A cikin ganewar asali da kuma kula da cututtuka na biliary, ci gaban fasahar endoscopic ya ci gaba da mayar da hankali kan maƙasudin maƙasudin mafi girma, ƙananan ɓarna, da kuma mafi aminci. Endoscopic retrograde cholangiopancreatography (ERCP), dokin aikin gano cutar biliary da jiyya, an daɗe ana yarda da shi don yanayin rashin tiyata da ƙarancin ɓarna. Duk da haka, idan aka fuskanci hadaddun raunuka na biliary, fasaha guda ɗaya sau da yawa yakan ragu. Wannan shine inda percutaneous transhepatic cholangioscopy (PTCS) ya zama mahimmin madaidaicin ERCP. Wannan haɗe-haɗen tsarin "dual-scope" ya ƙetare iyakokin jiyya na gargajiya kuma yana ba marasa lafiya sabon zaɓin bincike da magani gaba ɗaya.
ERCP da PTCS kowanne yana da nasa ƙwarewar musamman.
Don fahimtar ƙarfin haɗaɗɗen amfani da mahalli biyu, dole ne mutum ya fara fahimtar iyawar waɗannan kayan aikin guda biyu a sarari. Ko da yake duka biyu kayan aikin ne don gano cutar biliary da jiyya, suna amfani da hanyoyi daban-daban, suna ƙirƙirar cikakkiyar ma'amala.
ERCP: Kwarewar Endoscopic Shiga Tsarin narkewar abinci
ERCP yana nufin Endoscopic Retrograde Cholangiopancreatography. Ayyukansa yayi daidai da hanyar kewayawa na yin abubuwa. Likitan ya sanya duodenoscope ta baki, esophagus, da ciki, daga ƙarshe ya kai duodenum mai saukowa. Likitan yana gano wuraren buɗewar hanji na bile da pancreatic ducts (papilla duodenal). Sannan ana shigar da catheter ta tashar endoscopic biopsy. Bayan allurar da aka saba, ana yin gwajin X-ray ko duban dan tayi, wanda ke ba da damar gano alamun gani na bile da ducts na pancreatic.
A kan haka,ERCPHakanan zai iya aiwatar da hanyoyin warkewa iri-iri: alal misali, dilating kunkuntar bile ducts tare da balan-balan, buɗe wuraren da aka toshe tare da stent, cire duwatsu daga bile duct tare da kwandon cire dutse, da samun nama marasa lafiya don nazarin cututtukan cututtuka ta hanyar amfani da ƙarfin biopsy. Babban fa'idarsa ta ta'allaka ne a cikin gaskiyar cewa yana aiki gaba ɗaya ta cikin rami na halitta, yana kawar da buƙatar ɓarna a saman. Wannan yana ba da damar samun saurin dawowa bayan tiyata da ƙarancin rushewa ga jikin mai haƙuri. Yana da dacewa musamman don magance matsalolin bile duct kusa da hanji, kamar duwatsu a tsakiya da ƙananan ƙananan bile ducts, ƙananan ƙwayoyin bile, da raunuka a mahadar pancreatic da bile duct.
Duk da haka, ERCP kuma yana da "rauni": idan toshewar bile duct ya kasance mai tsanani kuma ba za a iya fitar da bile ba daidai ba, ma'aikacin bambanci zai yi wahala ya cika dukan bile duct, wanda zai shafi daidaiton ganewar asali; don intrahepatic bile duct duwatsu (musamman duwatsun da ke cikin zurfin hanta) da kuma matsayi mai tsayi na bile duct stenosis (kusa da hilum hanta da kuma sama), tasirin jiyya yakan ragu sosai saboda endoscope "ba zai iya isa" ko sararin aiki yana iyakance.
PTCS: Wani Majagaba Mai Haɓaka Yana Karye Ta Fannin Hanta
PTCS, ko percutaneous transhepatic choledochoscopy, yana amfani da hanyar "waje-ciki", sabanin tsarin "cikin waje" na ERCP. Ƙarƙashin jagorancin duban dan tayi ko CT, likitan fiɗa yana huda fata akan kirjin dama na majiyyaci ko cikin ciki, yana ratsa hanta daidai da samun damar dirartaccen bile duct na intrahepatic, yana haifar da rami na wucin gadi "fata-hanta-bile duct". Sannan ana shigar da choledochoscope ta wannan rami don lura da bututun bile na ciki kai tsaye yayin da ake yin jiyya a lokaci guda kamar cire dutse, lithotripsy, dilation na tsaurara, da sanya stent.
“makamin kisa” na PTCS ya ta’allaka ne a cikin iyawarsa ta kai tsaye kai tsaye ga raunukan bile duct na ciki. Yana da ƙwarewa musamman wajen magance "matsaloli masu zurfi" da wuya a kai tare da ERCP: alal misali, manyan duwatsun bile ducts sun wuce 2 cm a diamita, "dutse da yawa" sun warwatse ko'ina cikin rassan bile ducts masu yawa, matsanancin matsayi na bile ducts wanda ya haifar da ciwace-ciwacen ƙwayoyi ko kumburi, da kuma rikitarwa irin su anastomotic stenosis da bile fistubiliary. Bugu da ƙari kuma, lokacin da marasa lafiya ba za su iya yin amfani da ERCP ba saboda dalilai irin su duodenal papillary malformation da toshewar hanji, PTCS na iya zama madadin, saurin zubar da bile da kuma rage jaundice, don haka sayen lokaci don magani na gaba.
Koyaya, PTCS ba cikakke ba ne: tunda yana buƙatar huda a saman jiki, rikitarwa kamar zub da jini, zubar bile, da kamuwa da cuta na iya faruwa. Lokacin dawowa bayan tiyata ya ɗan ɗan tsayi fiye da ERCP, kuma fasahar huda likita da daidaiton jagorar hoto suna da girma sosai.
Haɗin Ƙarfi: Ma'anar "Aikin Ƙarfafawa" tare da Haɗin Dual-Scope
Lokacin da "fa'idodin endovascular" na ERCP ya sadu da "fa'idodin fa'ida" na PTCS, su biyun ba su da iyaka ga hanya ɗaya, amma a maimakon haka sun samar da tsarin bincike da magani wanda "ya buge duka ciki da wajen jiki." Wannan haɗin ba ƙari ba ne mai sauƙi na fasaha ba, sai dai tsarin "1+1>2" na musamman wanda ya dace da yanayin majiyyaci. Da farko ya ƙunshi nau'i biyu: "jere-biyu hade" da "hade a lokaci guda."
Haɗin Jeri: "Buɗe Hanyar Farko, Sannan Madaidaicin Jiyya"
Wannan ita ce hanyar haɗin kai ta gama gari, yawanci bin ƙa'idar "Magudanar ruwa Farko, Jiyya Daga baya." Misali, ga masu fama da jaundice mai tsanani da duwatsun bile duct na ciki ke haifarwa, mataki na farko shi ne a kafa tashar biliary magudanar ruwa ta hanyar huda PTCS don zubar da bile da ta taru, rage karfin hanta, rage hadarin kamuwa da cuta, kuma sannu a hankali ya dawo da aikin hanta na majiyyaci da yanayin jiki. Da zarar yanayin majiyyaci ya daidaita, ana yin ERCP daga gefen hanji don cire duwatsu a cikin ƙananan bile duct na yau da kullun, magance raunuka a cikin papilla duodenal, kuma a kara fadada ƙwayar bile ta hanyar amfani da balloon ko stent.
Sabanin haka, idan majiyyaci ya sha ERCP kuma an gano yana da ragowar hanta duwatsu ko babban stenosis wanda ba za a iya bi da shi ba, ana iya amfani da PTCS don kammala "aiki na ƙarshe" daga baya. Wannan samfurin yana ba da fa'idar "mataki-mataki-mataki tare da haɗarin da za a iya sarrafawa," yana mai da shi musamman dacewa ga marasa lafiya da yanayi masu rikitarwa da yanayin kiwon lafiya da suka rigaya.
Aiki Haɗe-haɗe na lokaci ɗaya: “Aiki guda biyu na lokaci guda,
Magani Daya Tsaya”
Ga marasa lafiya tare da bayyananniyar ganewar asali da kyakkyawar juriya ta jiki, likitoci na iya zaɓar hanyar "haɗaɗɗen lokaci guda". Yayin wannan tiyatar, ƙungiyoyin ERCP da PTCS suna aiki tare. Likitan fiɗa na ERCP yana amfani da endoscope daga gefen hanji, yana dilating duodenal papilla da kuma sanya jagorar jagora. Likitan fiɗa na PTCS, wanda ke jagoranta ta hanyar hoto, yana huda hanta kuma yana amfani da choledochoscope don gano wurin jagorar da aka sanya ERCP, yana samun daidaitaccen daidaitawar "tashoshi na ciki da na waje." Ƙungiyoyin biyu sun haɗa kai don yin lithotripsy, cire dutse, da kuma sanya stent.
Babban fa'idar wannan ƙirar ita ce ta magance batutuwa da yawa tare da hanya ɗaya, kawar da buƙatun maganin sa barci da tiyata da yawa, yana rage girman sake zagayowar jiyya. Misali, ga marasa lafiya tare da duwatsun bile ducts na intrahepatic da duwatsun bile na yau da kullun, ana iya amfani da PTCS lokaci guda don share duwatsun intrahepatic da ERCP don magance duwatsun bile duct na yau da kullun, kawar da buƙatar marasa lafiya don yin zagaye da yawa na maganin sa barci da tiyata, inganta ingantaccen magani.
Yanayi Mai Aiwatar: Wadanne Marasa lafiya Ne Ke Bukatar Haɗin Haɗin Matsala Biyu?
Ba duk cututtukan biliary ba ne ke buƙatar haɗe-haɗe-haɗe-haɗe-haɗe. Haɗe-haɗe-haɗe-haɗe-haɗe-haɗe ya dace da farko don rikitattun lokuta waɗanda ba za a iya magance su da fasaha ɗaya ba, da farko gami da masu zuwa:
Complex bile duct stones: Wannan shine farkon yanayin aikace-aikacen don haɗin CT mai nau'i biyu. Misali, marasa lafiya tare da duwatsun bile duct guda biyu na intrahepatic (musamman waɗanda ke cikin wurare masu nisa kamar lobe na gefen hagu ko lobe na bayan hanta na dama) da duwatsun bile duct na gama gari; marasa lafiya da duwatsu masu wuya fiye da 2 cm a diamita waɗanda ba za a iya cire su ta hanyar ERCP kadai ba; da marasa lafiya tare da duwatsun da ke kwance a cikin kunkuntar bile ducts, hana wucewar kayan aikin ERCP. Yin amfani da dual-scope hada CTCS, CTCS "karye" manyan duwatsu da kuma share reshe reshe daga cikin hanta, yayin da ERCP "share" ƙananan sassa daga hanji don hana saura duwatsu, cimma "cikakken tsarkakewar dutse."
Matsakaicin matakan bile ducts: Lokacin da tsaurin bile duct ya kasance sama da hilum hepatic (inda ducts na hanta na hagu da na dama suka hadu), ERCP endoscopes yana da wuyar isa, yana da wuya a tantance daidai tsanani da kuma dalilin tsananin. A cikin waɗannan lokuta, PTCS yana ba da damar hangen nesa kai tsaye na tsauraran ta hanyar tashoshi na ciki, ƙyale biopsies don tabbatar da yanayin raunin (kamar kumburi ko ƙari) yayin da ake yin dilatation na balan-balan lokaci guda ko sanya stent. ERCP, a gefe guda, yana ba da damar sanya stent a ƙasa, wanda ke aiki a matsayin relay don PTCS stent, yana tabbatar da magudanar ruwa ba tare da toshe ba na duka bile duct.
Rikicin bayan tiyata na biliary tiyata: Anastomotic stenosis, bile fistula, da sauran duwatsu na iya faruwa bayan tiyatar biliary. Idan mai haƙuri yana da matsananciyar matsananciyar hanji bayan tiyata kuma ERCP ba zai yiwu ba, ana iya amfani da PTCS don magudanar ruwa da magani. Idan stenosis anastomotic yana da tsayi kuma ERCP ba zai iya cika cikakke ba, PTCS za a iya haɗa shi tare da dilation na biyu don inganta nasarar nasarar magani.
Marasa lafiya waɗanda ba za su iya jure wa tiyata ɗaya ba: Misali, tsofaffi marasa lafiya ko marasa lafiya masu tsananin cututtukan zuciya ba za su iya jure wa dogon tiyata ɗaya ba. Haɗin madubai biyu na iya raba hadaddun aiki zuwa "ƙananan cin zarafi + kaɗan", rage haɗarin tiyata da nauyin jiki.
Mahimmanci na gaba: "Haɗin Haɓakawa" na Haɗin Haɗin Dual-Scope
Tare da ci gaban fasaha, haɗin ERCP da PTCS yana ci gaba da haɓakawa. A gefe ɗaya, ci gaban fasahar hoto yana ba da ƙarin takamaiman huda da matakai. Misali, hadewar intraoperative endoscopic duban dan tayi (EUS) da PTCS na iya hango tsarin ciki na bile duct a ainihin lokacin, yana rage matsalolin huda. A gefe guda kuma, sababbin abubuwa a cikin kayan aiki suna sa jiyya ya fi dacewa. Misali, masu sassauƙan choledochoscopes, ƙarin binciken lithotripsy mai dorewa, da stent mai ƙarfi suna ba da damar haɗawa da iko biyu don magance ƙarin hadaddun raunuka.
Bugu da ƙari kuma, "aiki tare da robot-assisted dual-scope hadedde" ya fito a matsayin sabon jagorar bincike: ta hanyar amfani da tsarin mutum-mutumi don sarrafa endoscopes da na'urorin huda, likitoci na iya yin matakai masu laushi a cikin yanayi mai dadi, ƙara inganta aikin tiyata da aminci. A nan gaba, tare da haɓaka haɗin gwiwar multidisciplinary (MDT), ERCP da PTCS za a kara haɗa su tare da laparoscopy da hanyoyin kwantar da hankali, samar da ƙarin keɓaɓɓen da keɓaɓɓen ganewar asali da zaɓuɓɓukan magani ga marasa lafiya da cututtukan biliary.
Haɗin kai-biyu na ERCP da PTCS yana karya iyakokin hanyar hanya ɗaya don gano cutar biliary da jiyya, yana magance cututtukan cututtukan biliary da yawa tare da ƙaramin ɓarna da madaidaicin hanya. Haɗin gwiwar wannan "ƙwararrun duo" ba wai kawai yana nuna ci gaban fasahar likitanci ba amma har ma ya ƙunshi tsarin kulawa da marasa lafiya don ganewar asali da magani. Yana canza abin da sau ɗaya ake buƙata babban laparotomy zuwa mafi ƙarancin jiyya tare da ƙarancin rauni da saurin murmurewa, ƙyale ƙarin marasa lafiya su shawo kan cututtukan su yayin da suke ci gaba da inganta rayuwa. Mun yi imanin cewa tare da ci gaba da ci gaba da fasaha na fasaha, haɗin haɗin gwiwar biyu zai buɗe ƙarin damar, yana kawo sababbin dama ga ganewar asali da kuma kula da cututtuka na biliary.
Mu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., wani manufacturer ne a kasar Sin ƙware a cikin endoscopic consumables, sun hada da GI line kamarbiopsy forceps, hemoclip, polyp tarko, allurar sclerotherapy, fesa catheter, cytology goge, jagora, kwandon dawo da dutse, hanci biliary drainage catheter, kumaSphincterotome da dai sauransu. wadanda ake amfani da su sosai a cikiEMR, ESD, ERCP.
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Lokacin aikawa: Nuwamba-14-2025