ERCP Chalk-Stone Extraction Basket
Dengu lochotsa mwala ndilothandiza kwambiri pochotsa miyala muzowonjezera za ERCP.Kwa madotolo ambiri omwe ali atsopano ku ERCP, dengu lamwala lingakhalebe lokhazikika ku lingaliro la "zida zonyamulira miyala", ndipo sikokwanira kuthana ndi zovuta za ERCP.Lero, ndifotokoza mwachidule ndikuwerenga chidziwitso choyenera cha madengu amiyala a ERCP kutengera zomwe ndafunsa.
Magulu onse
Chidengu chotengera miyalacho chimagawidwa m'mabasiketi otsogola ndi mawaya, chidengu chopanda mawaya chosatsogolera, ndi dengu lophatikizika lochotsa miyala.Pakati pawo, mabasiketi ophatikizika obwezeretsa-ophwanya ndi mabasiketi wamba omwe amawunikidwa omwe amaimiridwa ndi Micro-Tech ndi Rapid Exchange (RX) mabasiketi othamangitsa omwe amaimiridwa ndi Boston Scientifi.Chifukwa mabasiketi ophatikizika otengera-crush ndi basiketi yosintha mwachangu ndi okwera mtengo kuposa mabasiketi wamba, mayunitsi ena ndi madotolo opangira opaleshoni amatha kuchepetsa kugwiritsa ntchito kwawo chifukwa chazovuta.Komabe, mosasamala kanthu za mtengo wongousiya, madotolo ambiri opangira opaleshoni amakhala okonzeka kugwiritsa ntchito dengu (lokhala ndi waya wowongolera) pogawanika, makamaka pamiyala yokulirapo pang'ono.
Malingana ndi mawonekedwe a dengu, akhoza kugawidwa mu "hexagonal", "diamondi" ndi "spiral", zomwe ndi diamondi, Dormia ndi spiral, zomwe zimagwiritsidwa ntchito kwambiri madengu a Dormia.Mabasiketi omwe ali pamwambawa ali ndi ubwino ndi kuipa kwawo, ndipo amayenera kusankhidwa mosinthasintha malinga ndi momwe zinthu zilili komanso zizolowezi zake zogwiritsira ntchito.
Chifukwa dengu lokhala ngati diamondi ndi dengu la Dormia ndilopangidwa ndi dengu losinthika lokhala ndi "mapeto otambasulidwa akutsogolo ndi malekezero ochepetsedwa", zitha kukhala zosavuta kuti dengu litulutse miyala.Ngati mwalawo sungathe kuutulutsa pambuyo potsekeredwa chifukwa mwalawo ndi waukulu kwambiri, dengulo likhoza kumasulidwa bwinobwino, kuti musachite ngozi zochititsa manyazi.
Wamba "diamondi" dengu
Madengu okhazikika a "hexagon-rhombus" amagwiritsidwa ntchito kawirikawiri, kapena mumadengu ophwanyira miyala okha.Chifukwa cha danga lalikulu la dengu la "diamondi", ndizosavuta kuti miyala yaying'ono ituluke mudengu.Dengu looneka ngati lozungulira lili ndi mawonekedwe "osavuta kuvala koma osavuta kumasula".Kugwiritsa ntchito dengu looneka ngati spiral kumafuna kumvetsetsa bwino mwalawo komanso momwe angagwiritsire ntchito kuti miyalayo isamamatire momwe mungathere.
Spiral basket
Dengu losinthana mwachangu lomwe limaphatikizidwa ndi kuphwanya ndi kuphwanya limagwiritsidwa ntchito pochotsa miyala yayikulu, yomwe imatha kufupikitsa nthawi yogwira ntchito ndikuwongolera bwino kuphwanya.Kuonjezera apo, ngati dengu liyenera kugwiritsidwa ntchito pojambula, chosiyanitsacho chikhoza kutsukidwa kale ndikutha chidengucho chisanalowe mu bile.
Chachiwiri, kupanga ndondomeko
Kapangidwe kake kadengu kakang'ono kamene kamapangidwa ndi tsinde ladengu, chigoba chakunja ndi chogwirira.Pakatikati pa basket wapangidwa ndi basket waya (titanium-nickel alloy) ndi kukoka waya (304 chitsulo chosapanga dzimbiri chamankhwala).Waya wadengu ndi mawonekedwe opangidwa ndi alloy, ofanana ndi mapangidwe opangidwa ndi msampha, omwe amathandiza kulanda chandamale, kuteteza kutsetsereka, ndi kusunga kupsinjika kwakukulu ndipo sikuli kosavuta kusweka.Waya wokoka ndi waya wapadera wazachipatala wokhala ndi mphamvu zolimba komanso zolimba, kotero sindifotokoza mwatsatanetsatane apa.
Mfundo yofunika kukambapo ndi mmene kuwotcherera pakati pa waya wokoka ndi waya wadengu, waya wadengu ndi mutu wachitsulo wadengu.Makamaka, malo owotcherera pakati pa waya wokoka ndi waya wadengu ndiyofunikira kwambiri.Kutengera kapangidwe kameneka, zofunikira pakuwotcherera ndizokwera kwambiri.Dengu lomwe silili bwino pang'ono silingalephere kuphwanya mwala komanso kupangitsa kuti nsonga yowotcherera yomwe ili pakati pa waya wokoka ndi waya wa mesh dengu kuthyoka panthawi yophwanya mwala utachotsedwa, zomwe zimapangitsa kuti dengu ndi mwala wotsalira mu njira ya ndulu, ndi kuchotsedwa kotsatira.Zovuta (nthawi zambiri zimatha kubwezedwa ndi dengu lachiwiri) ndipo zingafunike opaleshoni.
Kuwotcherera kosauka kwa waya ndi mutu wachitsulo wa madengu ambiri wamba kungachititse kuti dengu lisyoke mosavuta.Komabe, madengu a Boston Scientific ayesetsa kwambiri pankhaniyi ndikupanga njira yotetezera chitetezo.Izi zikutanthauza kuti, ngati miyalayo sichitha kuthyoledwa ndi miyala yothamanga kwambiri, dengu lomwe limamangiriza miyalayo limatha kuteteza mutu wachitsulo kutsogolo kwa dengu kuti zitsimikizire kusakanikirana kwa waya wadengu ndi waya wokoka.Kukhulupirika, potero kupewa madengu ndi miyala yotsalira munjira ya ndulu.
Sindidzafotokoza zambiri za chubu lakunja la sheath ndi chogwirira.Kuphatikiza apo, opanga ma crusher osiyanasiyana amiyala adzakhala ndi zophwanya miyala zosiyanasiyana, ndipo ndidzakhala ndi mwayi wodziwa zambiri pambuyo pake.
Momwe mungagwiritsire ntchito
Kuchotsa miyala m'ndende ndi chinthu chovuta kwambiri.Izi zitha kukhala kunyalanyazidwa kwa woyendetsa za mkhalidwe wa wodwalayo ndi zida zake, kapena zitha kukhala gawo la miyala ya ndulu.Mulimonse mmene zingakhalire, choyamba tiyenera kudziwa mmene tingapewere kutsekeredwa m’ndende, ndiyeno tiyenera kudziwa chochita ngati kumangidwa kwachitika.
Pofuna kupewa kutsekeredwa m'ndende, baluni ya columnar iyenera kugwiritsidwa ntchito kukulitsa pobowola nsonga zamabele musanazule mwala.Njira zina zomwe zingagwiritsidwe ntchito kuchotsa dengu lomangidwa ndi izi: kugwiritsa ntchito dengu lachiwiri (basket-basket) ndi kuchotsa opaleshoni, ndipo nkhani yaposachedwa yanenanso kuti theka (2 kapena 3) la mawaya akhoza kuwotchedwa APC.kuswa, ndi kumasula dengu lomangidwa.
Chachinayi, chithandizo cha kutsekera mtanga mwala
Kugwiritsa ntchito dengu makamaka kumaphatikizapo: kusankha kwa dengu ndi zomwe zili mudengu kuti zitenge mwala.Pankhani ya kusankha basket, zimatengera mawonekedwe a dengu, kukula kwa dengu, komanso kugwiritsa ntchito kapena kupulumutsa mwadzidzidzi lithotripsy (nthawi zambiri, malo a endoscopy amakonzedwa nthawi zonse).
Pakalipano, dengu la "diamondi" limagwiritsidwa ntchito mobwerezabwereza, ndiko kuti, dengu la Dormia.Mu chitsogozo cha ERCP, dengu lamtunduwu limatchulidwa momveka bwino mu gawo la kuchotsa miyala pamiyala wamba ya bile.Ili ndi chiwongolero chapamwamba cha kuchotsa miyala ndipo ndi yosavuta kuchotsa.Ndilo kusankha kwa mzere woyamba pakuchotsa miyala yambiri.Kwa kukula kwa dengu, dengu lolingana liyenera kusankhidwa molingana ndi kukula kwa mwala.Ndizosamveka kunena zambiri za kusankha kwamitundu yamabasiketi, chonde sankhani malinga ndi zizolowezi zanu.
Maluso ochotsa miyala: Dengu limayikidwa pamwamba pa mwala, ndipo mwalawo umayesedwa poyang'aniridwa ndi angiographic.Inde, EST kapena EPBD iyenera kuchitidwa molingana ndi kukula kwa mwala musanatenge mwala.Pamene njira ya ndulu yavulala kapena yopapatiza, sipangakhale malo okwanira kuti mutsegule dengu.Iyenera kutengedwa molingana ndi momwe zinthu zilili.Ndi mwayi wopeza njira yotumizira mwalawo kumalo otakasuka a ndulu kuti ukatengedwe.Kwa miyala ya hilar bile duct, ziyenera kudziwidwa kuti miyalayo idzakankhidwira m'chiwindi ndipo sichingatengedwenso pamene dengu likuchotsedwa mudengu kapena kuyesa.
Pali zikhalidwe ziwiri zochotsa miyala mumtanga wamwala: imodzi ndi yakuti pali malo okwanira pamwamba pa mwalawo kapena pambali pa mwala kuti dengu litseguke;china ndikupewa kutenga miyala yayikulu kwambiri, ngakhale dengu litatsegulidwa kwathunthu, silingatulutsidwe.Takumananso ndi miyala ya 3 cm yomwe idachotsedwa pambuyo pa endoscopic lithotripsy, yonse yomwe iyenera kukhala lithotripsy.Komabe, izi zikadali zowopsa ndipo zimafunikira dokotala wodziwa zambiri kuti achite opaleshoni.
Nthawi yotumiza: May-13-2022