I ka ʻike ʻana a me ka mālama ʻana i nā maʻi biliary, ua kālele mau ka hoʻomohala ʻana o ka ʻenehana endoscopic i nā pahuhopu o ka pololei nui aʻe, ka emi ʻana o ka invasiveness, a me ka palekana nui aʻe. ʻO ka Endoscopic retrograde cholangiopancreatography (ERCP), ka lio hana o ka ʻike ʻana a me ka mālama ʻana i nā maʻi biliary, ua ʻae nui ʻia no kona ʻano ʻoki ʻole a me ka minimally invasive. Eia naʻe, i ka wā e kū ai i nā ʻeha biliary paʻakikī, hāʻule pinepine kahi ʻenehana hoʻokahi. ʻO kēia kahi e lilo ai ka percutaneous transhepatic cholangioscopy (PTCS) i mea hoʻohui koʻikoʻi i ka ERCP. ʻO kēia ala "dual-scope" i hui pū ʻia e ʻoi aku ma mua o nā palena o nā lāʻau lapaʻau kuʻuna a hāʻawi i nā mea maʻi i kahi koho diagnostic a me ka mālama hou loa.
Loaʻa i kēlā me kēia ʻo ERCP a me PTCS ko lākou mau mākaukau ponoʻī.
I mea e maopopo ai ka mana o ka hoʻohana ʻana i hui pū ʻia me ka ʻelua ʻāpana, pono e hoʻomaopopo mua kekahi i nā hiki kūikawā o kēia mau mea hana ʻelua. ʻOiai he mau mea hana ʻelua no ka ʻike ʻana a me ka mālama ʻana i ka biliary, hoʻohana lākou i nā ʻano hana like ʻole, e hana ana i kahi hoʻopihapiha kūpono.
ERCP: He ʻIke Endoscopic e komo ana i ka ʻAla Digestive
ʻO ke kū ʻana o ERCP no Endoscopic Retrograde Cholangiopancreatography. Ua like kāna hana me kahi ala hana pōʻai. Hoʻokomo ke kauka i kahi duodenoscope ma o ka waha, esophagus, a me ka ʻōpū, a hiki i ka duodenum iho. Huli ke kauka i nā puka ʻōpū o nā ʻāpana bile a me nā pancreatic (ka duodenal papilla). A laila hoʻokomo ʻia kahi catheter ma o ka puka biopsy endoscopic. Ma hope o ka hoʻokomo ʻana i kahi mea hoʻohālikelike, hana ʻia kahi hoʻokolokolo X-ray a ultrasound paha, e hiki ai ke ʻike maka i nā ʻāpana bile a me nā pancreatic.
Ma luna o kēia kumu,ERCPhiki ke hana i nā ʻano hana lapaʻau like ʻole: no ka laʻana, ka hoʻonui ʻana i nā ʻauwai bile i haiki ʻia me kahi balloon, ka wehe ʻana i nā ala i ālai ʻia me nā stents, ka wehe ʻana i nā pōhaku mai ke auwai bile me kahi hīnaʻi wehe pōhaku, a me ka loaʻa ʻana o nā ʻiʻo maʻi no ka nānā ʻana i ka pathology me ka hoʻohana ʻana i nā forceps biopsy. ʻO kona pono nui ma ka ʻoiaʻiʻo e hana holoʻokoʻa ia ma o ke ana kūlohelohe, e hoʻopau ana i ka pono no nā ʻoki ʻili. ʻAe kēia i ka hoʻōla wikiwiki ʻana ma hope o ka hana a me ka liʻiliʻi o ka hoʻopilikia ʻana i ke kino o ka mea maʻi. He kūpono loa ia no ka mālama ʻana i nā pilikia o ke auwai bile kokoke i ka ʻōpū, e like me nā pōhaku ma ke auwai bile waena a me lalo, nā strictures o ke auwai bile haʻahaʻa, a me nā lesions ma ka pancreatic a me ka bile duct junction.
Eia nō naʻe, he mau "nāwaliwali" ko ERCP: inā koʻikoʻi ka ālai ʻana o ke ala bile a ʻaʻole hiki ke hoʻokuʻu mālie ʻia ke ala bile, e pilikia ka mea hoʻohālikelike i ka hoʻopiha ʻana i ke ala bile holoʻokoʻa, kahi e hoʻopilikia ai i ka pololei o ka hōʻailona; no nā pōhaku ala bile intrahepatic (ʻoi aku hoʻi nā pōhaku i loaʻa hohonu i loko o ke akepaʻa) a me ka stenosis ala bile kiʻekiʻe (kokoke i ka hilum akepaʻa a ma luna), hoʻemi pinepine ʻia ka hopena lapaʻau no ka mea "ʻaʻole hiki ke hōʻea" ka endoscope a i ʻole ua kaupalena ʻia ka wahi hana.
PTCS: He Paionia Percutaneous e uhaʻi ana i ka ʻili o ke akepaʻa
Hoʻohana ka PTCS, a i ʻole percutaneous transhepatic choledochoscopy, i kahi ala "waho-i loko", i ka hoʻohālikelike ʻana me ke ala "i loko-i waho" o ERCP. Ma lalo o ke alakaʻi ʻana o ka ultrasound a i ʻole CT, hou ke kauka ʻoki i ka ʻili ma ka umauma ʻākau a i ʻole ka ʻōpū o ka mea maʻi, e hele pololei ana i loko o ka ʻiʻo ate a komo i ke ala bile intrahepatic i hoʻonui ʻia, e hana ana i kahi tunnel "ʻili-ate-bile duct" hana. A laila hoʻokomo ʻia kahi choledochoscope ma o kēia tunnel e nānā pololei i ke ala bile intrahepatic i ka manawa like e hana ana i nā lāʻau lapaʻau e like me ka wehe ʻana i ka pōhaku, lithotripsy, dilation of strictures, a me ke kau ʻana o stent.
ʻO ka "mea kaua pepehi kanaka" a PTCS aia i kona hiki ke hōʻea pololei i nā ʻeha o ke ala bile intrahepatic. He akamai loa ia i ka hoʻoponopono ʻana i nā "pilikia hohonu" paʻakikī ke hōʻea me ka ERCP: no ka laʻana, nā pōhaku ala bile nui i ʻoi aku ma mua o 2 cm ke anawaena, nā "pōhaku he nui" i hoʻopuehu ʻia ma nā lālā ala bile intrahepatic he nui, nā ʻūlū ala bile kiʻekiʻe i hoʻokumu ʻia e nā ʻōpū a i ʻole ka mumū, a me nā pilikia paʻakikī e like me ka stenosis anastomotic a me nā fistulas bile e kū mai ana ma hope o ke ʻoki ʻana o ka biliary. Eia kekahi, i ka wā hiki ʻole i nā maʻi ke hana i ka ERCP ma muli o nā kumu e like me ka duodenal papillary malformation a me ka ʻōpū o ka ʻōpū, hiki i ka PTCS ke lawelawe ma ke ʻano he koho ʻē aʻe, e hoʻokahe koke ana i ka bile a hoʻomaha i ka jaundice, no laila e kūʻai ana i ka manawa no ka mālama ʻana ma hope.
Eia nō naʻe, ʻaʻole hemolele ka PTCS: ʻoiai e pono ai ke hou ʻana ma ka ʻili o ke kino, hiki ke loaʻa nā pilikia e like me ke kahe ʻana o ke koko, ka liki ʻana o ka bile, a me ka maʻi. ʻOi aku ka lōʻihi o ka manawa hoʻōla ma hope o ke ʻoki ʻana ma mua o ka ERCP, a kiʻekiʻe loa ka ʻenehana hou ʻana a ke kauka a me ka pololei o ke alakaʻi kiʻi.
He Hui Mana: Ke Kumu o ka "Hana Synergistic" me ka Hui Dual-Scope
Ke hui nā "pōmaikaʻi endovascular" o ERCP me nā "pōmaikaʻi percutaneous" o PTCS, ʻaʻole i kaupalena ʻia nā mea ʻelua i hoʻokahi ala, akā, e hana i kahi ʻōnaehana diagnostic a me ka mālama ʻana e "hoʻopilikia i loko a ma waho o ke kino." ʻAʻole kēia hui pū ʻana he hoʻohui maʻalahi o nā ʻenehana, akā, he hoʻolālā "1+1>2" pilikino i hoʻopilikino ʻia i ke kūlana o ka mea maʻi. ʻO ka mea nui, ʻelua mau hiʻohiʻona: "hui pū ʻia" a me "hui pū ʻia."
Hoʻohuihui Kaʻina: "E wehe mua i ke Alanui, a laila ka Lapaʻau Kūpono"
ʻO kēia ke ʻano hui pū ʻia maʻamau, ma muli o ke kumumanaʻo o "drainage First, Treatment Later." No ka laʻana, no nā poʻe maʻi me ka jaundice obstructive koʻikoʻi i hoʻokumu ʻia e nā pōhaku bile duct intrahepatic, ʻo ka hana mua ka hoʻokumu ʻana i kahi kahawai hoʻokahe biliary ma o ka puncture PTCS e hoʻokahe i ka bile i hōʻiliʻili ʻia, hoʻomaha i ke kaomi o ke ake, hoʻemi i ka pilikia o ka maʻi, a hoʻihoʻi mālie i ka hana ate o ka mea maʻi a me ke kūlana kino. Ke paʻa ke kūlana o ka mea maʻi, a laila hana ʻia ka ERCP mai ka ʻaoʻao ʻōpū e wehe i nā pōhaku ma ka ʻāpana bile maʻamau haʻahaʻa, mālama i nā lesions ma ka duodenal papilla, a hoʻonui hou i ka bile duct stricture me ka hoʻohana ʻana i ka balloon a i ʻole stent.
I ka ʻaoʻao ʻē aʻe, inā e hana ʻia ka ERCP i kahi mea maʻi a ʻike ʻia he mau pōhaku akepaʻa i koe a i ʻole ka stenosis kiʻekiʻe i hiki ʻole ke mālama ʻia, hiki ke hoʻohana ʻia ka PTCS e hoʻopau i ka "hana hoʻopau" ma hope. Hāʻawi kēia kumu hoʻohālike i ka pono o kahi "ʻano hana ʻanuʻu me nā pilikia hiki ke hoʻokele ʻia," e kūpono loa ia no nā mea maʻi me nā kūlana paʻakikī a me nā kūlana olakino mua.
Hana Hoʻohui Pū ʻIa: "Hana Pālua-ʻĀpana Pū ʻIa,
Hoʻonā Kū Hoʻokahi
No nā maʻi me kahi hōʻailona maopopo a me ka hoʻomanawanui kino maikaʻi, hiki i nā kauka ke koho i kahi kaʻina hana "hui pū ʻia". I ka wā o ke ʻoki kino like, hana pū nā hui ERCP a me PTCS. Hoʻohana ke kauka ʻoki ERCP i ka endoscope mai ka ʻaoʻao ʻōpū, e hoʻonui ana i ka papilla duodenal a kau i kahi alakaʻi. ʻO ke kauka ʻoki PTCS, i alakaʻi ʻia e ke kiʻi ʻana, e hou i ke akepaʻa a hoʻohana i ka choledochoscope e ʻimi i ke alakaʻi i kau ʻia e ERCP, e hoʻokō ana i ka hoʻonohonoho pololei o nā "kahawai kūloko a me waho." A laila hui pū nā hui ʻelua e hana i ka lithotripsy, ka wehe ʻana i ka pōhaku, a me ke kau ʻana o ka stent.
ʻO ka pōmaikaʻi nui loa o kēia kumu hoʻohālike, ʻo ia ka hoʻoponopono ʻana i nā pilikia he nui me kahi hana hoʻokahi, e hoʻopau ana i ka pono no nā anesthesia a me nā ʻoki kino he nui, e hoʻopōkole nui ana i ke kaʻina hana. No ka laʻana, no nā poʻe maʻi me nā pōhaku ʻōpū bile intrahepatic a me nā pōhaku ʻōpū bile maʻamau, hiki ke hoʻohana ʻia ka PTCS i ka manawa like e hoʻomaʻemaʻe i nā pōhaku intrahepatic a me ERCP e hoʻoponopono i nā pōhaku ʻōpū bile maʻamau, e hoʻopau ana i ka pono no nā poʻe maʻi e hana i nā pōʻai he nui o ka anesthesia a me ke ʻoki kino, e hoʻomaikaʻi nui ana i ka pono o ka mālama ʻana.
Kūlana kūpono: ʻO wai nā maʻi e pono ai ka hui pū ʻana o Dual-Scope?
ʻAʻole pono nā maʻi biliary āpau i ke kiʻi hui pū ʻana me ka dual-scope. ʻO ke kiʻi hui pū ʻana me ka dual-scope he mea kūpono loa ia no nā hihia paʻakikī i hiki ʻole ke hoʻoponopono ʻia me kahi ʻenehana hoʻokahi, ʻo ia hoʻi kēia mau mea:
Nā pōhaku ʻauwai bile paʻakikī: ʻO kēia ke ʻano noi mua no ka CT hui pū ʻia me ka ʻelua ʻano. No ka laʻana, nā maʻi me nā pōhaku ʻauwai bile intrahepatic (ʻoi aku ka poʻe i loaʻa ma nā wahi mamao e like me ka lobe ʻaoʻao hema a i ʻole ka lobe hope ʻākau o ke akepaʻa) a me nā pōhaku ʻauwai bile maʻamau; nā maʻi me nā pōhaku paʻakikī i ʻoi aku ma mua o 2 cm ke anawaena ʻaʻole hiki ke wehe ʻia e ERCP wale nō; a me nā maʻi me nā pōhaku i hoʻopaʻa ʻia i loko o nā ʻauwai bile i haiki, e pale ana i ka hele ʻana o nā mea hana ERCP. Ma ka hoʻohana ʻana i ka CTCS hui pū ʻia me ka ʻelua ʻano, ʻo CTCS "e uhaʻi" i nā pōhaku nui a hoʻomaʻemaʻe i nā pōhaku lālā mai loko mai o ke akepaʻa, ʻoiai ʻo ERCP "e hoʻomaʻemaʻe" i nā ala haʻahaʻa mai ka ʻōpū e pale aku i nā pōhaku i koe, e hoʻokō ana i ka "hoʻomaʻemaʻe piha ʻana o ka pōhaku."
ʻO nā ʻūmiʻi o ke ala bile kiʻekiʻe: Ke kau ʻia nā ʻūmiʻi o ke ala bile ma luna o ka hilum hepatic (kahi e hui ai nā ala hepatic hema a me ka ʻākau), paʻakikī ke kiʻi ʻana i nā endoscopes ERCP, e paʻakikī ai ke loiloi pololei i ke koʻikoʻi a me ke kumu o ka ʻūmiʻi. I kēia mau hihia, ʻae ka PTCS i ka nānā pololei ʻana i ka ʻūmiʻi ma o nā kahawai intrahepatic, e ʻae ana i nā biopsies e hōʻoia i ke ʻano o ka lesion (e like me ka mumū a i ʻole ka puʻupuʻu) i ka manawa like e hana ana i ka dilatation balloon a i ʻole ke kau ʻana o ka stent. ʻO ka ERCP, ma ka ʻaoʻao ʻē aʻe, ʻae i ke kau ʻana o kahi stent ma lalo, kahi e hana ai ma ke ʻano he relay no ka stent PTCS, e hōʻoia ana i ka hoʻokahe ʻana o ka ala bile holoʻokoʻa me ke keakea ʻole.
Nā pilikia ma hope o ke ʻoki ʻana o ka biliary: Hiki ke loaʻa ka stenosis anastomotic, ka fistula bile, a me nā pōhaku i koe ma hope o ke ʻoki ʻana o ka biliary. Inā loaʻa i ka mea maʻi nā pipili ʻōpū koʻikoʻi ma hope o ke ʻoki ʻana a ʻaʻole hiki ke ERCP, hiki ke hoʻohana ʻia ka PTCS no ka hoʻokahe ʻana a me ka mālama ʻana. Inā kiʻekiʻe ka stenosis anastomotic a ʻaʻole hiki i ka ERCP ke hoʻonui piha, hiki ke hoʻohui ʻia ka PTCS me ka dilation bilateral e hoʻomaikaʻi i ka holomua o ka mālama ʻana.
ʻO nā maʻi i hiki ʻole ke ʻae i hoʻokahi ʻoki kino: No ka laʻana, ʻaʻole hiki i nā maʻi ʻelemakule a i ʻole nā maʻi me nā maʻi cardiopulmonary koʻikoʻi ke kū i kahi ʻoki kino lōʻihi hoʻokahi. Hiki i ka hui pū ʻana o nā aniani pālua ke hoʻokaʻawale i ka hana paʻakikī i "minimally invasive + minimally invasive", e hōʻemi ana i nā pilikia ʻoki kino a me ke kaumaha kino.
Nānā i ka Wā E Hiki Mai Ana: Ke "Alakaʻi Hoʻonui" o ka Hui Pū ʻana o Dual-Scope
Me ka holomua o ka ʻenehana, ke hoʻomau nei ka ulu ʻana o ka hui pū ʻana o ERCP a me PTCS. Ma kekahi ʻaoʻao, ʻo ka holomua o ka ʻenehana kiʻi e hiki ai ke hoʻopaʻa pololei i nā punctures a me nā kaʻina hana. No ka laʻana, ʻo ka hui pū ʻana o ka intraoperative endoscopic ultrasound (EUS) a me PTCS hiki ke nānā i ke ʻano o loko o ka bile duct i ka manawa maoli, e hōʻemi ana i nā pilikia puncture. Ma kekahi ʻaoʻao, ʻoi aku ka maikaʻi o nā hana hou i nā mea hana. No ka laʻana, ʻoi aku ka maikaʻi o nā choledochoscopes flexible, nā probes lithotripsy paʻa, a me nā stents bioresorbable e hiki ai ke hoʻohui ʻia nā ʻano lua e hoʻoponopono i nā lesions paʻakikī.
Eia kekahi, ua puka mai ka "robot-assisted dual-scope combined" ma ke ʻano he kuhikuhi noiʻi hou: ma ka hoʻohana ʻana i nā ʻōnaehana robotic e kāohi i nā endoscopes a me nā mea hana puncture, hiki i nā kauka ke hana i nā kaʻina hana akahai i kahi ʻoluʻolu, e hoʻomaikaʻi hou aku i ka pololei a me ka palekana o ke ʻoki ʻana. I ka wā e hiki mai ana, me ka hoʻonui ʻia ʻana o ka hui pū ʻana o nā multidisciplinary (MDT), e hoʻohui hou ʻia ʻo ERCP a me PTCS me ka laparoscopy a me nā therapies interventional, e hāʻawi ana i nā koho diagnostics a me nā koho lapaʻau pilikino a kiʻekiʻe hoʻi no nā maʻi me nā maʻi biliary.
ʻO ka hui pū ʻana o ERCP a me PTCS me nā ʻano ʻelua e uhaki ana i nā palena o ke ala hoʻokahi no ka ʻike ʻana a me ka mālama ʻana i ka biliary, e hoʻoponopono ana i nā maʻi biliary paʻakikī he nui me kahi ala minimally invasive a pololei. ʻO ka hui pū ʻana o kēia "duo talena" ʻaʻole wale ia e hōʻike i ka holomua o ka ʻenehana lapaʻau akā e hoʻokomo pū ana i ke ʻano o ka mea maʻi i ka ʻike ʻana a me ka mālama ʻana. Hoʻololi ia i ka mea i koi mua ʻia ai ka laparotomy nui i nā lāʻau lapaʻau minimally invasive me ka emi ʻana o ka trauma a me ka hoʻōla wikiwiki, e ʻae ana i nā mea maʻi hou aku e lanakila i ko lākou mau maʻi me ka mālama ʻana i kahi ola kiʻekiʻe. Manaʻo mākou me ka hoʻomau ʻana o nā holomua ʻenehana, e wehe ka hui ʻana o nā ʻano ʻelua i nā hiki hou aʻe, e lawe mai ana i nā hiki hou i ka ʻike ʻana a me ka mālama ʻana i nā maʻi biliary.
ʻO mākou, ʻo Jiangxi Zhuoruihua Medical Instrument Co., Ltd., he mea hana ma Kina e loea ana i nā mea hoʻopau endoscopic, me ka laina GI e like menā forceps biopsy, hemoclip, ʻūpā polyp, nila sclerotherapy, ʻaukā pīpī, nā palaki cytology, uea alakaʻi, hīnaʻi kiʻi pōhaku, catheter hoʻokahe wai biliary ihu, a meSphincterotome a pēlā aku. i hoʻohana nui ʻia maEMR, ESD, ERCP.
Ua hōʻoia ʻia kā mākou huahana e CE a me ka ʻae ʻia e FDA 510K, a ua hōʻoia ʻia kā mākou mau mea kanu e ISO. Ua hoʻokuʻu ʻia aku kā mākou waiwai i ʻEulopa, ʻAmelika ʻĀkau, Hikina Waena a me kekahi ʻāpana o ʻAsia, a ua loaʻa nui ka ʻike a me ka hoʻomaikaʻi ʻia e ka mea kūʻai aku!
Ka manawa hoʻouna: Nov-14-2025