I roto i te tātaritanga me te rongoā i ngā mate ate me te ate, kua aro tonu te whanaketanga o te hangarau endoscopic ki ngā whāinga kia tika ake, kia iti ake te whakaekenga, kia nui ake te haumaru. Ko te Endoscopic retrograde cholangiopancreatography (ERCP), te mea tino kaha o te tātaritanga me te rongoā i ngā mate ate me te ate, kua roa e whakaaetia whānuitia ana mō tōna āhua kore-pokanga me te iti rawa te whakaekenga. Heoi, ina tūtaki ki ngā whara ate me te ate uaua, ka hapa te tikanga kotahi. Koinei te wā ka noho te percutaneous transhepatic cholangioscopy (PTCS) hei tāpiri nui ki te ERCP. Ka hipa atu tēnei huarahi "rua-whānui" i ngā herenga o ngā maimoatanga tuku iho, ā, ka tukuna ki ngā tūroro he kōwhiringa tātaritanga me te rongoā hou.
He pūkenga motuhake tō te ERCP me te PTCS.
Hei mārama ki te kaha o te whakamahinga tahi o ngā tirohanga rua, me mārama tuatahi ki ngā āheinga ahurei o ēnei taputapu e rua. Ahakoa he taputapu e rua mō te tātaritanga me te maimoatanga o te ate, he rerekē ngā tikanga e whakamahia ana e rāua, ā, he tino pai te tāpiritanga.
ERCP: He Tohungatanga Endoscopic e Whakauru Ana ki te Ara Nakunaku
Ko te ERCP he whakarāpopototanga mō te Endoscopic Retrograde Cholangiopancreatography. He rite tonu tana mahi ki te mahi porowhita. Ka whakaurua e te tākuta he duodenoscope mā te waha, te esophagus, me te puku, ā, ka tae atu ki te duodenum e heke ana. Ka kimihia e te tākuta ngā pūaha o te whekau o te au me ngā awa pancreatic (te duodenal papilla). Kātahi ka whakaurua he catheter mā te putanga biopsy endoscopic. Whai muri i te werohanga o te kaihoko rerekē, ka mahia he whakamātautau hihi-X, he whakamātautau ultrasound rānei, kia taea ai te tātaritanga tirohanga o ngā awa me ngā awa pancreatic.
I runga i tēnei kaupapa,ERCPka taea hoki te mahi i ngā momo tikanga whakaora: hei tauira, te whakawhānui i ngā awaawa aukume whaiti me te poihau, te whakatuwhera i ngā ara kua āraia me ngā stent, te tango i ngā kōhatu mai i te awaawa aukume me te kete tango kōhatu, me te tiki i ngā kiko mate mō te tātaritanga mate mā te whakamahi i ngā forceps koiora. Ko tōna painga matua kei roto i te meka e mahi katoa ana i roto i te kōhao tūturu, ka whakakorea te hiahia mō ngā tapahi mata. Mā tēnei ka taea te whakaora tere i muri i te pokanga me te iti o te whakararuraru ki te tinana o te tūroro. He tino pai mō te rongoā i ngā raruraru awaawa aukume e tata ana ki te whekau, pērā i ngā kōhatu i te awaawa aukume noa o waenganui me raro, ngā whakawhāititanga o te awaawa aukume o raro, me ngā whara i te hononga o te pancreas me te awaawa aukume.
Heoi anō, kei a ERCP anō ōna "ngoikoretanga": ki te tino aukati te awaawa o te ate, ā, kāore e taea te tuku mārie i te awaawa o te ate, ka uaua ki te kaihoko whakawhiti te whakakī i te awaawa katoa, ka pā ki te tika o te tātaritanga; mō ngā kōhatu awaawa o roto i te ate (ina koa ko ngā kōhatu kei roto i te ate) me te stenosis awaawa o te ate kei te teitei te tūranga (e tata ana ki te hilum o te ate me runga ake), ka tino heke te hua o te maimoatanga nā te mea "kāore e taea e te endoscope te tae atu" he iti rānei te wāhi mahi.
PTCS: He Paionia Ā-Kiri e Pakaru Ana i te Mata o te Ate
Ko te PTCS, arā, ko te percutaneous transhepatic choledochoscopy, e whakamahi ana i te huarahi "waho-ki-roto", he rerekē ki te huarahi "roto-ki-waho" o te ERCP. I raro i te arataki a te ultrasound, CT rānei, ka werohia e te taote pokanga te kiri o te uma matau, o te puku rānei o te tūroro, ka tika te haere i roto i te kiko ate, ka uru atu ki te awaawa aukume intrahepatic kua whānui, ka hanga he kauhanga "kiri-ate-awaawa aukume" horihori. Kātahi ka whakauruhia he choledochoscope mā roto i tēnei kauhanga hei tirotiro tika i te awaawa aukume intrahepatic, me te mahi i ngā maimoatanga pēnei i te tango kohatu, te lithotripsy, te whakawhānui i ngā strictures, me te whakatakotoranga stent.
Ko te "patu whakamate" a te PTCS kei roto i tōna kaha ki te toro tika atu ki ngā whara o te awaawa o roto i te ate. He tino pūkenga ki te whakatika i ngā "raruraru hohonu" e uaua ana ki te toro atu me te ERCP: hei tauira, ngā kōhatu awaawa nunui e neke atu ana i te 2 cm te whānui, ngā "kōhatu maha" e marara ana i roto i ngā manga awaawa o roto i te ate, ngā whakawhāititanga o te awaawa o te ate e tū ana i runga i te teitei i puta mai i ngā pukupuku, i te mumura rānei, me ngā raruraru uaua pēnei i te stenosis anastomotic me ngā fistula awaawa e puta ana i muri i te pokanga awaawa. Hei tāpiri, ina kore e taea e ngā tūroro te mahi ERCP nā ngā take pēnei i te duodenal papillary malformation me te aukati i te puku, ka taea e te PTCS te mahi hei huarahi kē atu, ka tere te mimiti i te awaawa me te whakaiti i te jaundice, ā, ka hoko wā mō te maimoatanga i muri mai.
Heoi, kāore te PTCS i te tino tika: nā te mea me wero te mata o te tinana, ka puta pea ngā raruraru pēnei i te toto, te turuturu o te au, me te mate. He roa ake te wā whakaora i muri i te pokanga i te ERCP, ā, he tino teitei te hangarau wero a te tākuta me te tika o te arataki whakaahua.
He Huinga Kaha: Te Arorau o te "Mahi Tahi" me te Huinga Whānui-Rua
Ina tutuki ngā "painga endovascular" o te ERCP ki ngā "painga percutaneous" o te PTCS, kāore e herea ngā mea e rua ki te huarahi kotahi, engari ka hangaia he anga tātaritanga me te maimoatanga e "pā ana ki roto, ki waho hoki o te tinana." Ehara tēnei huinga i te tāpiri noa o ngā hangarau, engari he mahere "1+1>2" whaiaro kua whakaritea mō te āhua o te tūroro. Ko te nuinga o ngā tauira e rua: "whakakotahi raupapa" me te "whakakotahi tukutahi."
Huinga Raupapa: "Whakatuwheratia te Ara i te Tuatahi, Kātahi ka Whakamaarama Tika"
Koinei te huarahi whakakotahitanga tino noa, e whai ana i te mātāpono "te tango wai i te tuatahi, te maimoatanga i muri mai." Hei tauira, mō ngā tūroro he jaundice aukati nui i puta mai i ngā kōhatu o te awaawa o roto i te ate, ko te taahiraa tuatahi ko te whakatū i tētahi awaawa tango wai i roto i te PTCS wetewete hei tango i te awaawa kua kohia, hei whakamama i te pēhanga ate, hei whakaiti i te mōrearea o te mate, ā, hei whakaora mārire i te mahi ate me te āhua tinana o te tūroro. Kia tau te āhua o te tūroro, ka mahia te ERCP mai i te taha puku hei tango i ngā kōhatu i roto i te awaawa o raro, hei rongoā i ngā whara i roto i te papilla duodenal, ā, hei whakawhānui ake i te stricture o te awaawa o te ate mā te whakamahi i tētahi poihau, i tētahi stent rānei.
I tetahi atu taha, ki te whiwhi ERCP te tūroro, ā, ka kitea he kohatu ate toenga, he stenosis taumata teitei rānei kāore e taea te rongoā, ka taea te whakamahi i te PTCS hei whakaoti i te "mahi whakaoti" i muri mai. Ka tukuna e tēnei tauira te painga o te "huarahi taahiraa-i-te-taahiraa me ngā mōrearea ka taea te whakahaere," he mea tino pai mō ngā tūroro he mate uaua me ngā mate hauora o mua.
Mahi Whakakotahi Tukutahi: "Mahi Whānui-rua Tukutahi,
"Otinga Kotahi-Mutu"
Mō ngā tūroro kua mārama te tautuhi mate, ā, he pai te manawanui tinana, ka whiriwhiri pea ngā tākuta i tētahi tikanga "whakakotahi i te wā kotahi". I te wā o te pokanga kotahi, ka mahi tahi ngā tīma ERCP me te PTCS. Ka whakamahia e te taote pokanga ERCP te endoscope mai i te taha puku, ka whakawhānui i te papilla duodenal ka whakatakoto i tētahi waea ārahi. Ka werohia e te taote pokanga PTCS, mā te whakaahua e ārahi, te ate ka whakamahi i te choledochoscope hei kimi i te waea ārahi kua whakatakotoria ki te ERCP, kia tutuki ai te tūnga tika o ngā "awa o roto me o waho." Kātahi ka mahi tahi ngā tīma e rua ki te mahi lithotripsy, te tango kohatu, me te whakatakoto stent.
Ko te painga nui o tēnei tauira ko tana aro atu ki ngā take maha mā te whakamahi i te tikanga kotahi, ka kore e hiahiatia he maha o ngā rongoā whakamoe me ngā pokanga, ka whakapotoa te huringa maimoatanga. Hei tauira, mō ngā tūroro he kōhatu awaawa ate me ngā kōhatu awaawa ate noa, ka taea te whakamahi i te PTCS i te wā kotahi hei whakakore i ngā kōhatu awaawa ate me te ERCP hei whakatika i ngā kōhatu awaawa ate noa, ka kore e hiahiatia he maha o ngā rongoā whakamoe me te pokanga mō ngā tūroro, ka whakapai ake i te whai huatanga o te maimoatanga.
Horopaki e tika ana: Ko ēhea Tūroro e hiahia ana ki te whakakotahitanga o ngā whānuitanga-rua?
Kāore e hiahiatia ana he whakaahua whakakotahi rua-tirohanga mō ngā mate ate katoa. He pai te whakaahua whakakotahi rua-tirohanga mō ngā take uaua kāore e taea te whakatika mā te tikanga kotahi, tae atu ki ēnei e whai ake nei:
Ngā kōhatu uaua o te awaawa o te ate: Koinei te whakamahinga matua mō te CT whakakotahi rua-tirohanga. Hei tauira, ko ngā tūroro he kōhatu awaawa o roto i te ate (ina koa ko ērā kei ngā wāhi tawhiti pērā i te taha maui o te ate, te taha matau rānei o muri o te ate) me ngā kōhatu awaawa noa; ko ngā tūroro he kōhatu mārō neke atu i te 2 cm te whānui kāore e taea te tango mā te ERCP anake; me ngā tūroro he kōhatu kei roto i ngā awaawa o te ate whaiti, e aukati ana i te haerenga o ngā taputapu ERCP. Mā te whakamahi i te CTCS whakakotahi rua-tirohanga, ka "pakaru" te CTCS i ngā kōhatu nunui, ka whakakore i ngā kōhatu peka mai i roto i te ate, ko te ERCP ia ka "whakakore" i ngā ara o raro mai i te whekau hei ārai i ngā kōhatu toenga, ka tutuki ai te "whakakorenga katoa o te kōhatu."
Ngā whāititanga o te awaawa o te ate: Ina kei runga ake i te hilum hepatic (te wāhi e tūtaki ai ngā awaawa o te ate maui me te matau) ngā whāititanga o te awaawa o te ate, he uaua ki te toro atu ki ngā endoscope ERCP, ā, he uaua ki te aromatawai tika i te kaha me te take o te whāititanga. I ēnei wā, ka taea e te PTCS te tirotiro tika i te whāititanga mā roto i ngā awaawa o roto i te ate, ka taea ai e ngā biopsy te whakaū i te āhua o te whara (pēnei i te mumura, te pukupuku rānei) i te wā kotahi e whakawhanui ana i te poihau, e whakanoho ana rānei i te stent. I tētahi atu taha, ka taea e te ERCP te whakanoho i te stent ki raro, e mahi ana hei whakawhiti mō te stent PTCS, e whakarite ana kia kore e āraihia te rerenga o te awaawa o te awaawa katoa.
Ngā raruraru i muri i te pokanga o te pokanga biliary: Tērā pea ka puta te stenosis anastomotic, te fistula bile, me ngā kohatu toenga i muri i te pokanga biliary. Mena he nui ngā piri o te puku o te tūroro i muri i te pokanga, ā, kāore e taea te ERCP, ka taea te whakamahi i te PTCS mō te tango wai me te maimoatanga. Mena kei te teitei te stenosis anastomotic, ā, kāore e taea e te ERCP te whānui katoa, ka taea te whakakotahi i te PTCS me te whakawhānui rua hei whakapai ake i te angitu o te maimoatanga.
Ngā tūroro kāore e taea te aro ki tētahi pokanga kotahi: Hei tauira, kāore e taea e ngā tūroro kaumātua, ngā tūroro rānei he mate manawa nui tō rātou te aro ki tētahi pokanga roa kotahi. Mā te whakakotahitanga o ngā whakaata takirua ka taea te wehewehe i te pokanga uaua ki te "iti rawa te whakaekenga me te iti rawa te whakaekenga", ka whakaiti i ngā mōrearea pokanga me te taumahatanga tinana.
Te Tirohanga ā-Mārama: Te "Ahunga Whakapai Ake" o te Whakakotahitanga Whānui-Rua
I roto i ngā whanaketanga hangarau, kei te whanake tonu te whakakotahitanga o te ERCP me te PTCS. I tētahi taha, mā ngā whanaketanga hangarau whakaahua ka taea te hanga poka me ngā tikanga tika ake. Hei tauira, mā te whakakotahitanga o te ultrasound endoscopic (EUS) i te wā o te pokanga me te PTCS ka taea te tiro i te hanganga o roto o te awaawa o te ate i te wā tūturu, ka whakaiti i ngā raruraru poka. I tētahi atu taha, mā ngā mahi auaha i roto i ngā taputapu ka pai ake te maimoatanga. Hei tauira, mā ngā choledochoscope ngāwari, ngā probe lithotripsy pakari ake, me ngā stent bioresorbable ka taea te whakakotahi i ngā tirohanga-rua ki te aro atu ki ngā whara uaua ake.
Hei tāpiri atu, kua puta ake te "whakakotahitanga o te tirohanga-rua e āwhinahia ana e te karetao" hei huarahi rangahau hou: mā te whakamahi i ngā pūnaha karetao hei whakahaere i ngā endoscope me ngā taputapu pokanga, ka taea e ngā tākuta te mahi i ngā tikanga ātaahua i roto i te taiao whakamarie ake, ka whakapai ake i te tika me te haumaru o te pokanga. I te heke mai, me te pikinga ake o te whakamahi i te mahi tahi maha-mātauranga (MDT), ka whakauruhia te ERCP me te PTCS ki ngā maimoatanga laparoscopy me te wawaotanga, ka whakarato i ngā whiringa tātaritanga me te maimoatanga whaiaro me te kounga teitei ake mō ngā tūroro e mate ana i te biliary.
Mā te whakakotahitanga o te ERCP me te PTCS e rua ngā tirohanga ka pakaruhia ngā herenga o te huarahi kotahi-ara mō te tātaritanga me te maimoatanga o te ate, ka aro atu ki ngā mate ate uaua maha me te huarahi iti rawa te whakaekenga me te tika. Ko te mahi tahi a tēnei "takirua pūkenga" ehara i te mea e whakaata ana i te whanaketanga o te hangarau hauora engari e whakaatu ana hoki i te huarahi e aro ana ki te tūroro ki te tātaritanga me te maimoatanga. Ka hurihia ngā mea i mua i hiahiatia he laparotomy nui ki ngā maimoatanga iti rawa te whakaekenga me te iti o te whara me te tere o te whakaoranga, ka taea e te maha atu o ngā tūroro te wikitoria i ō rātou mate me te pupuri tonu i te kounga teitei o te oranga. E whakapono ana mātou mā te haere tonu o ngā whanaketanga hangarau, ka iritihia e te whakakotahitanga o te tirohanga rua ētahi atu āheinga, ka kawea mai he huarahi hou ki te tātaritanga me te maimoatanga o ngā mate ate.
Ko mātou, ko Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., he kaihanga i Haina e tohunga ana ki ngā taonga endoscopic, tae atu ki te raina GI pēnei i tengā kukupa koiora, hemoclip, mahanga poripi, ngira whakaora kiriuhi, pūwero rehu, paraihe cytology, waea ārahi, kete tiki kohatu, te katitere whakaheke wai ihu, meSphincterotome me ētahi atue whakamahia whānuitia ana i roto iEMR, ESD, ERCP.
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Wā tuku: Whiringa-ā-rangi 14-2025