Pakuzindikira ndi kuchiza matenda a biliary, chitukuko chaukadaulo wa endoscopic nthawi zonse chimayang'ana zolinga zakulondola kwambiri, kusalowerera pang'ono, komanso chitetezo chochulukirapo. Endoscopic retrograde cholangiopancreatography (ERCP), njira yowunikira komanso chithandizo cha matenda a biliary, yakhala ikuvomerezedwa kwanthawi yayitali chifukwa chosapanga opaleshoni komanso kusokoneza pang'ono. Komabe, mukakumana ndi zotupa zovuta za biliary, njira imodzi nthawi zambiri imakhala yochepa. Apa ndi pamene percutaneous transhepatic cholangioscopy (PTCS) imakhala yothandiza kwambiri ku ERCP. Njira yophatikizika iyi ya "dual-scope" imadutsa malire amankhwala achikhalidwe ndikuwapatsa odwala njira yatsopano yodziwira matenda ndi chithandizo.
ERCP ndi PTCS aliyense ali ndi luso lawo lapadera.
Kuti timvetsetse mphamvu ya kugwiritsiridwa ntchito kophatikizana kwapawiri, choyamba munthu ayenera kumvetsetsa bwino luso lapadera la zida ziwirizi. Ngakhale zonsezi ndi zida zowunikira komanso kuchiza matenda a biliary, amagwiritsa ntchito njira zosiyanasiyana, zomwe zimapangitsa kuti pakhale chothandizira.
ERCP: Katswiri wa Endoscopic Kulowa mu Digestive Tract
ERCP imayimira Endoscopic Retrograde Cholangiopancreatography. Ntchito yake ikufanana ndi njira yozungulira yochitira zinthu. Dokotala amalowetsa duodenoscope m'kamwa, kum'mero, ndi m'mimba, ndipo pamapeto pake amafika ku duodenum. Dokotala amapeza matumbo a bile ndi pancreatic ducts (duodenal papilla). Kenako catheter imayikidwa kudzera pa endoscopic biopsy port. Pambuyo pobaya jekeseni wosiyanitsa, kuyezetsa kwa X-ray kapena ultrasound kumachitika, kupangitsa kuti azindikire za bile ndi pancreatic ducts.
Pamaziko awa,ERCPAthanso kuchita njira zingapo zochizira: mwachitsanzo, kukulitsa ma ducts ocheperako ndi baluni, kutsegula ndime zotsekeka ndi ma stents, kuchotsa miyala munjira ya ndulu ndi dengu lochotsa miyala, ndikupeza minofu yodwala kuti ifufuze matenda pogwiritsa ntchito biopsy forceps. Ubwino wake waukulu umakhala kuti umagwira ntchito monse kudzera m'mitsempha yachilengedwe, ndikuchotsa kufunikira kwa kudulidwa pamwamba. Izi zimathandiza kuchira msanga pambuyo pa opaleshoni komanso kusokoneza kochepa kwa thupi la wodwalayo. Ndiwoyenera kwambiri pochiza zovuta za ndulu pafupi ndi matumbo, monga miyala yapakati ndi yotsika ya ndulu, kutsika kwa ndulu, ndi zotupa pa pancreatic ndi bile duct junction.
Komabe, ERCP imakhalanso ndi "zofooka" zake: ngati kutsekeka kwa bile kumakhala koopsa ndipo ndulu sichikhoza kutulutsidwa bwino, wothandizira wosiyanitsa adzakhala ndi vuto lodzaza njira yonse ya bile, zomwe zidzakhudza kulondola kwa matendawa; kwa miyala ya intrahepatic bile duct (makamaka miyala yomwe ili mkati mwa chiwindi) ndi malo apamwamba a bile duct stenosis (pafupi ndi chiwindi cha hilum ndi pamwamba), zotsatira za mankhwala nthawi zambiri zimachepetsedwa kwambiri chifukwa endoscope "singathe kufika" kapena malo opangira opaleshoni ndi ochepa.
PTCS: Mpainiya Wokhazikika Wodutsa Pachiwindi
PTCS, kapena percutaneous transhepatic choledochoscopy, imagwiritsa ntchito njira ya "kunja," mosiyana ndi njira ya "mkati-kunja" ya ERCP. Poyang'aniridwa ndi ultrasound kapena CT, dokotalayo amaboola khungu pachifuwa chakumanja kapena pamimba pa wodwalayo, ndikudutsa m'chiwindi ndikulowa munjira ya intrahepatic intrahepatic bile duct, ndikupanga njira yopangira "khungu-chiwindi-bile duct". Choledochoscope imalowetsedwa kudzera mumsewuwu kuti ayang'ane njira ya intrahepatic bile panthawi imodzimodziyo akuchiritsa monga kuchotsa miyala, lithotripsy, dilation of strictures, ndi kuika stent.
"Chida chakupha" cha PTCS chagona pakutha kufikira zotupa za intrahepatic bile ducts. Ndiwodziwa kwambiri kuthana ndi "mavuto akuya" ovuta kuwapeza ndi ERCP: mwachitsanzo, miyala yayikulu ya ndulu yopitilira 2 cm, "miyala ingapo" yomwe imamwazika munthambi zambiri za intrahepatic bile duct, zotumphukira zapamwamba za bile zomwe zimayambitsidwa ndi zotupa kapena kutupa, ndi zovuta zovuta monga anastomotic stenosis yomwe imachitika pambuyo pa opaleshoni ya bile. Komanso, pamene odwala sangathe kudwala ERCP chifukwa cha zifukwa monga duodenal papillary malformation ndi kutsekeka kwa m'mimba, PTCS ikhoza kukhala njira ina, kukhetsa ndulu mofulumira ndi kuchepetsa jaundice, potero kugula nthawi ya chithandizo chotsatira.
Komabe, PTCS si yangwiro: chifukwa imafunika kubaya pamwamba pa thupi, zovuta monga magazi, kutuluka kwa bile, ndi matenda amatha kuchitika. Nthawi yochira pambuyo pa opaleshoni ndi yotalikirapo pang'ono kuposa ERCP, ndipo ukadaulo woboola adotolo ndi kulondola kwachitsogozo kwazithunzi ndizokwera kwambiri.
Kuphatikiza Kwamphamvu: Lingaliro la "Synergistic Operation" yokhala ndi Dual-Scope Combination
Pamene "endovascular ubwino" wa ERCP ukukumana ndi "percutaneous ubwino" wa PTCS, awiriwa sakhalanso ndi njira imodzi yokha, koma m'malo mwake amapanga ndondomeko yowonetsera matenda ndi mankhwala omwe "amakhudza mkati ndi kunja kwa thupi." Kuphatikizika kumeneku sikungowonjezera umisiri wamba, koma pulani ya “1+1>2” yogwirizana ndi mmene wodwalayo alili.
Kuphatikizika kwa Sequential: "Tsegulani Njira Choyamba, Kenako Kuchiza Molondola"
Iyi ndiye njira yophatikizira yodziwika bwino, yomwe nthawi zambiri imatsatira mfundo ya "kukhetsa madzi Choyamba, Kuchiza Pambuyo pake." Mwachitsanzo, kwa odwala kwambiri obstructive jaundice chifukwa cha intrahepatic ndulu duct miyala, sitepe yoyamba ndi kukhazikitsa biliary ngalande ngalande kudzera PTCS puncture kukhetsa anasonkhanitsa ndulu, kuchepetsa kuthamanga kwa chiwindi, kuchepetsa chiopsezo cha matenda, ndipo pang`onopang`ono kubwezeretsa chiwindi ntchito ndi thupi la wodwalayo. Mkhalidwe wa wodwalayo ukakhazikika, ERCP imachitidwa kuchokera m'mimba kuti ichotse miyala yomwe ili m'munsi mwa njira ya ndulu, kuchiza zotupa mu duodenal papilla, ndi kukulitsa njira ya ndulu pogwiritsa ntchito baluni kapena stent.
Mosiyana ndi zimenezi, ngati wodwala akukumana ndi ERCP ndipo amapezeka kuti ali ndi miyala yotsalira ya chiwindi kapena stenosis yapamwamba yomwe sichitha kuchiritsidwa, PTCS ingagwiritsidwe ntchito pomaliza "ntchito yomaliza" pambuyo pake. Chitsanzochi chimapereka ubwino wa "njira ya sitepe ndi sitepe yokhala ndi zoopsa zomwe zingatheke," zomwe zimapangitsa kuti zikhale zoyenera makamaka kwa odwala omwe ali ndi zovuta komanso thanzi lomwe linalipo kale.
Ntchito Yophatikiza Nthawi Imodzi: "Kugwira Ntchito Pamodzi Pamodzi,
Single-Stop Solution”
Kwa odwala omwe ali ndi matenda odziwika bwino komanso kulolerana kwabwino kwa thupi, madokotala angasankhe njira "yophatikizana nthawi imodzi". Pa opaleshoni yomweyi, magulu a ERCP ndi PTCS amagwira ntchito limodzi. Dokotala wa opaleshoni wa ERCP amagwiritsa ntchito endoscope kuchokera kumbali ya matumbo, kukulitsa duodenal papilla ndikuyika waya wowongolera. Dokotala wa opaleshoni wa PTCS, motsogozedwa ndi kujambula, amaboola pachiwindi ndikugwiritsa ntchito choledochoscope kuti apeze chowongolera choyikidwa ndi ERCP, ndikukwaniritsa kulondola kwa "njira zamkati ndi zakunja." Magulu awiriwa amalumikizana kuti apange lithotripsy, kuchotsa miyala, ndikuyika ma stent.
Ubwino waukulu wa chitsanzo ichi ndikuti umakhudza nkhani zambiri ndi ndondomeko imodzi, kuchotsa kufunikira kwa anesthesia angapo ndi opaleshoni, kuchepetsa kwambiri njira ya chithandizo. Mwachitsanzo, kwa odwala omwe ali ndi miyala ya intrahepatic bile duct komanso miyala yodziwika bwino ya bile, PTCS ingagwiritsidwe ntchito nthawi imodzi kuchotsa miyala ya intrahepatic ndi ERCP kuthana ndi miyala wamba ya bile, kuchotseratu kufunikira kwa odwala kuti adutse maulendo angapo a anesthesia ndi opaleshoni, kuwongolera kwambiri chithandizo chamankhwala.
Zochitika Zomwe Zingachitike: Ndi Odwala Ati Amene Amafuna Kuphatikizika Kwapawiri?
Sikuti matenda onse a biliary amafunikira kuyerekeza kwapawiri-kuphatikizana. Kujambula kophatikizana kwapawiri ndikoyenera makamaka pamilandu yovuta yomwe singathe kuyankhidwa ndi njira imodzi, makamaka kuphatikiza izi:
Miyala yovuta kwambiri ya bile duct: Iyi ndiye njira yoyamba yogwiritsira ntchito ma CT amitundu iwiri. Mwachitsanzo, odwala omwe ali ndi miyala ya intrahepatic bile duct (makamaka yomwe ili kumadera akutali monga lobe lakumanzere lakumanzere kapena kumanja kwa chiwindi) ndi miyala yodziwika bwino ya bile; odwala omwe ali ndi miyala yolimba yopitilira 2 cm m'mimba mwake yomwe singathe kuchotsedwa ndi ERCP yokha; ndi odwala omwe ali ndi miyala yotsekeredwa munjira zochepetsetsa za bile, kulepheretsa zida za ERCP kupita. Pogwiritsa ntchito maulendo awiri ophatikizana a CTCS, CTCS "imathyola" miyala ikuluikulu ndikuchotsa miyala yanthambi m'chiwindi, pamene ERCP "imachotsa" matumbo a m'munsi kuti ateteze miyala yotsalira, kukwaniritsa "mwala wathunthu."
Mitsempha ya ndulu yapamwamba kwambiri: Pamene ma ducts a bile amakhala pamwamba pa hepatic hilum (pamene njira ya kumanzere ndi kumanja ya chiwindi imakumana), ma endoscopes a ERCP amakhala ovuta kufika, zomwe zimapangitsa kuti zikhale zovuta kuyesa molondola kuuma kwake ndi chifukwa chake. Pazifukwa izi, PTCS imalola kuwonetsetsa kwachindunji kwazitsulozo kudzera mu njira za intrahepatic, kulola kuti ma biopsies atsimikizire mtundu wa chotupacho (monga kutupa kapena chotupa) panthawi imodzimodziyo kutulutsa baluni kapena kuika stent. ERCP, kumbali ina, imalola kuyika kwa stent pansipa, yomwe imakhala ngati relay kwa PTCS stent, kuonetsetsa kuti madzi amadzimadzi amtundu wonse wa bile.
Zovuta za pambuyo pa opaleshoni ya biliary: Anastomotic stenosis, bile fistula, ndi miyala yotsalira ikhoza kuchitika pambuyo pa opaleshoni ya biliary. Ngati wodwalayo ali ndi matumbo akuluakulu a m'mimba pambuyo pa opaleshoni ndipo ERCP sizingatheke, PTCS ingagwiritsidwe ntchito pochotsa madzi ndi kuchiza. Ngati anastomotic stenosis ili pamwamba ndipo ERCP sichitha kufalikira, PTCS ikhoza kuphatikizidwa ndi kufalikira kwa mayiko awiri kuti apititse patsogolo chithandizo chamankhwala.
Odwala omwe sangathe kupirira opaleshoni imodzi: Mwachitsanzo, odwala okalamba kapena odwala omwe ali ndi matenda aakulu a mtima wamtima sangathe kupirira opaleshoni imodzi yaitali. Kuphatikizika kwa magalasi awiri kungathe kugawaniza ntchito yovutayi kukhala "yosokoneza pang'ono + yochepa", kuchepetsa zoopsa za opaleshoni ndi kulemedwa kwa thupi.
Tsogolo la Tsogolo: "Mayendedwe Okweza" a Dual-Scope Combination
Ndi kupita patsogolo kwaukadaulo, kuphatikiza kwa ERCP ndi PTCS kukupitilizabe kusinthika. Kumbali imodzi, kupita patsogolo kwaukadaulo wamajambula kumapangitsa kuti ma punctures ndi njira zolondola kwambiri. Mwachitsanzo, kuphatikizika kwa intraoperative endoscopic ultrasound (EUS) ndi PTCS kumatha kuwonetsa mawonekedwe amkati a bile duct mu nthawi yeniyeni, kuchepetsa zovuta zopumira. Kumbali inayi, zatsopano mu zida zikupanga chithandizo chamankhwala bwino. Mwachitsanzo, ma choledochoscopes osinthika, ma probes olimba kwambiri a lithotripsy, ndi ma stents opangidwa ndi bioresorbable amathandizira kuphatikiza kwamitundu iwiri kuthana ndi zotupa zovuta kwambiri.
Kuphatikiza apo, "robot-assisted dual-scope together" yatulukira ngati njira yatsopano yofufuzira: pogwiritsa ntchito makina a robotic kuwongolera ma endoscopes ndi zida zoboola, madotolo amatha kuchitapo kanthu m'malo omasuka, kupititsa patsogolo kulondola kwa maopaleshoni ndi chitetezo. M'tsogolomu, ndi kuwonjezeka kwa mgwirizano wamagulu osiyanasiyana (MDT), ERCP ndi PTCS zidzaphatikizidwanso ndi laparoscopy ndi chithandizo chothandizira, kupereka chithandizo chaumwini komanso chapamwamba komanso njira zothandizira odwala omwe ali ndi matenda a biliary.
Kuphatikizika kwapawiri kwa ERCP ndi PTCS kumaphwanya malire a njira imodzi yodziwira matenda a biliary ndi chithandizo, kuthana ndi matenda ambiri ovuta a biliary omwe ali ndi njira yocheperako komanso yolondola. Kugwirizana kwa "duo aluso" awa sikungowonetsa kupita patsogolo kwaukadaulo wamankhwala komanso kumaphatikiza njira yokhazikika ya odwala pakuzindikira matenda ndi chithandizo. Zimasintha zomwe poyamba zinkafuna laparotomy yaikulu kukhala chithandizo chochepa kwambiri chokhala ndi zovuta zochepa komanso kuchira msanga, kulola odwala ambiri kugonjetsa matenda awo pokhalabe ndi moyo wapamwamba. Tikukhulupirira kuti ndikupita patsogolo kwaukadaulo, kuphatikiza kwapawiri kudzatsegula luso lochulukirapo, kubweretsa mwayi watsopano wozindikira ndi kuchiza matenda a biliary.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China okhazikika pazakudya zama endoscopic, kuphatikiza GI mzere mongabiopsy forceps, hemoclip, polyp msampha, sclerotherapy singano, kupopera catheter, maburashi a cytology, guidewire, dengu lochotsa miyala, catheter ya nasal biliary drainage,ndiSphincterotome etc. zomwe zimagwiritsidwa ntchito kwambiri muEMR, ESD, ERCP.
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Nthawi yotumiza: Nov-14-2025