Pakuzindikira ndi kuchiza matenda a biliary, chitukuko cha ukadaulo wa endoscopic chakhala chikuyang'ana kwambiri zolinga za kulondola kwambiri, kuchepetsa kulowererapo, komanso chitetezo chachikulu. Endoscopic retrograde cholangiopancreatography (ERCP), njira yodziwira ndi kuchiza matenda a biliary, yakhala ikuvomerezedwa kwa nthawi yayitali chifukwa cha kusachita opaleshoni komanso kulowererapo pang'ono. Komabe, ikakumana ndi zilonda zovuta za biliary, njira imodzi nthawi zambiri imalephera. Apa ndi pomwe percutaneous transhepatic cholangioscopy (PTCS) imakhala yowonjezera yofunika kwambiri ku ERCP. Njira yophatikizana iyi ya "dual-scope" imadutsa malire a chithandizo chachikhalidwe ndipo imapatsa odwala njira yatsopano yodziwira ndi kuchiza.
ERCP ndi PTCS aliyense ali ndi luso lake lapadera.
Kuti mumvetse mphamvu ya kugwiritsa ntchito njira ziwiri pamodzi, choyamba muyenera kumvetsetsa bwino luso lapadera la zida ziwirizi. Ngakhale kuti zonsezi ndi zida zodziwira matenda a ndulu ndi chithandizo, zimagwiritsa ntchito njira zosiyanasiyana, zomwe zimapangitsa kuti zikhale zowonjezera bwino.
ERCP: Katswiri wa Endoscopic Wolowa mu Njira Yogaya Chakudya
ERCP imayimira Endoscopic Retrograde Cholangiopancreatography. Ntchito yake ikufanana ndi njira yozungulira yochitira zinthu. Dokotala amaika duodenoscope kudzera pakamwa, m'mero, ndi m'mimba, kenako n’kufika ku duodenum yotsika. Dokotalayo amapeza matumbo a ndulu ndi pancreatic ducts (duodenal papilla). Kenako catheter imayikidwa kudzera mu endoscopic biopsy port. Pambuyo pobaya contrast agent, X-ray kapena ultrasound imachitidwa, zomwe zimathandiza kuzindikira ndulu ndi pancreatic ducts m'maso.
Pachifukwa ichi,ERCPAngathenso kuchita njira zosiyanasiyana zochiritsira: mwachitsanzo, kukulitsa njira zodulira ndulu zopapatiza ndi baluni, kutsegula njira zotsekeka ndi stent, kuchotsa miyala mu njira yodulira ndulu ndi dengu lochotsera miyala, ndikupeza minofu yodwala kuti iwunikenso matenda pogwiritsa ntchito biopsy forceps. Ubwino wake waukulu uli m'chakuti imagwira ntchito yonse kudzera m'bowo lachilengedwe, kuchotsa kufunikira kodula pamwamba. Izi zimathandiza kuti wodwalayo achire mwachangu pambuyo pa opaleshoni komanso kuchepetsa kusokonezeka kwa thupi. Ndi yoyenera kwambiri pochiza mavuto a njira yodulira ndulu pafupi ndi matumbo, monga miyala yomwe ili pakati ndi pansi pa njira yodulira ndulu, kutsekeka kwa njira yodulira ndulu, ndi zilonda pa malo olumikizirana ndulu ndi njira yodulira ndulu.
Komabe, ERCP ilinso ndi "zofooka" zake: ngati kutsekeka kwa ndulu kuli kwakukulu ndipo ndulu singathe kutulutsidwa bwino, choyezera chosiyanitsa chidzakhala chovuta kudzaza ndulu yonse, zomwe zidzakhudza kulondola kwa matenda; pa miyala ya ndulu ya intrahepatic (makamaka miyala yomwe ili mkati mwa chiwindi) ndi stenosis ya ndulu yokhazikika (pafupi ndi hilum ya chiwindi ndi pamwambapa), zotsatira za chithandizo nthawi zambiri zimachepa kwambiri chifukwa endoscope "singathe kufikira" kapena malo ogwirira ntchito ndi ochepa.
PTCS: Woyambitsa Wachiwindi Wodutsa Pamwamba pa Chiwindi
PTCS, kapena percutaneous transhepatic choledochoscopy, imagwiritsa ntchito njira ya "kunja-mkati", mosiyana ndi njira ya "mkati-kunja" ya ERCP. Motsogozedwa ndi ultrasound kapena CT, dokotalayo amaboola khungu pachifuwa chamanja cha wodwalayo kapena pamimba, kudutsa minofu ya chiwindi ndikupeza njira yotambasula ya bile ya intrahepatic, ndikupanga ngalande yopangira ya "khungu-chiwindi-bile". Kenako choledoscope imayikidwa kudzera mu ngalande iyi kuti ione mwachindunji njira ya bile ya intrahepatic pamene ikuchita nthawi yomweyo chithandizo monga kuchotsa miyala, lithotripsy, kukulitsa strictures, ndi kuyika stent.
"Chida chopha" cha PTCS chili ndi kuthekera kwake kufikira mwachindunji zilonda za duct ya bile mkati mwa chiwindi. Ndi katswiri kwambiri pothana ndi "mavuto akuya" ovuta kuwafikira ndi ERCP: mwachitsanzo, miyala ikuluikulu ya duct ya bile yoposa 2 cm m'mimba mwake, "miyala ingapo" yofalikira m'nthambi zambiri za duct ya bile mkati mwa chiwindi, kutsekeka kwa duct ya bile komwe kumakhalapo chifukwa cha zotupa kapena kutupa, komanso zovuta monga anastomotic stenosis ndi bile fistula zomwe zimachitika pambuyo pa opaleshoni ya duct. Kuphatikiza apo, odwala akalephera kuchita ERCP chifukwa cha zifukwa monga malformation ya duodenal papillary ndi kutsekeka kwa matumbo, PTCS ikhoza kukhala njira ina, kutulutsa duct ya bile mwachangu ndikuchepetsa jaundice, motero kupeza nthawi yoti alandire chithandizo china.
Komabe, PTCS si yangwiro: popeza imafuna kuboola pamwamba pa thupi, mavuto monga kutuluka magazi, kutuluka kwa ndulu, ndi matenda amatha kuchitika. Nthawi yochira pambuyo pa opaleshoni ndi yayitali pang'ono kuposa ERCP, ndipo ukadaulo wa dokotala woboola ndi kulondola kwa chitsogozo cha chithunzi ndipamwamba kwambiri.
Kuphatikiza Kwamphamvu: Malingaliro a "Kugwira Ntchito Mogwirizana" ndi Kuphatikizana kwa Dual-Scope
Pamene "ubwino wa endovascular" wa ERCP ukukwaniritsa "ubwino wa percutaneous" wa PTCS, awiriwa samangokhala njira imodzi yokha, koma m'malo mwake amapanga njira yodziwira matenda ndi chithandizo chomwe "chimagwira ntchito mkati ndi kunja kwa thupi." Kuphatikiza kumeneku si njira yophweka yowonjezeramo ukadaulo, koma ndi dongosolo la "1+1>2" lopangidwa ndi munthu payekha logwirizana ndi mkhalidwe wa wodwalayo. Lili makamaka ndi mitundu iwiri: "yophatikizana motsatizana" ndi "yophatikizana nthawi imodzi."
Kuphatikiza Kotsatizana: "Tsegulani Njira Choyamba, Kenako Chithandizo Cholondola"
Iyi ndi njira yodziwika bwino yophatikizana, nthawi zambiri kutsatira mfundo ya "kutulutsa madzi m'thupi Choyamba, Chithandizo Pambuyo pake." Mwachitsanzo, kwa odwala omwe ali ndi vuto la jaundice lotsekeka kwambiri lomwe limayamba chifukwa cha miyala ya ndulu ya chiwindi, gawo loyamba ndikukhazikitsa njira yotulutsira madzi m'chiwindi kudzera mu PTCS kuti atulutse ndulu yosonkhanitsidwa, kuchepetsa kuthamanga kwa chiwindi, kuchepetsa chiopsezo cha matenda, ndikubwezeretsa pang'onopang'ono ntchito ya chiwindi cha wodwalayo komanso momwe thupi lake lilili. Matenda a wodwalayo akakhazikika, ERCP imachitidwa kuchokera m'matumbo kuti achotse miyala mu ndulu ya ndulu yapansi, kuchiza zilonda mu duodenal papilla, ndikuwonjezera kuuma kwa ndulu pogwiritsa ntchito baluni kapena stent.
Mosiyana ndi zimenezi, ngati wodwala achita ERCP ndipo apezeka kuti ali ndi miyala yotsala ya chiwindi kapena stenosis yapamwamba yomwe singathe kuchiritsidwa, PTCS ingagwiritsidwe ntchito kumaliza "ntchito yomaliza" pambuyo pake. Chitsanzochi chimapereka ubwino wa "njira yotsatizana ndi pang'ono yokhala ndi zoopsa zomwe zingatheke," zomwe zimapangitsa kuti ikhale yoyenera kwambiri kwa odwala omwe ali ndi matenda ovuta komanso omwe analipo kale.
Ntchito Yophatikizana Pamodzi: “Ntchito Yophatikizana Pamodzi,
Yankho Loyimitsa Limodzi”
Kwa odwala omwe ali ndi matenda omveka bwino komanso omwe ali ndi mphamvu zotha kupirira bwino thupi, madokotala angasankhe njira "yophatikizana nthawi imodzi". Pa opaleshoni yomweyo, magulu a ERCP ndi PTCS amagwira ntchito limodzi. Dokotala wa opaleshoni ya ERCP amagwiritsa ntchito endoscope kuchokera m'matumbo, ndikukulitsa duodenal papilla ndikuyika waya wotsogolera. Dokotala wa opaleshoni ya PTCS, motsogozedwa ndi kujambula zithunzi, amaboola chiwindi ndikugwiritsa ntchito choledochoscope kuti apeze waya wotsogolera womwe uli ndi ERCP, kuti akwaniritse bwino "njira zamkati ndi zakunja." Magulu awiriwa kenako amagwirira ntchito limodzi kuti achite lithotripsy, kuchotsa miyala, ndi kuika stent.
Ubwino waukulu wa chitsanzochi ndikuti chimathetsa mavuto ambiri pogwiritsa ntchito njira imodzi, kuchotsa kufunikira kwa opaleshoni yambiri, kuchepetsa kwambiri nthawi yochizira. Mwachitsanzo, kwa odwala omwe ali ndi miyala ya bile duct ya m'chiwindi ndi miyala ya duct ya bile, PTCS ingagwiritsidwe ntchito nthawi imodzi kuchotsa miyala ya intrahepatic ndi ERCP kuti ithetse miyala ya bile duct ya m'chiwindi, kuchotsa kufunikira kwa odwala kuti achite opaleshoni yambiri, zomwe zimapangitsa kuti chithandizo chikhale bwino.
Chitsanzo Choyenera: Ndi Odwala Ati Omwe Amafunika Kusakaniza Kawiri-Scope?
Si matenda onse a biliary omwe amafuna kujambula zithunzi zophatikizana za dual-scope. Kujambula zithunzi zophatikizana za dual-scope ndikofunikira makamaka pazochitika zovuta zomwe sizingathe kuthetsedwa ndi njira imodzi, makamaka kuphatikiza izi:
Miyala ya ndulu yovuta: Iyi ndiyo njira yoyamba yogwiritsira ntchito CT yophatikizana ndi ma scope awiri. Mwachitsanzo, odwala omwe ali ndi miyala ya ndulu ya intrahepatic (makamaka yomwe ili m'malo akutali monga kumanzere kwamanzere kapena kumanja kwa kumbuyo kwa chiwindi) ndi miyala ya ndulu yodziwika bwino; odwala omwe ali ndi miyala yolimba yoposa 2 cm m'mimba mwake yomwe singachotsedwe ndi ERCP yokha; ndi odwala omwe ali ndi miyala yomwe ili m'mitsempha ya ndulu yopapatiza, zomwe zimalepheretsa kuti zida za ERCP zisadutse. Pogwiritsa ntchito CTCS yophatikizana ndi ma scope awiri, CTCS "imaswa" miyala ikuluikulu ndikuchotsa miyala yomwe ili mkati mwa chiwindi, pomwe ERCP "imachotsa" njira zapansi kuchokera m'matumbo kuti ateteze miyala yotsala, ndikupangitsa "kuchotsa miyala yonse."
Kukhazikika kwa ndulu m'maselo a bile: Pamene ndulu m'maselo a bile zili pamwamba pa hepatic hilum (komwe ndulu za chiwindi za kumanzere ndi kumanja zimakumana), ma endoscope a ERCP ndi ovuta kuwafikira, zomwe zimapangitsa kuti zikhale zovuta kuwona molondola kuopsa ndi chifukwa cha ndulu. Pazochitika izi, PTCS imalola kuwona mwachindunji ndulu m'maselo kudzera mu njira zamkati mwa chiwindi, zomwe zimathandiza kuti ma biopsies atsimikizire mtundu wa chotupa (monga kutupa kapena chotupa) pamene nthawi yomweyo akukulitsa baluni kapena kuika stent. ERCP, kumbali ina, imalola kuyika stent pansi, yomwe imagwira ntchito ngati relay ya stent ya PTCS, kuonetsetsa kuti madzi onse a bile sakutsekedwa.
Mavuto a opaleshoni ya ndulu pambuyo pa opaleshoni: Kutupa kwa ndulu, fistula ya ndulu, ndi miyala yotsala zingachitike pambuyo pa opaleshoni ya ndulu. Ngati wodwalayo ali ndi vuto lalikulu m'matumbo pambuyo pa opaleshoni ndipo ERCP singatheke, PTCS ingagwiritsidwe ntchito potulutsa madzi ndi kuchiza. Ngati kutupa kwa ndulu kuli pamwamba ndipo ERCP singathe kukulirakulira mokwanira, PTCS ikhoza kuphatikizidwa ndi kukulirakulira kwa mbali ziwiri kuti ziwongolere kuchuluka kwa chithandizo.
Odwala omwe sangathe kupirira opaleshoni imodzi: Mwachitsanzo, odwala okalamba kapena odwala matenda oopsa a mtima ndi mapapo sangathe kupirira opaleshoni imodzi yayitali. Kuphatikiza magalasi awiri kungagawanitse opaleshoni yovutayi kukhala "yosavulaza kwambiri + yosavulaza pang'ono", kuchepetsa zoopsa za opaleshoni ndi zovuta zakuthupi.
Chiyembekezo cha Mtsogolo: "Njira Yokwezera" ya Kusakaniza kwa Dual-Scope
Ndi kupita patsogolo kwa ukadaulo, kuphatikiza kwa ERCP ndi PTCS kukupitilirabe kusintha. Kumbali imodzi, kupita patsogolo kwa ukadaulo wojambulira zithunzi kukupangitsa kuti pakhale kubowola ndi njira zolondola kwambiri. Mwachitsanzo, kuphatikiza kwa intraoperative endoscopic ultrasound (EUS) ndi PTCS kumatha kuwona kapangidwe ka mkati mwa ndulu nthawi yeniyeni, kuchepetsa zovuta zobowola. Kumbali ina, zatsopano mu zida zikupangitsa kuti chithandizo chikhale chogwira mtima kwambiri. Mwachitsanzo, ma choledoscope osinthasintha, ma lithotripsy probes olimba kwambiri, ndi ma bioresorbable stents akuthandizira kuphatikiza kwa dual-scope kuti athetse zilonda zovuta kwambiri.
Kuphatikiza apo, "ma robot-assisted dual-scope combined" aonekera ngati njira yatsopano yofufuzira: pogwiritsa ntchito makina a robotic kuti azitha kuwongolera ma endoscope ndi zida zoboola, madokotala amatha kuchita njira zofewa pamalo abwino, zomwe zimapangitsa kuti opaleshoni ikhale yolondola komanso yotetezeka. M'tsogolomu, ndi kugwiritsa ntchito bwino kwa mgwirizano wamitundu yambiri (MDT), ERCP ndi PTCS zidzaphatikizidwanso ndi laparoscopy ndi njira zochiritsira, zomwe zipereka njira zodziwira matenda ndi chithandizo chapadera komanso chapamwamba kwa odwala omwe ali ndi matenda a biliary.
Kuphatikiza kwa ERCP ndi PTCS kwa ma scope awiri kumaphwanya zoletsa za njira imodzi yodziwira ndi kuchiza matenda a biliary, kuthana ndi matenda ambiri ovuta a biliary ndi njira yocheperako komanso yolondola. Kugwirizana kwa "awiri aluso" awa sikuti kumangowonetsa kupita patsogolo kwa ukadaulo wazachipatala komanso kumaphatikizapo njira yowunikira ndi kuchiza yomwe imayang'ana kwambiri wodwala. Kumasintha zomwe kale zinkafuna laparotomy yayikulu kukhala chithandizo chocheperako chopanda kuvulala komanso kuchira mwachangu, kulola odwala ambiri kuthana ndi matenda awo pomwe akukhalabe ndi moyo wabwino. Tikukhulupirira kuti ndi kupita patsogolo kwaukadaulo, kuphatikiza kwa ma scope awiriwa kudzatsegula luso lochulukirapo, kubweretsa mwayi watsopano wodziwira ndi kuchiza matenda a biliary.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China omwe amagwira ntchito kwambiri pazinthu zogwiritsidwa ntchito m'ma endoscopic, kuphatikizapo mzere wa GI mongamphamvu ya biopsy, hemoclip, msampha wa polyp, singano ya sclerotherapy, katheta wopopera, maburashi a cytology, waya wotsogolera, dengu lotengera miyala, katheta yotulutsira madzi m'mphunondiSphincterotome ndi zina zoterozomwe zimagwiritsidwa ntchito kwambiri muEMR, ESD, ERCP.
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Nthawi yotumizira: Novembala-14-2025