Hauv kev kuaj mob thiab kho cov kab mob biliary, kev tsim kho endoscopic thev naus laus zis tau tsom mus rau lub hom phiaj ntawm qhov tseeb dua, tsis muaj kev cuam tshuam, thiab kev nyab xeeb dua. Endoscopic retrograde cholangiopancreatography (ERCP), tus neeg ua haujlwm ntawm kev kuaj mob biliary kab mob thiab kev kho mob, tau ntev tau txais dav dav rau nws qhov tsis yog phais thiab qhov tshwm sim tsawg heev. Txawm li cas los xij, thaum ntsib nrog cov kab mob biliary nyuaj, ib qho txheej txheem feem ntau poob qis. Qhov no yog qhov uas percutaneous transhepatic cholangioscopy (PTCS) ua ib qho tseem ceeb ntxiv rau ERCP. Qhov kev sib koom ua ke "dual-scope" txoj hauv kev hla dhau cov kev txwv ntawm cov kev kho mob ib txwm muaj thiab muab cov neeg mob rau kev kuaj mob thiab kev kho mob tshiab.
ERCP thiab PTCS txhua tus muaj lawv tus kheej cov txuj ci tshwj xeeb.
Yuav kom nkag siab txog lub zog ntawm kev siv dual-scope ua ke, ib qho yuav tsum xub nkag siab meej txog cov peev txheej ntawm ob lub cuab yeej no. Txawm hais tias ob qho tib si yog cov cuab yeej rau kev kuaj mob biliary thiab kev kho mob, lawv siv cov kev sib txawv, tsim kom muaj qhov sib ntxiv zoo.
ERCP: Cov kws tshaj lij endoscopic nkag mus rau hauv plab hnyuv
ERCP sawv cev rau Endoscopic Retrograde Cholangiopancreatography. Nws txoj haujlwm yog zoo ib yam li txoj kev ncig ua haujlwm. Tus kws kho mob tso lub duodenoscope los ntawm lub qhov ncauj, txoj hlab pas, thiab lub plab, thaum kawg mus txog qhov descending duodenum. Tus kws kho mob nrhiav cov kab mob hauv plab hnyuv ntawm cov kua tsib thiab cov kab mob pancreatic (duodenal papilla). Tom qab ntawd lub catheter yog muab tso rau ntawm qhov chaw nres nkoj endoscopic biopsy. Tom qab txhaj tshuaj rau tus neeg sawv cev sib txawv, kuaj X-ray lossis ultrasound, ua kom pom qhov pom ntawm cov kua tsib thiab cov kab mob pancreatic.
Raws li qhov no,ERCPKuj tseem tuaj yeem ua tau ntau yam kev kho mob: piv txwv li, dilating nqaim cov ducts nrog lub zais pa, qhib cov ntawv thaiv nrog stents, tshem cov pob zeb los ntawm cov kua tsib nrog lub pob zeb tshem tawm, thiab tau txais cov ntaub so ntswg mob rau kev tshuaj xyuas kab mob siv biopsy forceps. Nws lub ntsiab kom zoo dua yog nyob rau hauv lub fact tias nws ua hauj lwm tag nrho los ntawm lub ntuj kab noj hniav, tshem tawm qhov yuav tsum tau rau nto incisions. Qhov no tso cai rau kev rov ua haujlwm sai sai thiab cuam tshuam tsawg kawg rau tus neeg mob lub cev. Nws yog tshwj xeeb tshaj yog haum rau kev kho cov kab mob hauv cov kab mob ze rau txoj hnyuv, xws li pob zeb nyob rau hauv nruab nrab thiab qis dua cov kua tsib duct, cov kua tsib qis qis, thiab cov kab mob ntawm cov kab mob pancreatic thiab cov kua tsib duct junction.
Txawm li cas los xij, ERCP kuj tseem muaj nws qhov "tsis muaj zog": yog tias cov kab mob hauv lub cev muaj zog hnyav thiab cov kua tsib tsis tuaj yeem tso tawm tau yooj yim, tus neeg sawv cev sib txawv yuav muaj teeb meem sau tag nrho cov kua tsib, uas yuav cuam tshuam qhov tseeb ntawm kev kuaj mob; rau cov pob zeb intrahepatic bile ducts (tshwj xeeb tshaj yog cov pob zeb nyob tob hauv daim siab) thiab lub siab ua haujlwm siab duct stenosis (ze rau lub siab hilum thiab saum toj no), cov kev kho mob feem ntau txo qis vim qhov endoscope "tsis tuaj yeem ncav cuag" lossis qhov chaw khiav hauj lwm raug txwv.
PTCS: Ib Tug Neeg Pioneer Tawg Los Ntawm Lub Siab Nto
PTCS, lossis percutaneous transhepatic choledochoscopy, ntiav txoj hauv kev "sab nraum-hauv", piv rau "sab hauv-tawm" txoj hauv kev ntawm ERCP. Raws li ultrasound lossis CT kev taw qhia, tus kws phais mob punctures ntawm daim tawv nqaij ntawm tus neeg mob lub hauv siab sab xis los yog lub plab mog, precisely traversing daim siab cov ntaub so ntswg thiab nkag mus rau lub dilated intrahepatic bile duct, tsim ib tug dag "skin- siab-bile duct" qhov. Ib qho choledochoscope yog muab tso rau hauv lub qhov dej no kom ncaj qha saib xyuas cov kab mob hauv cov kab mob hauv lub cev thaum tib lub sijhawm ua haujlwm xws li tshem tawm pob zeb, lithotripsy, dilation ntawm strictures, thiab stent tso.
PTCS's "killer riam phom" nyob rau hauv nws lub peev xwm mus ncaj qha mus rau intrahepatic bile ducts. Nws yog qhov tshwj xeeb tshaj plaws ntawm kev hais txog "cov teeb meem sib sib zog nqus" nyuaj rau kev ncav cuag nrog ERCP: piv txwv li, cov pob zeb loj heev hauv cov kav dej loj tshaj 2 cm hauv txoj kab uas hla, "ntau lub pob zeb" tawg mus thoob plaws ntau yam kab mob intrahepatic bile duct ceg, cov kab mob siab siab uas tshwm sim los ntawm cov qog los yog o, thiab cov teeb meem nyuaj xws li kev phais mob bile thiab anastomosis. Tsis tas li ntawd, thaum cov neeg mob tsis tuaj yeem ua rau ERCP vim yog vim li cas xws li duodenal papillary malformation thiab plab hnyuv, PTCS tuaj yeem ua lwm txoj hauv kev, ua kom cov kua tsib sai sai thiab txo cov kab mob jaundice, yog li yuav lub sijhawm rau kev kho mob tom ntej.
Txawm li cas los xij, PTCS tsis zoo tag nrho: vim tias nws yuav tsum tau txhaj tshuaj rau ntawm lub cev, muaj teeb meem xws li los ntshav, kua tsib, thiab kab mob yuav tshwm sim. Lub sijhawm rov qab ua haujlwm tom qab siv sijhawm ntev dua li ERCP, thiab tus kws kho mob cov cuab yeej siv tshuab thiab cov duab taw qhia qhov tseeb yog qhov siab heev.
Kev sib xyaw ua ke muaj zog: Lub Logic ntawm "Synergistic Operation" nrog Dual-Scope Combination
Thaum "qhov txiaj ntsig zoo ntawm endovascular" ntawm ERCP ua tau raws li "qhov zoo ntawm percutaneous" ntawm PTCS, ob qho tib si tsis txwv rau ib txoj hauv kev, tab sis hloov txoj kev kuaj mob thiab kev kho mob uas "tawm sab hauv thiab sab nraud lub cev." Kev sib xyaw ua ke no tsis yog ib qho yooj yim ntxiv ntawm cov thev naus laus zis, tab sis yog tus kheej "1 + 1> 2" txoj kev npaj kom haum rau tus neeg mob tus mob.
Sequential Combination: "Qhib Txoj Kev Ua Ntej, Tom Qab Kev Kho Mob"
Qhov no yog qhov kev sib xyaw ua ke ntau tshaj plaws, feem ntau ua raws li lub hauv paus ntsiab lus ntawm "drainage First, Treatment Later." Piv txwv li, rau cov neeg mob uas muaj mob hnyav jaundice tshwm sim los ntawm cov pob zeb intrahepatic bile ducts, thawj kauj ruam yog tsim kom muaj cov kua dej hauv lub cev los ntawm PTCS puncture kom ntws cov kua tsib, txo lub siab siab, txo qhov kev pheej hmoo ntawm kev kis kab mob, thiab maj mam kho tus neeg mob lub siab ua haujlwm thiab lub cev lub cev. Thaum tus neeg mob tus mob ruaj khov, ERCP yog tom qab ntawd ua los ntawm txoj hnyuv tawm kom tshem tawm cov pob zeb hauv cov kab mob hauv cov kab mob qis, kho cov kab mob hauv duodenal papilla, thiab ntxiv cov kua tsib kom nruj siv lub zais pa lossis stent.
Hloov pauv, yog tias tus neeg mob tau txais ERCP thiab pom tias muaj pob zeb nyob hauv siab lossis qib siab stenosis uas tsis tuaj yeem kho, PTCS tuaj yeem siv los ua kom tiav "ua haujlwm tiav" tom qab. Cov qauv no muab qhov zoo ntawm "txoj kev mus rau ib kauj ruam nrog cov kev pheej hmoo tswj tau," ua rau nws tsim nyog tshwj xeeb rau cov neeg mob uas muaj kev nyuaj siab thiab muaj kev noj qab haus huv ua ntej.
Kev Ua Haujlwm Ib Simultaneous Combined Operation: "Simultaneous Dual-scope Operation,
Single-Stop Solution”
Rau cov neeg mob uas muaj kev kuaj pom tseeb thiab kev ua siab ntev ntawm lub cev, cov kws kho mob tuaj yeem xaiv txoj kev "ib txhij ua ke". Thaum tib txoj kev phais, pawg ERCP thiab PTCS ua haujlwm ua ke. Tus kws phais ERCP siv lub endoscope los ntawm txoj hnyuv, dilating lub duodenal papilla thiab muab ib tug guidewire. Tus kws phais PTCS, coj los ntawm kev kos duab, punctures lub siab thiab siv lub choledochoscope los nrhiav ERCP-tso cov lus qhia, ua tiav qhov kev sib raug zoo ntawm "sab hauv thiab sab nraud." Ob pab pawg tom qab ntawd koom tes ua lithotripsy, tshem tawm pob zeb, thiab tso stent.
Qhov zoo tshaj plaws ntawm cov qauv no yog tias nws hais txog ntau yam teeb meem nrog ib tus txheej txheem, tshem tawm qhov xav tau rau ntau yam tshuaj loog thiab kev phais, ua rau lub voj voog kho kom luv. Piv txwv li, rau cov neeg mob uas muaj ob lub pob zeb intrahepatic bile ducts thiab cov pob zeb hauv cov kua tsib, PTCS tuaj yeem siv tib lub sijhawm kom tshem tawm cov pob zeb intrahepatic thiab ERCP los daws cov pob zeb hauv cov kua tsib, tshem tawm cov kev xav tau rau cov neeg mob mus rau ntau qhov kev tshuaj loog thiab phais, txhim kho kev kho mob.
Muaj feem cuam tshuam: Cov neeg mob twg xav tau kev sib xyaw ua ke dual-Scope?
Tsis yog tag nrho cov kab mob biliary yuav tsum tau muab ob npaug rau-scope ua ke. Dual-scope ua ke imaging yog feem ntau haum rau cov teeb meem nyuaj uas tsis tuaj yeem hais nrog ib qho txheej txheem, feem ntau suav nrog cov hauv qab no:
Complex bile duct pob zeb: Qhov no yog thawj daim ntawv thov scenario rau dual-scope ua ke CT. Piv txwv li, cov neeg mob uas muaj ob lub pob zeb intrahepatic bile ducts (tshwj xeeb tshaj yog cov nyob rau hauv tej thaj chaw deb qhov chaw xws li sab laug sab lobe los yog sab xis posterior lobe ntawm daim siab) thiab ntau cov kua tsib duct pob zeb; cov neeg mob uas muaj pob zeb nyuaj tshaj 2 cm nyob rau hauv txoj kab uas hla uas tsis tuaj yeem raug tshem tawm los ntawm ERCP ib leeg; thiab cov neeg mob uas muaj pob zeb nyob hauv cov ducts nqaim, tiv thaiv kev hla ntawm ERCP cov cuab yeej. Siv dual-scope ua ke CTCS, CTCS "tawg" pob zeb loj thiab tshem tawm cov pob zeb hauv lub siab, thaum ERCP "clear" cov kab hauv qab ntawm txoj hnyuv los tiv thaiv cov pob zeb seem, ua tiav "ua tiav pob zeb tshem tawm."
High-level bile duct strictures: Thaum cov kua tsib duct strictures nyob saum lub hepatic hilum (qhov twg sab laug thiab txoj cai hepatic ducts sib ntsib), ERCP endoscopes nyuaj mus cuag, ua rau nws tsis yooj yim rau kev ntsuam xyuas qhov hnyav thiab ua rau kom nruj. Hauv cov xwm txheej no, PTCS tso cai rau kev pom ncaj qha ntawm qhov nruj los ntawm cov kab mob intrahepatic, tso cai rau biopsies kom paub meej qhov xwm txheej ntawm qhov txhab (xws li mob lossis qog nqaij hlav) thaum tib lub sijhawm ua lub zais pa dilatation lossis stent tso. ERCP, ntawm qhov tod tes, tso cai rau kev tso chaw ntawm stent hauv qab no, uas ua raws li kev xa mus rau PTCS stent, kom ntseeg tau tias tsis muaj kev cuam tshuam ntawm tag nrho cov kua tsib.
Postoperative teeb meem ntawm biliary phais: Anastomotic stenosis, bile fistula, thiab cov pob zeb seem yuav tshwm sim tom qab kev phais biliary. Yog tias tus neeg mob muaj cov kab mob plab hnyuv loj tom qab kev phais thiab ERCP tsis tuaj yeem ua tau, PTCS tuaj yeem siv rau cov kua dej thiab kev kho mob. Yog tias qhov anastomotic stenosis nyob siab thiab ERCP tsis tuaj yeem nthuav dav tag nrho, PTCS tuaj yeem ua ke nrog ob sab dilation los txhim kho qhov ua tiav ntawm kev kho mob.
Cov neeg mob uas tsis tuaj yeem zam ib qho kev phais ib zaug: Piv txwv li, cov neeg mob laus lossis cov neeg mob uas muaj kab mob plawv tsis tuaj yeem tiv taus ib qho kev phais ntev ntev. Kev sib xyaw ua ke ntawm ob daim iav tuaj yeem faib cov kev ua haujlwm nyuaj rau hauv "tseem ceeb + cuam tshuam tsawg", txo qhov kev pheej hmoo ntawm kev phais thiab lub cev hnyav.
Yav Tom Ntej Outlook: Qhov "Txhim Kho Kev Taw Qhia" ntawm Dual-Scope Combination
Nrog kev txhim kho thev naus laus zis, kev sib xyaw ntawm ERCP thiab PTCS txuas ntxiv mus. Ntawm qhov tod tes, kev nce qib hauv kev yees duab thev naus laus zis tau ua kom muaj txiaj ntsig ntau dua thiab cov txheej txheem. Piv txwv li, kev sib xyaw ua ke ntawm intraoperative endoscopic ultrasound (EUS) thiab PTCS tuaj yeem pom cov qauv sab hauv ntawm cov kav dej hauv lub sijhawm, txo cov teeb meem puncture. Ntawm qhov tod tes, kev tsim kho tshiab hauv cov cuab yeej ua rau kev kho mob zoo dua. Piv txwv li, choledochoscopes saj zawg zog, ntau ruaj khov lithotripsy probes, thiab bioresorbable stents yog ua kom muaj kev sib xyaw ua ke los daws cov kab mob ntau dua.
Tsis tas li ntawd, "neeg hlau-pab dual-scope ua ke" tau tshwm sim raws li kev tshawb fawb tshiab: los ntawm kev siv cov tshuab neeg hlau los tswj cov tshuaj endoscopes thiab cov cuab yeej puncture, cov kws kho mob tuaj yeem ua cov txheej txheem me me hauv ib puag ncig zoo dua, ntxiv kev txhim kho kev phais thiab kev nyab xeeb. Nyob rau hauv lub neej yav tom ntej, nrog rau kev siv ntau txoj kev sib koom tes (MDT), ERCP thiab PTCS yuav tau txuas ntxiv nrog kev laparoscopy thiab kev kho mob, muab kev kuaj mob tus kheej ntau dua thiab muaj txiaj ntsig zoo rau cov neeg mob uas muaj kab mob biliary.
Kev sib xyaw ua ke ob ntawm ERCP thiab PTCS rhuav tshem cov kev txwv ntawm ib txoj hauv kev rau kev kuaj mob biliary thiab kev kho mob, hais txog ntau yam kab mob biliary uas muaj kev cuam tshuam tsawg thiab meej. Kev sib koom tes ntawm qhov "tus txawj ntse duo" tsis yog tsuas yog qhia txog kev nce qib ntawm kev kho mob thev naus laus zis tab sis kuj tseem cuam tshuam rau tus neeg mob txoj hauv kev rau kev kuaj mob thiab kev kho mob. Nws hloov pauv dab tsi ib zaug xav tau loj laparotomy rau hauv kev kho mob me me nrog kev raug mob tsawg dua thiab rov qab sai dua, tso cai rau ntau tus neeg mob kom kov yeej lawv cov kab mob thaum tswj hwm lub neej zoo dua. Peb ntseeg hais tias nrog kev txuas ntxiv thev naus laus zis, kev sib xyaw ua ke dual-scope yuav qhib lub peev xwm ntau dua, ua rau muaj peev xwm tshiab rau kev kuaj mob thiab kho cov kab mob biliary.
Peb, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., yog cov chaw tsim khoom hauv Suav teb tshwj xeeb hauv cov khoom siv endoscopic, suav nrog GI kab xws libiopsy forceps, hemoclip, polyp nuv, koob sclerotherapy, tshuaj tsuag catheter, cytology txhuam, phau ntawv qhia, pob zeb retrieval pob tawb, qhov ntswg biliary kua catheter, thiabSphincterotome thiab lwm yam. uas yog dav siv nyob rau hauvEMR, ESD, ERCP.
Peb cov khoom muaj ntawv pov thawj CE thiab nrog FDA 510K pom zoo, thiab peb cov nroj tsuag tau ntawv pov thawj ISO. Peb cov khoom tau raug xa tawm mus rau Tebchaws Europe, North America, Middle East thiab ib feem ntawm Asia, thiab tau txais cov neeg siv khoom ntawm kev lees paub thiab qhuas!
Post lub sij hawm: Nov-14-2025