Ukadaulo Watsopano wa ERCP: Zatsopano ndi Zovuta pa Kuzindikira ndi Kuchiza Kochepa

Kwa zaka 50 zapitazi,ERCPUkadaulo wasintha kuchoka pa chida chosavuta chodziwira matenda kukhala nsanja yosavulaza kwambiri yophatikiza matenda ndi chithandizo. Ndi kuyambitsidwa kwa ukadaulo watsopano monga endoscopy ya biliary ndi pancreatic duct ndi endoscopy yopyapyala kwambiri,ERCPPang'onopang'ono ikusintha 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, zomwe zikuwonetsa momwe "opaleshoni yachipatala ikukhala yowonjezereka komanso opaleshoni ikukhala yosavulaza kwambiri," kupatsa odwala ambiri njira zochizira zoyenera komanso zothandiza. Komabe, ikukumananso ndi zopinga pakugwiritsa ntchito kuchipatala, monga kuchuluka kwa ukadaulo komanso kudalira kwambiri zida.

 

ChatsopanoERCPMaukadaulo 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 cholondola.

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.

 

 

SpyGlass	Insight-eyeMax

 

Ubwino waukulu wa chatsopanochoERCPUkadaulo wake ndi wakuti wasintha kuchoka pa kuyang'anitsitsa mosalunjika kupita ku kuzindikira mwachindunji, zomwe zimathandiza madokotala kuona zilonda za mucosa ya ndulu ndi pancreatic duct mwachisawawa komanso kuchita biopsy ndi chithandizo cholondola nthawi imodzi panthawi yozindikira matendawa. Kufunika kwake kuchipatala kumaonekera makamaka m'mbali zitatu: kukonza kulondola kwa matenda, kukulitsa kuchuluka kwa zizindikiro, komanso kuchepetsa chiopsezo cha zovuta.

Ponena za kukonza kulondola kwa matenda, cholangiopancreatography (ERCP) zimathandiza madokotala kuona mwachindunji mucosa wa ndulu ndi pancreatic duct, zomwe zimapangitsa kuti athe kusiyanitsa pakati pa ma strictures abwino ndi oipa.ERCPKudalira zinthu zosiyanitsa kuti ziwone 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 zimapangitsa kuti munthu azitha kuzindikira matenda. Ngati iphatikizidwa ndi MRCP, kulondola kwa matendawa kumatha kufika pa 97.4%, ndipo kulondola kwa matenda a miyala ya bile >9mm m'mimba mwake kuli pafupi ndi 100%. Ponena za zotsatira za chithandizo, njira yachikhalidwe yodziwira matenda ndi yachibadwa.ERCPIli ndi chiwopsezo chachikulu chochotsa miyala ya pancreatic duct yokhala ndi mainchesi pafupifupi 5mm, koma chiwopsezo chachikulu cholephera pa miyala yovuta (monga yomwe ili >2cm kapena pambuyo pokonzanso m'mimba). CP pamodzi ndi laser lithotripsy zimatha kupititsa patsogolo chiwopsezo cha opaleshoni yotseguka.

Ponena za kukulitsa kuchuluka kwa zizindikiro, ukadaulo watsopanowu ukukweza kwambiri kuchuluka kwa kupambana kwaERCPKwa odwala omwe achita opaleshoni yochotsa m'mimba, zomwe zimawathandiza kuthana ndi matenda ovuta kwambiri a biliary ndi pancreatic. Mwachitsanzo, m'mavuto ovuta monga cholangitis ya post-liver transplant ndi pancreatic duct IPMN, biliary ndi pancreatic duct endoscopy zingapereke chithunzi chomveka bwino, zomwe zimathandiza kuzindikira ndi kuchiza matenda molondola.

 

 

Kuchuluka kwa matenda a pancreatitis pambuyo pa matenda achikhalidweERCPndi pafupifupi 3%-10%. Njira zatsopano, kudzera mu kuwona mwachindunji, zimachepetsa kusayika bwino kwa njira zotulutsira pancreatic duct, kukonza njira, ndikufupikitsa nthawi yogwirira 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 zidachitika m'gulu lachikhalidwe.ERCPgulu, koma gulu la TCP linawonetsa ubwino waukulu pa kuchuluka kwa zovuta.

ChatsopanoERCPUkadaulowu 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 m'zipatala zosamalira odwala. Kachitatu, zizindikiro zake zimakhala zochepa, ndipo pakadalibe chiopsezo cha kulephera kwa njira zina. Mwachitsanzo, ngati pali vuto lalikulu la m'mimba (monga zipsera za m'mero) kapena kutsekeka kwathunthu kwa chotupa, kusintha kukhala PTCD kapena opaleshoni kungakhale kofunikira.

  

Zochitika zamtsogolo za chitukuko cha zatsopanoERCPUkadaulo umayang'ana kwambiri mbali zitatu: kukwezedwa kwa anthu wamba, kuphatikiza AI, ndi kufalitsa opaleshoni ya masana. Ponena za kukwezedwa kwa anthu wamba, mapulogalamu ophunzitsira ndi ubwino wokwera mtengo wa zida zopangidwa m'dziko muno zidzasintha pang'onopang'ono.ERCPkuthekera kwa zipatala zazikulu. Ponena za kuphatikiza kwa AI, ukadaulo wozindikira zithunzi nthawi yeniyeni uli ndi lonjezo lokulitsa magwiridwe antchito ozindikira matenda, koma umakumana ndi zovuta monga kukhazikika kwa deta ndi kuwonekera bwino kwa chitsanzo, zomwe zimafuna kukonzedwanso kwina.

Ponena za kutchuka kwa opaleshoni ya masana, mgwirizano wa 2025 umalimbikitsa kuphatikizidwa kwaERCPpa kasamalidwe ka opaleshoni ya masana, 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 zothandizira zachipatala ndikuwonjezera kugwiritsa ntchito bwino zinthu zachipatala. Ndi kukhwima komanso kufalikira kwa ukadaulo,ERCPikuyembekezeka kugwiritsidwa ntchito m'zipatala zambiri, kupereka chithandizo cholondola komanso chothandiza kwambiri kwa odwala ambiri omwe ali ndi matenda a biliary ndi pancreatic.

 

 

 

Chidule ndi Malangizo

 

ERCP, ukadaulo watsopano, ukuyimira chitukuko chachikulu pakupeza ndi kuchiza matenda a biliary ndi pancreatic. Umathandizira kulondola kwa matenda kudzera mu kuwona mwachindunji ndi biopsy yeniyeni, umachepetsa chiopsezo cha zovuta mwa kukonza bwino njira ndikufupikitsa nthawi ya chithandizo, komanso umathandiza 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 azilimbitsaERCPmaphunziro ndi ndalama zothandizira kuti luso la madokotala komanso kupezeka kwa zida lipitirire. Ndikofunikiranso kusankha njira zoyenera zochiritsira kutengera momwe wodwalayo alili; pa matenda ovuta a biliary ndi pancreatic,ERCPchithandizo chothandizidwa ndi ukadaulo watsopano chingaganiziridwe. Kuphatikiza apo, tikukulimbikitsani kuti muwongolere magwiridwe antchito ndi mtengo wakeERCP, kuthetsa nkhani zokhudza kufalikira ndi kuwonekera poyera kwa machitidwe othandizidwa ndi AI, ndikulimbikitsa kugwiritsa ntchito njira zambiriERCPm'zipatala zosamalira odwala akuluakulu.

 

ERCPMndandanda wa zinthu zogulitsa zotentha kuchokera ku ZRHmed.

Sphincterotome	Mawaya Othandizira Opanda Mitsempha	Madengu Otengera Miyala Otayidwa	Ma Catheters Otayidwa a Nasobiliary

 

 

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 monga biopsy forceps, hemoclip, polyp snare, sclerotherapy needle, spray catheter, cytology brushes,waya wotsogolera, dengu lotengera miyala, cathete ya m'mphuno ya biliary drainage ndi zina zotero zomwe zimagwiritsidwa ntchito kwambiri mu EMR, ESD,ERCPZogulitsa zathu zili ndi satifiketi ya CE ndipo zili ndi chilolezo cha FDA 510K, ndipo mafakitale athu ali ndi satifiketi ya ISO. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi mbali ina ya Asia, ndipo makasitomala ambiri amalandira ulemu ndi kutamandidwa!