinshi zikomeye z’inkari hakoreshejwe uburyo budakunze kugaragara kandi bunoze. Ubufatanye bw’aba "bafite impano" ntibwigaragaza gusa iterambere ry’ikoranabuhanga mu buvuzi, ahubwo bunagaragaza uburyo bwo gusuzuma no kuvura umurwayi bushingiye ku murwayi. Buhindura ibyari bikenewe ko abarwayi bavurwa mu buryo bwa laparotomy mu buryo budakunze kugaragara, butuma abarwayi benshi bashobora gutsinda indwara zabo mu gihe bakomeza kugira ubuzima bwiza. Twizera ko hamwe n’iterambere ry’ikoranabuhanga rikomeje, ubwo buryo buzafungura ubushobozi bwinshi, buzana amahirwe mashya yo gusuzuma no kuvura indwara z’inkari.
Twebwe, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ni uruganda rukora ibikoresho byo mu Bushinwa rwihariye mu bikoresho bikoreshwa mu ikoranabuhanga, birimo umurongo wa GI nkaforceps za biopsy, hemoklip, umutego wa polyp, urushinge rwo kuvura sclerotherapy, katheteri itera umuti, uburoso bwa cytology, insinga y'ubuyobozi, agasanduku ko gukurura amabuye, katheteri itwara amazi mu mazuru, naSphincterotome n'ibindi. bikoreshwa cyane muriEMR, ESD, ERCP.
Ibicuruzwa byacu bifite icyemezo cya CE kandi byemejwe na FDA 510K, kandi inganda zacu zifite icyemezo cya ISO. Ibicuruzwa byacu byoherejwe mu Burayi, Amerika ya Ruguru, Uburasirazuba bwo Hagati no mu gice kimwe cya Aziya, kandi bihabwa abakiriya benshi icyubahiro n'ishimwe!
Igihe cyo kohereza: Ugushyingo-14-2025