Na nchoputa na ọgwụgwọ nke ọrịa biliary, mmepe nke nkà na ụzụ endoscopic anọgidewo na-elekwasị anya n'ebumnobi nke oke nkenke, obere mmekpa ahụ, na nchekwa dị ukwuu. Endoscopic retrograde cholangiopancreatography (ERCP), onye na-arụ ọrụ nyocha na ọgwụgwọ ọrịa biliary, ka anabatala ogologo oge n'ihi na ọ bụghị ịwa ahụ na obere mmekpa ahụ. Agbanyeghị, mgbe enwere ọnya biliary dị mgbagwoju anya, otu usoro na-adakarị mkpụmkpụ. Nke a bụ ebe percutaneous transhepatic cholangioscopy (PTCS) na-aghọ ihe nkwado dị mkpa na ERCP. Usoro a jikọtara "abụọ-scope" gafere oke nke ọgwụgwọ ọdịnala ma na-enye ndị ọrịa nhọrọ nyocha na ọgwụgwọ ọhụrụ kpamkpam.
ERCP na PTCS nke ọ bụla nwere nka pụrụ iche.
Iji ghọta ike nke ejikọtara ọnụ ụzọ abụọ, mmadụ ga-ebu ụzọ ghọta nke ọma ike pụrụ iche nke ngwa abụọ a. Ọ bụ ezie na ha abụọ bụ ngwaọrụ maka nyocha na ọgwụgwọ biliary, ha na-eji ụzọ dị iche iche eme ihe, na-emepụta ihe zuru oke.
ERCP: Ọkachamara endoscopic na-abanye na tract digestive
ERCP na-anọchi anya Endoscopic Retrograde Cholangiopancreatography. Arụmọrụ ya dị ka ụzọ okirikiri si eme ihe. Dọkịta na-etinye duodenoscope site n'ọnụ, esophagus, na afo, n'ikpeazụ rute duodenum na-agbada. Dọkịta ahụ chọtara oghere eriri afọ nke bile na pancreatic ducts (papilla duodenal). A na-etinyezi catheter site na ọdụ ụgbọ mmiri endoscopic biopsy. Mgbe ịgbanye ihe dị iche iche, a na-eme nyocha X-ray ma ọ bụ ultrasound, na-eme ka nyocha anya nke bile na pancreatic ducts.
N'ihi nke a,ERCPnwekwara ike ịrụ usoro ọgwụgwọ dị iche iche: dịka ọmụmaatụ, iji balloon na-eji balloon na-emepe ducts bile dị warara, imeghe oghere ndị egbochiri na stent, wepụ nkume site na bile duct na nkata iwepụ nkume, na ịnweta anụ ahụ na-arịa ọrịa maka nyocha nke pathological site na iji biopsy forceps. Uru ya bụ isi bụ n'eziokwu na ọ na-arụ ọrụ kpamkpam site na oghere okike, na-ewepụ mkpa ọ dị maka mbepụ elu. Nke a na-enye ohere maka mgbake ngwa ngwa mgbe ịwachara ahụ gasịrị yana nkwụsịtụ ntakịrị na ahụ onye ọrịa. Ọ dị mma karịsịa maka ịgwọ nsogbu bile duct dị nso na eriri afọ, dị ka nkume dị n'etiti na ala nke bile ducts, nkwụsị nke bile duct na ọnya na nkwụsị nke pancreatic na bile duct.
Otú ọ dị, ERCP nwekwara "adịghị ike" ya: ọ bụrụ na nkwụsị nke bile duct dị njọ ma enweghi ike ịpụpụ bile nke ọma, onye na-ahụ maka ọdịiche ga-esiri ya ike imeju oghere bile dum, nke ga-emetụta izi ezi nke nchoputa ahụ; maka nkume bile duct intrahepatic (karịsịa nkume ndị dị n'ime imeju) na stenosis bile duct stenosis dị elu (nke dị nso na imeju imeju na n'elu), mmetụta ọgwụgwọ na-ebelata nke ukwuu n'ihi na endoscope "enweghị ike iru" ma ọ bụ ohere ọrụ dị oke.
PTCS: Onye ọsụ ụzọ na-agbaji n'elu elu imeju
PTCS, ma ọ bụ percutaneous transhepatic choledochoscopy, na-eji ụzọ "n'èzí-na", n'ụzọ dị iche na ụzọ "ime-ime" nke ERCP. N'okpuru nduzi nke ultrasound ma ọ bụ CT, dọkịta na-awa ahụ na-akụnye akpụkpọ ahụ n'obi aka nri ma ọ bụ afọ afọ onye ọrịa, na-agafe anụ ahụ imeju kpọmkwem wee banye n'ime oghere intrahepatic bile duct, na-emepụta ọwara "akpụkpọ anụ-imeju-bile duct". A na-etinyezi choledochoscope site na ọwara a ka ọ na-eleba anya ozugbo na ọnya bile intrahepatic ka a na-eme n'otu oge ọgwụgwọ dị ka iwepụ nkume, lithotripsy, ịgbasa nke siri ike, na ntinye stent.
“Ngwa ngwa egbu egbu” PTCS dabere na ikike ya iru ọnya bile duct intrahepatic ozugbo. Ọ mara mma nke ukwuu n'ịkọ "nsogbu miri emi" siri ike iru na ERCP: dịka ọmụmaatụ, nnukwu nkume bile duct na-agafe 2 cm na dayameta, "ọtụtụ nkume" gbasasịrị n'ofe ọtụtụ alaka bile duct intrahepatic, nkwụsị nke bile duct nke dị elu kpatara etuto ma ọ bụ mbufụt, na mgbagwoju anya dị ka anastomotic stenosis na bile fistubiliary. Ọzọkwa, mgbe ndị ọrịa na-enweghị ike ịnweta ERCP n'ihi ihe ndị dị ka duodenal papillary malformation na intestinal obstruction, PTCS nwere ike ije ozi dị ka ihe ọzọ, ngwa ngwa na-agbapụta bile na ibelata jaundice, si otú ahụ na-azụta oge maka ọgwụgwọ na-esote.
Otú ọ dị, PTCS ezughị okè: ebe ọ bụ na ọ na-achọ nkwụsị n'elu ahụ, nsogbu ndị dị ka ọbara ọgbụgba, nsị bile, na ọrịa nwere ike ime. Oge mgbake mgbe arụchara ọrụ ahụ dị ntakịrị ogologo karịa ERCP, yana teknụzụ ntinye nke dọkịta na nzizi ihe onyonyo dị oke elu.
Ngwakọta dị ike: Echiche nke "arụmọrụ synergistic" yana ngwakọta Dual-Scope
Mgbe "uru endovascular" nke ERCP zutere "uru dị oke egwu" nke PTCS, ha abụọ adịkwaghị n'otu ụzọ, kama kama usoro nyocha na ọgwụgwọ nke "na-adaba n'ime ma n'èzí ahụ." Ngwakọta a abụghị mgbakwunye dị mfe nke teknụzụ, kama ọ bụ atụmatụ “1+1>2” ahaziri nke ahaziri maka ọnọdụ onye ọrịa. Ọ bụ isi ihe mejupụtara ụdị abụọ: “usoro jikọtara ọnụ” na “agwakọta nke otu oge.”
Ngwakọta usoro: "Mepee ụzọ mbụ, wee gwọọ nke ọma"
Nke a bụ usoro nchikota a na-ahụkarị, na-agbaso ụkpụrụ nke "mmiri mmiri mbụ, ọgwụgwọ emechaa." Dịka ọmụmaatụ, maka ndị ọrịa nwere jaundice siri ike nke na-akpata site na nkume nkume bile duct intrahepatic, nzọụkwụ mbụ bụ ịmepụta ọwa mmiri biliary site na PTCS puncture iji wepụ bile ahụ gbakọtara, belata nrụgide imeju, belata ihe ize ndụ nke ibute ọrịa, ma jiri nwayọọ nwayọọ weghachite ọrụ imeju onye ọrịa na ọnọdụ anụ ahụ. Ozugbo ọnọdụ onye ọrịa ahụ kwụsiri ike, a na-eme ERCP site na akụkụ eriri afọ iji wepụ okwute n'ime duct bile nke dị ala, na-agwọ ọnya na papilla duodenal, wee gbasaa nkwụsị nke bile duct site na iji balloon ma ọ bụ stent.
N'aka nke ọzọ, ọ bụrụ na onye ọrịa na-enweta ERCP ma chọpụta na ọ nwere nkume imeju fọdụrụnụ ma ọ bụ stenosis dị elu nke a na-apụghị ịgwọta, PTCS nwere ike iji mechaa "ọrụ mmecha" mgbe e mesịrị. Ihe nlereanya a na-enye uru nke "usoro nzọụkwụ site na nzọụkwụ na ihe ize ndụ a na-achịkwa," na-eme ka ọ dị mma maka ndị ọrịa nwere ọnọdụ mgbagwoju anya na ọnọdụ ahụike dị adị.
Ọrụ ejikọtara ọnụ n'otu oge: "Orụ ọrụ ọnụọgụ abụọ n'otu oge,
Ngwọta Naanị Nkwụsị
Maka ndị ọrịa nwere nchoputa doro anya na ezigbo nnabata anụ ahụ, ndị dọkịta nwere ike ịhọrọ usoro "otu oge jikọtara ọnụ". N'otu oge ịwa ahụ ahụ, ndị otu ERCP na PTCS na-arụkọ ọrụ ọnụ. Dọkịta dọkịta na-awa ERCP na-eji endoscope si n'akụkụ eriri afọ, na-agbasa papilla duodenal ma na-etinye ntuziaka. Dọkịta dọkịta na-awa PTCS, nke eserese na-eduzi, na-akụ imeju ma na-eji choledochoscope iji chọta ebe ntuziaka ERCP etinyere, na-enweta nhazi ziri ezi nke "ọwa ime na mpụta." Otu abụọ ahụ na-emekọ ihe ọnụ iji mee lithotripsy, iwepụ okwute, na ntinye stent.
Uru kachasị mma nke ihe nlereanya a bụ na ọ na-edozi ọtụtụ okwu na otu usoro, na-ewepụ mkpa maka ọtụtụ anesthesia na ịwa ahụ, na-ebelata usoro ọgwụgwọ nke ukwuu. Dịka ọmụmaatụ, maka ndị ọrịa nwere ma nkume bile duct intrahepatic na nkume bile duct, enwere ike iji PTCS mee ihe n'otu oge iji kpochapụ nkume intrahepatic na ERCP iji dozie okwute bile duct, na-ewepụ mkpa maka ndị ọrịa na-enweta ọtụtụ mgbatị ahụ na ịwa ahụ, na-eme ka usoro ọgwụgwọ dịkwuo mma.
Ọdabara Ọdabara: Kedu ndị ọrịa chọrọ nchikota ọnụọgụ abụọ?
Ọ bụghị ọrịa biliary niile chọrọ onyonyo jikọtara ọnụ nke akụkụ abụọ. Onyonyo jikọtara ọnụ nwere akụkụ abụọ dabara adaba maka okwu dị mgbagwoju anya nke enweghị ike iji otu usoro kwuo ya, ọkachasị gụnyere ndị a:
Nkume bile duct dị mgbagwoju anya: Nke a bụ ọnọdụ izizi maka CT jikọtara ọnụ nke abụọ. Dịka ọmụmaatụ, ndị ọrịa nwere ma nkume bile duct intrahepatic (karịsịa ndị dị na ebe dịpụrụ adịpụ dị ka akụkụ aka ekpe ma ọ bụ akụkụ aka nri nke imeju nke imeju) na nkume bile ducts; ndị ọrịa nwere nkume siri ike karịrị 2 cm na dayameta nke ERCP naanị enweghị ike iwepụ; na ndị ọrịa nwere okwute nọ n'ime oghere bile dị warara, na-egbochi ịgafe ngwa ERCP. Iji dual-scope jikọtara CTCS, CTCS "na-agbajisị" nnukwu nkume ma na-ekpochapụ alaka okwute n'ime imeju, ebe ERCP "na-ekpochapụ" akụkụ nke ala site na eriri afọ iji gbochie okwute fọdụrụnụ, na-enweta "nkume mkpochapụ zuru ezu."
Ọkpụkpụ bile duct dị elu: Mgbe ọnyà bile dị n'elu hepatic hilum (ebe akụkụ aka ekpe na aka nri na-ezute), ERCP endoscopes na-esiri ike iru, na-eme ka ọ sie ike ịchọpụta nke ọma na ịdị njọ na ihe kpatara nkwụsị ahụ. N'okwu ndị a, PTCS na-enye ohere ịhụ anya kpọmkwem nke siri ike site na ọwa intrahepatic, na-enye ohere biopsies iji kwado ọdịdị nke ọnya ahụ (dịka mbufụt ma ọ bụ tumor) ka ọ na-eme n'otu oge na-eme ka balloon dilatation ma ọ bụ ntinye stent. ERCP, n'aka nke ọzọ, na-enye ohere maka ntinye nke stent n'okpuru ebe a, nke na-arụ ọrụ dị ka relay maka PTCS stent, na-eme ka mmiri na-adịghị egbochi nke bile duct dum.
Nsogbu gbasara ịwa ahụ biliary gachara: Anastomotic stenosis, bile fistula, na okwute ndị fọdụrụ nwere ike ime mgbe ịwachara ahụ biliary. Ọ bụrụ na onye ọrịa ahụ nwere nnukwu eriri afọ nke eriri afọ mgbe ịwachara ahụ na ERCP agaghị ekwe omume, PTCS nwere ike iji mee mmiri mmiri na ọgwụgwọ. Ọ bụrụ na stenosis anastomotic dị elu na ERCP enweghị ike ịgbasa n'ụzọ zuru ezu, PTCS nwere ike ijikọta ya na dilation nke abụọ iji meziwanye ọnụego ọgwụgwọ.
Ndị ọrịa na-enweghị ike ịnabata otu ịwa ahụ: Dịka ọmụmaatụ, ndị ọrịa agadi ma ọ bụ ndị ọrịa nwere ọrịa obi siri ike enweghị ike ịnagide otu ịwa ahụ dị ogologo. Nchikota nke enyo abụọ nwere ike kewaa ọrụ mgbagwoju anya n'ime "obere mkpachapụ + nke ntanarị", na-ebelata ihe egwu ịwa ahụ na ibu anụ ahụ.
Echiche Ọdịnihu: “Ntuziaka nkwalite” nke ngwakọta Dual-Scope
Site na ọganihu teknụzụ, nchikota nke ERCP na PTCS na-aga n'ihu na-etolite. N'otu aka ahụ, ọganihu na teknụzụ onyonyo na-enye aka nkuku na usoro ziri ezi. Dịka ọmụmaatụ, ngwakọta nke ultrasound endoscopic intraoperative (EUS) na PTCS nwere ike iji anya nke uche hụ usoro dị n'ime ụlọ nke bile duct ozugbo, na-ebelata ihe mgbagwoju anya. N'aka nke ọzọ, ihe ọhụrụ na ngwá ọrụ na-eme ka ọgwụgwọ dịkwuo mma. Dịka ọmụmaatụ, choledochoscopes na-agbanwe agbanwe, nyocha lithotripsy na-adịgide adịgide, na stent bioresorbable na-eme ka nchikota okpukpu abụọ nwee ike ileba anya ọnya dị mgbagwoju anya.
Ọzọkwa, "robot-enyere aka dual-scope jikọtara" apụtala dị ka ntụzịaka nyocha ọhụrụ: site n'iji sistemu roboti chịkwaa endoscopes na ngwa ọkpọ, ndị dọkịta nwere ike ịrụ usoro siri ike na gburugburu ebe dị mma karị, na-emekwu nke ọma n'ịwa ahụ na nchekwa. N'ọdịnihu, n'ịbawanye nkwado nke mmekorita multidisciplinary (MDT), ERCP na PTCS ga-ejikọta ya na usoro ọgwụgwọ laparoscopy na ntinye aka, na-enye ndị ọzọ nyocha na ọgwụgwọ dị elu maka ndị ọrịa nwere ọrịa biliary.
Ngwakọta ọnụọgụ abụọ nke ERCP na PTCS na-agbaji njedebe nke ụzọ otu ụzọ maka nyocha na ọgwụgwọ biliary, na-agwa ọtụtụ ọrịa biliary mgbagwoju anya na ụzọ dị ntakịrị na-emerụ ahụ na nke ziri ezi. Njikọ aka nke "duo nwere nkà" a abụghị nanị na-egosipụta ọganihu nke nkà na ụzụ ahụike kamakwa ọ na-agụnye usoro onye ọrịa na-adabere na nyocha na ọgwụgwọ. Ọ na-agbanwe ihe a na-achọbu nnukwu laparotomy ka ọ bụrụ ọgwụgwọ na-akpasu iwe na obere mmerụ ahụ yana mgbake ngwa ngwa, na-enye ohere ka ọtụtụ ndị ọrịa merie ọrịa ha ma na-edobe ndụ dị elu. Anyị kwenyere na site n'ịga n'ihu na nkà na ụzụ na-aga n'ihu, nchikota ọnụọgụ abụọ ga-emeghe ọbụna ikike ndị ọzọ, na-eweta ohere ọhụrụ na nchọpụta na ọgwụgwọ nke ọrịa biliary.
Anyị, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., bụ emeputa na China ọkachamara na endoscopic consumables, gụnyere GI akara dị kabiopsy forceps, hemoclip, polyp ọnyà, sclerotherapy agịga, ịgba catheter, cytology brushes, ndumodu, nkata eweghachite okwute, imi biliary drainage catheter, naSphincterotome wdg. nke a na-ejikarị eme ihe naEMR, ESD, ERCP.
Ngwaahịa anyị bụ CE asambodo yana nkwado FDA 510K, yana osisi anyị nwetara asambodo ISO. Ebupụla ngwongwo anyị na Europe, North America, Middle East na akụkụ nke Eshia, na-enwetakwa ndị ahịa nke nnabata na otuto!
Oge nzipu: Nov-14-2025