Ngā Taputapu ERCP - Kete Tango Kōhatu
Ko te kete tango kōhatu he mea āwhina tango kōhatu e whakamahia whānuitia ana i roto i ngā taputapu ERCP. Mō te nuinga o ngā tākuta hou ki te ERCP, tera pea ka herea tonu te kete kōhatu ki te ariā o "ngā taputapu mō te tango kōhatu", ā, kāore e ranea hei whakatau i te āhuatanga uaua o te ERCP. I tēnei rā, ka whakarāpopototia e au, ka akohia hoki ngā mōhiotanga e tika ana mō ngā kete kōhatu ERCP i runga i ngā mōhiohio e tika ana kua tirohia e au.
Whakarōpūtanga whānui
Kua wehea te kete tango kōhatu ki te kete arataki waea ārahi, te kete arataki waea kore-arataki, me te kete tango kōhatu whakauru. I roto i ēnei, ko ngā kete tango-kume whakauru ko ngā kete tango-kume noa e tohuhia ana e Micro-Tech me ngā kete tango-kume Rapid Exchange (RX) e tohuhia ana e Boston Scientifi. Nā te mea he nui ake te utu o te kete tango-kume whakauru me te kete whakawhiti-tere i ngā kete noa, ka whakaitihia pea e ētahi wāhanga me ngā tākuta whakahaere tā rātou whakamahinga nā runga i ngā take utu. Heoi, ahakoa te utu o te whakarērea noa iho, he pai ake te nuinga o ngā tākuta whakahaere ki te whakamahi i te kete (me te waea arataki) mō te wehewehe, inā koa mō ngā kōhatu awaawa nui ake.
E ai ki te āhua o te kete, ka taea te wehewehe ki ngā momo "hexagonal", "taimana" me te "porowhita", arā, te taimana, te Dormia me te porowhita, ā, ko ngā kete Dormia ētahi e whakamahia whānuitia ana. He painga me he ngoikoretanga anō ō ngā kete o runga ake nei, ā, me whiriwhiri ngāwari i runga i te āhuatanga tūturu me ngā tikanga whakamahi whaiaro.
Nā te mea he hanganga kete ngāwari te kete āhua taimana me te kete Dormia me te "pito whakawhanui me te pito whakawhāiti", ka māmā ake te tiki kōhatu mā te kete. Mēnā kāore e taea te tango i te kōhatu i muri i te mauheretia nā te mea he nui rawa te kōhatu, ka taea te tuku mārire i te kete, kia kore ai e whakama.
Kete "taimana" noa
Kāore i te tino whakamahia ngā kete "hexagon-rhombus" noa, i roto rānei i ngā kete kuru kohatu anake. Nā te nui o te wāhi o te kete "taimana", he ngāwari te mawhiti o ngā kohatu iti mai i te kete. Ko ngā āhuatanga o te kete porowhita he "ngāwari ki te mau engari kāore e ngāwari ki te wetewete". Ko te whakamahinga o te kete porowhita me mārama katoa ki te kohatu me te whakatau tata i te mahi kia kore ai te kohatu e mau i te nuinga o te wā.
Kete porowhita
Ka whakamahia te kete whakawhiti-tere e whakauruhia ana ki te kuru me te kuru i te wā e tangohia ana ngā kōhatu nunui, ka taea te whakapoto i te wā mahi me te whakapai ake i te reiti angitu o te kuru. Hei tāpiri, ki te hiahiatia te whakamahi i te kete mō te whakaahua, ka taea te horoi i mua i te otinga o te rongoā whakawhiti ira me te pau i mua i te urunga o te kete ki te awaawa au.
Tuarua, te tukanga whakaputa
Ko te hanganga matua o te kete kōhatu he mea hanga mai i te matua o te kete, he pūeru o waho, me te kakau. Ko te matua o te kete he mea hanga mai i te waea kete (te konukōre titanium-nickel) me te waea kukume (te maitai kore waikura hauora 304). He hanganga whiri konumohe te waea kete, he rite ki te hanganga whiri o te mahanga, e āwhina ana ki te hopu i te ūnga, ki te ārai i te paheke, me te pupuri i te kukū teitei, ā, kāore e ngāwari ki te whati. He waea hauora motuhake te waea kukume, he kaha kukū me te pakari, nō reira kāore au e kōrero taipitopito i konei.
Ko te mea nui hei kōrero ko te hanganga whakarewa i waenganui i te waea kukume me te waea kete, te waea kete me te pane whakarewa o te kete. Ina koa, ko te pūwāhi whakarewa i waenganui i te waea kukume me te waea kete te mea nui ake. I runga i tēnei hoahoa, he tino teitei ngā whakaritenga mō te tukanga whakarewa. Tērā pea ka kore e pakaru te kōhatu e te kete he iti te kounga, engari ka whati hoki te pūwāhi whakarewa i waenganui i te waea kukume me te waea kete mata i te wā e pakaru ana te kōhatu i muri i te tangohanga o te kōhatu, ka noho tonu te kete me te kōhatu ki roto i te awaawa au, ā, ka tangohia i muri mai. He uaua (ka taea te tiki ake mā te kete tuarua) ā, me pokanga pea.
Mā te ngoikore o te tukanga whakarewa o te waea me te pane whakarewa o te nuinga o ngā kete noa ka pakaru ngāwari te kete. Heoi, kua kaha ake ngā kete a Boston Scientific ki tēnei kaupapa, ā, kua hangaia he tikanga tiaki haumaru. Arā, ki te kore tonu e taea te pakaru i ngā kōhatu ki ngā kōhatu kuru pehanga teitei, ka taea e te kete e whakau ana i ngā kōhatu te tiaki i te pane whakarewa i te pito o mua o te kete kia pai ai te whakaurunga o te waea kete me te waea kukume. He pono, ā, ka kore e toe ngā kete me ngā kōhatu ki roto i te awaawa au.
Kāore au e kōrero taipitopito mō te ngongo me te kakau o waho. Hei tāpiri, he rerekē ngā momo mīhini kuru kohatu a ngā kaihanga, ā, ka whai wāhi ahau ki te ako atu i muri mai.
Me pēhea te whakamahi
He mea uaua ake te tango i te kōhatu i roto i te whare herehere. Tērā pea he whakaitiiti te kaiwhakahaere i te āhua me ngā taputapu o te tūroro, he āhuatanga rānei nō ngā kōhatu o te awa au. Ahakoa pēhea, me mōhio tuatahi tātou me pēhea te karo i te noho herehere, kātahi ka mōhio tātou me aha mēnā ka noho herehere.
Hei karo i te mauheretanga o te kete, me whakamahi he poihau poutū hei whakawhanui i te whakatuwheratanga o te uma i mua i te tango kohatu. Ko ētahi atu tikanga ka taea te whakamahi hei tango i te kete mauhere ko: te whakamahi i tētahi kete tuarua (kete-ki-te-kete) me te tango pokanga, ā, kua pūrongohia hoki e tētahi tuhinga tata nei ka taea te tahu i te haurua (2, 3 rānei) o ngā waea mā te whakamahi i te APC. Momotuhia, ka tukuna te kete mauhere.
Tuawhā, te maimoatanga o te mauheretanga kete kohatu
Ko te whakamahinga o te kete ko: te whiriwhiri i te kete me ngā mea e rua o roto i te kete hei tango i te kōhatu. Mō te whiriwhiri i te kete, ko te āhua o te kete, te whānui o te kete, me te whakamahi, te kore rānei e hiahiatia he lithotripsy ohorere (i te nuinga o te wā, ka whakaritea te pokapū endoscopy i ia wā).
I tēnei wā, ko te kete "taimana" te mea e whakamahia whānuitia ana, arā, ko te kete Dormia. I roto i te aratohu ERCP, kua whakahuatia māramatia tēnei momo kete i roto i te wāhanga tango kōhatu mō ngā kōhatu awaawa noa. He teitei te angitu o te tango kōhatu, ā, he ngāwari ki te tango. Koinei te kōwhiringa tuatahi mō te nuinga o ngā tango kōhatu. Mō te whānui o te kete, me whiriwhiri te kete e rite ana kia rite ki te rahi o te kōhatu. He uaua ki te kōrero atu mō te kōwhiringa o ngā waitohu kete, tēnā whiriwhiria kia rite ki ō ake tikanga.
Ngā pūkenga tango kōhatu: Ka whakatakotoria te kete ki runga ake i te kōhatu, ā, ka whakamātauria te kōhatu i raro i te tirotiro angiographic. Ko te tikanga, me mahi te EST, te EPBD rānei i runga i te rahi o te kōhatu i mua i te tango i te kōhatu. Ina whara, ina whaiti rānei te awaawa au, kāore pea he wāhi hei whakatuwhera i te kete. Me tiki mai i runga i te āhuatanga motuhake. He kōwhiringa anō hoki te kimi huarahi hei tuku i te kōhatu ki tētahi awaawa au whānui hei tiki mai. Mō ngā kōhatu awaawa au hilar, me mōhio ka panaia ngā kōhatu ki roto i te ate, ā, kāore e taea te tiki mai ina tangohia te kete i roto i te kete, ina mahia rānei te whakamātautau.
E rua ngā tikanga mō te tango i ngā kōhatu i roto i te kete kōhatu: ko tētahi he nui te wāhi i runga ake i te kōhatu, i te taha rānei o te kōhatu hei whakatuwhera i te kete; ko tētahi he karo i te tango i ngā kōhatu nunui rawa, ahakoa kua tuwhera katoa te kete, kāore e taea te tango. Kua tūtaki anō mātou ki ngā kōhatu 3 cm te whānui i tangohia i muri i te endoscopic lithotripsy, ā, me lithotripsy katoa ēnei. Heoi anō, he tino mōrearea tonu tēnei āhuatanga, ā, me whai tākuta mātau ki te mahi pokanga.
Wā tuku: Mei-13-2022