Kwa zaka 50 zapitazi, ukadaulo wa ERCP wasintha kuchoka pa chida chosavuta chodziwira matenda kukhala nsanja yochepetsera kufalikira kwa matenda ndi chithandizo. Ndi kuyambitsidwa kwa ukadaulo watsopano monga endoscopy ya biliary ndi pancreatic duct ndi endoscopy yopyapyala kwambiri, ERCP ikusintha pang'onopang'ono njira yachikhalidwe yodziwira matenda ndi chithandizo cha matenda a biliary ndi pancreatic. Yapita patsogolo kwambiri pakukonza kulondola kwa matenda, kukulitsa kuchuluka kwa zizindikiro, ndikuchepetsa chiopsezo cha zovuta, kuwonetsa momwe chitukuko cha "opaleshoni yachipatala ikukhala opaleshoni yambiri ndi opaleshoni kukhala yochepa kwambiri," kupatsa odwala ambiri njira zochizira zoyenera komanso zothandiza. Komabe, ikukumananso ndi zopinga pakugwiritsa ntchito kuchipatala, monga malire apamwamba aukadaulo ndi kudalira kwambiri zida.
Maukadaulo atsopano a ERCP amagawidwa m'magulu atatu: machitidwe a endoscopic a ducts ya bile ndi pancreatic, ma endoscopes owonda kwambiri, ndi machitidwe atsopano opangidwa mdziko muno. Machitidwe a endoscopic monga SpyGlass ndi Insight-eyeMax amapereka mawonekedwe owoneka bwino komanso amathandiza pa chithandizo choyenera.
Pakati pawo, dongosolo la SpyGlass lili ndi m'mimba mwake wa catheter wakunja wa 9F-11F ndi m'mimba mwake wa njira yogwirira ntchito wa 1.2mm kapena 2.0mm, zomwe zimathandiza munthu mmodzi kuyika subscope ya biliary ndi pancreatic duct kuti awonetse mwachindunji mucosa. Dongosolo la Insight-eyeMax lili ndi chithunzi chapamwamba cha 160,000-pixel, malo owonera a 120°, ndi chophimba choterera kwambiri, chomwe chimapereka malo owonera omveka bwino komanso otakata. Ma endoscope owonda kwambiri amagwiritsa ntchito m'mimba mwake wa chubu chaching'ono (nthawi zambiri osakwana 5mm) kuti alowe mwachindunji mu biliary duct, koma chifukwa cha kapangidwe kovuta ka njira ya m'mimba yapamwamba, zida zothandizira monga mabaluni omangirira, ma cannula akunja, ndi misampha nthawi zambiri zimafunika. Machitidwewa ali ndi ubwino wowonera mucosa ya biliary duct ndikuchita biopsies, koma ndi ovuta kugwiritsa ntchito.
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| SpyGlass | Insight-eyeMax |
Ubwino waukulu wa ukadaulo watsopano wa ERCP ndikuti wapita patsogolo kwambiri kuchokera pakuwona mosapita m'mbali kupita ku kuzindikira mwachindunji, zomwe zimathandiza madokotala kuwona zilonda za mucosa ya ndulu ndi pancreatic duct mwachidwi komanso kuchita biopsy ndi chithandizo cholondola nthawi imodzi panthawi yozindikira matendawa. Kufunika kwake kuchipatala kumaonekera makamaka m'mbali zitatu: kukonza kulondola kwa kuzindikira matenda, kukulitsa kuchuluka kwa zizindikiro, komanso kuchepetsa chiopsezo cha zovuta.
Ponena za kukonza kulondola kwa matenda, cholangiopancreatography (ERCP) imalola madokotala kuwona mwachindunji mucosa wa bile ndi pancreatic duct, zomwe zimapangitsa kuti athe kusiyanitsa pakati pa ma strictures abwino ndi oipa. ERCP yachikhalidwe imadalira zinthu zosiyanasiyana kuti iwonetse kapangidwe ka luminal, ndipo kuwunika kwa zilonda za mucosal kumadalira zizindikiro zosalunjika. Kuzindikira kwa kutsuka kwa maselo a bile duct ndi 45%-63% yokha, ndipo kuzindikira kwa biopsy ya minofu ndi 48.1% yokha.
Mosiyana ndi zimenezi, cholangiopancreatography (CP) imalola kuona mwachindunji mucosa, zomwe zimathandiza kwambiri kuzindikira matenda. Ikaphatikizidwa ndi MRCP, kulondola kwa matendawa kumatha kufika 97.4%, ndipo kulondola kwa matenda a miyala ya ndulu >9mm m'mimba mwake kuli pafupi ndi 100%. Ponena za zotsatira za chithandizo, ERCP yachikhalidwe ili ndi chiwopsezo chachikulu chochotsa miyala ya ndulu <5mm m'mimba mwake, koma chiwopsezo chachikulu cha kulephera kwa miyala yovuta (monga yomwe ili >2cm kapena pambuyo pokonzanso m'mimba). CP pamodzi ndi laser lithotripsy zimatha kukweza chiwopsezo cha kupambana kufika pafupi ndi mlingo wa opaleshoni yotseguka.
Ponena za kukulitsa kuchuluka kwa zizindikiro, ukadaulo watsopanowu ukukweza kwambiri kuchuluka kwa ERCP mwa odwala atachitidwa opaleshoni yochotsa m'mimba, zomwe zimawathandiza kuthana ndi matenda ovuta kwambiri a biliary ndi pancreatic. Mwachitsanzo, m'mavuto ovuta monga cholangitis yopatsirana chiwindi pambuyo pa opaleshoni ndi pancreatic duct IPMN, endoscopy ya biliary ndi pancreatic duct ingapereke chithunzi chomveka bwino, chomwe chingathandize kuzindikira ndi kuchiza molondola.
Kuchuluka kwa matenda a kapamba pambuyo pa ERCP yachikhalidwe ndi pafupifupi 3%-10%. Njira zatsopano, kudzera mu kuwona mwachindunji, zimachepetsa kusayika bwino kwa njira za kapamba, kukonza njira, ndikufupikitsa nthawi yogwira ntchito, zomwe zimachepetsa kwambiri kuchuluka kwa matenda a kapamba pambuyo pa opaleshoni ndi zovuta zina. Mu kusanthula kwa odwala 50 omwe ali ndi cholangiocarcinoma yayikulu, nthawi ya patency ya stent ndi zotsatira za chithandizo mu gulu la transoral cholangiopancreatography (TCP) zinali zofanana ndi zomwe zili mu gulu la ERCP yachikhalidwe, koma gulu la TCP linawonetsa mwayi waukulu pamlingo wamavuto.
Ukadaulo watsopano wa ERCP ukadali ndi zopinga zina pakugwiritsa ntchito kuchipatala. Choyamba, uli ndi malire apamwamba aukadaulo ndipo ndi wovuta, womwe umafuna akatswiri odziwa bwino ntchito za endoscopist. Kachiwiri, umadalira kwambiri zida, ndipo umawononga ndalama zambiri zosamalira ndi kugwiritsa ntchito, zomwe zimapangitsa kuti ugwiritsidwe ntchito kwambiri m'zipatala zosamalira odwala. Kachitatu, zizindikiro zake zimakhala zochepa, ndipo pakadalibe chiopsezo cha kulephera kwa opaleshoni nthawi zina. Mwachitsanzo, pakakhala kutsekeka kwakukulu kwa m'mimba (monga zipsera za m'mero) kapena kutsekeka kwathunthu kwa chotupa, kusintha kukhala PTCD kapena opaleshoni kungakhale kofunikira.
Zochitika zamtsogolo za ukadaulo watsopano wa ERCP zimayang'ana kwambiri mbali zitatu: kukwezedwa kwa anthu wamba, kuphatikiza AI, ndi kufalikira kwa opaleshoni ya masana. Ponena za kukwezedwa kwa anthu wamba, mapulogalamu ophunzitsira ndi ubwino wokwera mtengo wa zida zopangidwa m'dziko muno zidzakulitsa pang'onopang'ono luso la ERCP la zipatala zazikulu. Ponena za kuphatikiza AI, ukadaulo wozindikira zithunzi nthawi yeniyeni uli ndi lonjezo lokweza magwiridwe antchito ozindikira matenda, koma umakumana ndi zovuta monga kukhazikika kwa deta ndi kuwonekera bwino kwa chitsanzo, zomwe zimafuna kukonzedwanso kwina.
Ponena za kufalikira kwa opaleshoni ya tsiku ndi tsiku, mgwirizano wa 2025 umalimbikitsa kuphatikizidwa kwa ERCP mu kasamalidwe ka opaleshoni ya tsiku ndi tsiku, zomwe zimathandiza odwala ambiri kumaliza njira yogonekedwa m'chipatala, opaleshoni, kuyang'aniridwa pambuyo pa opaleshoni, ndi kutulutsidwa mkati mwa maola 24. Izi sizimangofupikitsa nthawi yomwe amakhala kuchipatala komanso zimachepetsa ndalama zachipatala ndikuwonjezera kugwiritsa ntchito bwino zinthu zachipatala. Ndi kukhwima ndi kufalikira kwa ukadaulo, ERCP ikuyembekezeka kugwiritsidwa ntchito m'mabungwe azachipatala ambiri, kupereka chithandizo cholondola komanso chothandiza kwambiri kwa odwala ambiri omwe ali ndi matenda a biliary ndi pancreatic.
Chidule ndi Malangizo
ERCP, ukadaulo watsopano, ndi njira yofunika kwambiri yodziwira ndi kuchiza matenda a biliary ndi pancreatic. Imawongolera kulondola kwa matenda kudzera mu kuwona mwachindunji ndi biopsy yolondola, imachepetsa chiopsezo cha zovuta mwa kukonza bwino njira ndikufupikitsa nthawi ya chithandizo, ndipo imapindulitsa odwala ambiri mwa kukulitsa zizindikiro zosiyanasiyana. Komabe, ukadaulo watsopanowu ukukumananso ndi zopinga pakugwiritsa ntchito kuchipatala, monga zopinga zazikulu zaukadaulo ndi kudalira kwambiri zida, zomwe zimafuna thandizo la magulu azachipatala apadera ndi zida zapamwamba. Ndikofunikira kuti mabungwe azachipatala alimbikitse maphunziro a ERCP ndi ndalama zogulira zida kuti akonze luso la madokotala ndi kupezeka kwa zida. Ndikofunikiranso kusankha njira zoyenera zochiritsira kutengera momwe wodwalayo alili; pa matenda ovuta a biliary ndi pancreatic, chithandizo cha ERCP chothandizidwa ndi ukadaulo watsopano chingaganizidwe. Kuphatikiza apo, ndikofunikira kuti tiwonjezere magwiridwe antchito ndi mtengo wa ERCP, kuthana ndi nkhani zofotokozera komanso kuwonekera bwino kwa machitidwe othandizidwa ndi AI, ndikulimbikitsa kugwiritsa ntchito ERCP m'zipatala zoyambira.
Zinthu zogulitsidwa kwambiri za ERCP Series kuchokera ku ZRHmed.
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| Sphincterotome | Mawaya Othandizira Opanda Mitsempha | Madengu Otengera Miyala Otayidwa | Ma Catheters Otayidwa a Nasobiliary |
Ife, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., ndife opanga ku China omwe amagwira ntchito kwambiri pazinthu zogwiritsidwa ntchito m'thupi, kuphatikizapo zinthu monga biopsy forceps, hemoclip, polyp snare, sclerotherapy needle, spray catheter, cytology brushes, guidewire wire, stone retrieval basket, nasal biliary drainage cathete etc. zomwe zimagwiritsidwa ntchito kwambiri mu EMR, ESD, ERCP. Zogulitsa zathu zili ndi CE certification ndipo zili ndi chilolezo cha FDA 510K, ndipo mafakitale athu ali ndi ISO certification. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi mbali ina ya Asia, ndipo makasitomala ambiri amalandira ulemu ndi kutamandidwa!
Sphincterotome、Chingwe chotsogolera、Dengu Lochotsera Miyala、Madzi Otulutsa M'mphunoChotsukira、ERCP
Nthawi yotumizira: Disembala-20-2025