I ka hōʻailona a me ka mālama ʻana i nā maʻi biliary, ua hoʻomau mau ka hoʻomohala ʻana o ka ʻenehana endoscopic i nā pahuhopu o ka ʻoi aku ka pololei, ka liʻiliʻi o ka invasiveness, a me ka palekana. ʻO ka Endoscopic retrograde cholangiopancreatography (ERCP), ka mea hana o ka maʻi biliary maʻi a me ka mālama ʻana, ua ʻae ʻia i ka lōʻihi no kona ʻano non-surgical a me ka liʻiliʻi invasive. Eia nō naʻe, i ka wā e kū ai i nā maʻi biliary paʻakikī, hāʻule pinepine ka ʻenehana hoʻokahi. ʻO kēia kahi e lilo ai ka percutaneous transhepatic cholangioscopy (PTCS) i mea kōkua nui i ka ERCP. ʻO kēia ʻano hoʻohui "ʻelua-scope" e ʻoi aku i nā palena o nā lāʻau kuʻuna a hāʻawi i nā mea maʻi i kahi koho diagnostic a me ka lāʻau lapaʻau hou loa.
Loaʻa iā ERCP a me PTCS ko lākou mau mākau kūʻokoʻa.
No ka hoʻomaopopo ʻana i ka mana o ka hoʻohana ʻia ʻana o ka lua-scope, pono e hoʻomaopopo mua i nā mana kūʻokoʻa o kēia mau mea kani ʻelua. ʻOiai he mau mea hana ʻelua no ka maʻi biliary a me ka mālama ʻana, hoʻohana lākou i nā ala ʻokoʻa, e hana ana i kahi hoʻopiha piha.
ERCP: He Hoʻonaʻauao Endoscopic e komo ana i ka Digestive Tract
Kū ka ERCP no ka Endoscopic Retrograde Cholangiopancreatography. ʻO kāna hana e like me kahi ala pōʻai o ka hana ʻana i nā mea. Hoʻokomo ke kauka i kahi duodenoscope ma ka waha, esophagus, a me ka ʻōpū, a hiki i ka duodenum iho. ʻIke ke kauka i ka wehe ʻana o ka ʻōpū o ka bile a me ka pancreatic ducts (ka duodenal papilla). Hoʻokomo ʻia kahi catheter ma o ke awa biopsy endoscopic. Ma hope o ka hoʻokomo ʻana i kahi mea hoʻokaʻawale, hana ʻia kahi hōʻike X-ray a i ʻole ultrasound, e hiki ai i ka ʻike maka o ka bile a me ka pancreatic ducts.
Ma keia kumu,ERCPHiki iā ia ke hana i nā kaʻina hana lapaʻau: no ka laʻana, ka hoʻomāhuahua ʻana i nā ducts bile narrowed me ka baluna, ka wehe ʻana i nā ala i hoʻopaʻa ʻia me nā stents, ka wehe ʻana i nā pōhaku mai ka ʻawa bile me kahi hīnaʻi wehe pōhaku, a me ka loaʻa ʻana o ka ʻiʻo maʻi no ka loiloi pathological me ka hoʻohana ʻana i ka biopsy forceps. Aia kona waiwai nui ma ka ʻoiaʻiʻo e holo holoʻokoʻa ana ia ma o ka lua kūlohelohe, e hoʻopau ana i ka pono o nā ʻokiʻoki. ʻAe kēia i ka hoʻihoʻi wikiwiki ʻana o ka postoperative a me ka hoʻohaunaele liʻiliʻi i ke kino o ka mea maʻi. He mea kūpono ia no ka mālama ʻana i nā pilikia pili i ka ʻōpū bile kokoke i ka ʻōpū, e like me nā pōhaku ma ka waena a me ka lalo bile duct maʻamau, nā ʻāʻī o ka bile duct haʻahaʻa, a me nā ʻeha ma ka hui pancreatic a me ka bile duct.
Eia nō naʻe, loaʻa i ka ERCP kona mau "nāwaliwali": inā he koʻikoʻi ke keʻakeʻa ʻana o ka bile duct a ʻaʻole hiki ke hoʻokuʻu ʻia ka bile me ka maʻalahi, e paʻakikī ana ka mea hoʻohālikelike i ka hoʻopiha ʻana i ka bile duct holoʻokoʻa, e pili ana i ka pololei o ka ʻike; no nā pōhaku ʻōpū bile intrahepatic (ʻoi aku ka nui o nā pōhaku i loko o ke akepaʻa) a me ke kūlana kiʻekiʻe o ka bile duct stenosis (kokoke i ka hilum ate a ma luna), ua hoʻemi nui ʻia ka hopena o ka mālama ʻana no ka mea ʻaʻole hiki i ka endoscope ke "hiki" a i ʻole ka palena o ka wahi hana.
PTCS: He Paionia Percutaneous e haki ana i ka ʻili o ke ake
ʻO ka PTCS, a i ʻole ka percutaneous transhepatic choledochoscopy, ke hoʻohana nei i kahi ala "waho-i loko", ʻokoʻa me ke ala "loko-waho" o ERCP. Ma lalo o ke alakaʻi ultrasound a i ʻole CT, hoʻopaʻa ke kauka ʻoki i ka ʻili ma ka umauma ʻākau a i ʻole ka ʻōpū o ka mea maʻi, e hele pololei ana i ka ʻiʻo o ke ake a komo i ka ʻawaʻawa bile intrahepatic i hoʻopalahalaha ʻia, e hana ana i kahi tunnel "skin-liver-bile duct". A laila hoʻokomo ʻia kahi choledochoscope ma loko o kēia tunnel e nānā pono ai i ke kahe bile intrahepatic ʻoiai e hana like ana i nā lāʻau lapaʻau e like me ka wehe ʻana i nā pōhaku, lithotripsy, dilation of strictures, a me ka hoʻokomo ʻana i ka stent.
Aia ka "mea pepehi kanaka" a PTCS i kona hiki ke komo pololei i nā ʻeha o ka ʻōpū bile intrahepatic. Maikaʻi loa ia i ka hoʻoponopono ʻana i nā "pilikia hohonu" paʻakikī ke loaʻa me ERCP: no ka laʻana, nā pōhaku nui bile duct i ʻoi aku ma mua o 2 knm ke anawaena, "nā pōhaku he nui" i hoʻopuehu ʻia ma nā lālā bile intrahepatic he nui, kiʻekiʻe ke kūlana bile duct stricture ma muli o nā ʻōpū a i ʻole ka mumū, a me nā pilikia paʻakikī e like me ka anastomotic fistnosis a me ka bile fistula. Eia kekahi, inā hiki ʻole i ka poʻe 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 ʻokoʻa, hoʻokahe wikiwiki i ka bile a hoʻopau i ka jaundice, a laila kūʻai i ka manawa no ka mālama ʻana.
Akā naʻe, ʻaʻole kūpono ʻo PTCS: no ka mea, pono ia e ʻoki ʻia ma ka ʻili o ke kino, hiki mai nā pilikia e like me ke kahe ʻana o ke koko, ka leaka bile, a me ka maʻi. ʻOi aku ka lōʻihi o ka manawa hoʻōla ma hope o ka ERCP, a ʻoi aku ka kiʻekiʻe o ka ʻenehana puncture a ke kauka a me ka pololei alakaʻi kiʻi.
He Hui Mana Mana: ʻO ka Logic o "Synergistic Operation" me Dual-Scope Combination
I ka wā e hui ai nā "ʻoihana endovascular" o ERCP i nā "pono percutaneous" o PTCS, ʻaʻole i kaupalena ʻia nā mea ʻelua i kahi ala hoʻokahi, akā hoʻokumu i kahi papa hana diagnostic a me ka lāʻau lapaʻau e "paʻi i loko a i waho o ke kino." ʻAʻole kēia hui ʻana he hoʻohui maʻalahi o nā ʻenehana, akā he hoʻolālā pilikino "1+1>2" i hoʻohālikelike ʻia i ke kūlana o ka mea maʻi.
Hui Pū ʻIa: “E wehe mua i ke alahele, a laila hoʻoponopono pololei”
ʻO kēia ke ala hoʻohui maʻamau, e hahai maʻamau i ke kumu o "drainage First, Treatment Later." No ka laʻana, no nā poʻe maʻi me ka jaundice obstructive koʻikoʻi i hoʻokumu ʻia e ka intrahepatic bile duct ducts, ʻo ka hana mua e hoʻokumu i kahi ala wai biliary ma o ka PTCS puncture e hoʻokahe i ka bile i hōʻiliʻili ʻia, hoʻomaha i ke kaomi ate, hoʻemi i ka pilikia o ka maʻi, a hoʻihoʻi mālie i ka hana o ke ake a me ke kūlana kino. Ke hoʻopaʻa ʻia ke kūlana o ka mea maʻi, hana ʻia ka ERCP mai ka ʻaoʻao o ka ʻōpū e wehe i nā pōhaku ma ka ʻauwai bile maʻamau haʻahaʻa, mālama i nā ʻeha i loko o ka duodenal papilla, a hoʻomāhuahua hou aku i ka ʻawaʻawa bile me ka baluna a i ʻole stent.
ʻO ka mea ʻē aʻe, inā loaʻa ka mea maʻi i ka ERCP a ʻike ʻia he koena o ke akepaʻa a i ʻole stenosis kiʻekiʻe ʻaʻole hiki ke mālama ʻia, hiki ke hoʻohana ʻia ka PTCS e hoʻopau i ka "hana hoʻopau" ma hope. Hāʻawi kēia hiʻohiʻona i ka pono o kahi "step-by-step approach with manageable risks," i kūpono loa ia no nā poʻe maʻi me nā kūlana paʻakikī a me nā kūlana olakino mua.
ʻO ka hana hoʻohui like ʻana: “Ka hana ʻelua-scope i ka manawa like,
Hoʻokahi-Stop Solution”
No nā poʻe maʻi me kahi hōʻailona maʻemaʻe a me ka hoʻomanawanui kino maikaʻi, hiki i nā kauka ke koho i kahi kaʻina hana "hui pū". I loko o ka hana hoʻokahi, hana pū nā hui ERCP a me PTCS. Hoʻohana ke kauā ERCP i ka endoscope mai ka ʻaoʻao o ka ʻōpū, e hoʻomāhuahua i ka papilla duodenal a kau i kahi alakaʻi. ʻO ke kauka lapaʻau PTCS, alakaʻi ʻia e ke kiʻi kiʻi, hoʻopaʻa i ke ake a hoʻohana i ka choledochoscope e ʻimi i ke alakaʻi alakaʻi i hoʻonoho ʻia e ERCP, e loaʻa ana i ka hoʻonohonoho pololei ʻana o nā "kani o loko a me waho." A laila hui pū nā hui ʻelua e hana i ka lithotripsy, ka wehe ʻana i nā pōhaku, a me ka hoʻokomo ʻana i ka stent.
ʻO ka pōmaikaʻi nui loa o kēia ʻano hoʻohālike, ʻo ia ka hoʻoponopono ʻana i nā pilikia he nui me kahi kaʻina hana hoʻokahi, e hoʻopau ana i ka pono o nā anesthesia he nui a me nā ʻokiʻoki, e hoʻopōkole loa i ka pōʻai lapaʻau. No ka laʻana, no nā poʻe maʻi me nā pōhaku bile duct intrahepatic a me nā pōhaku bile duct 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 bile maʻamau, e hoʻopau ana i ka pono o nā maʻi e hana i nā pōʻai he nui o ka anesthesia a me ka hoʻomaʻamaʻa ʻana, me ka hoʻomaikaʻi nui ʻana i ka mālama ʻana.
ʻAno kūpono: ʻO wai ka poʻe maʻi e koi ai i ka hui ʻana o Dual-Scope?
ʻAʻole pono nā maʻi biliary āpau i ke kiʻi ʻelua-scope i hui ʻia. ʻO ke kiʻi kiʻi ʻelua-scope he mea kūpono ia no nā hihia paʻakikī ʻaʻole hiki ke hoʻoponopono ʻia me kahi ʻenehana hoʻokahi, ʻo ia hoʻi:
ʻO nā pōhaku ʻawaʻawa bile paʻakikī: ʻO kēia ka hiʻohiʻona noi mua no ka CT i hui pū ʻia. No ka laʻana, nā poʻe maʻi me nā pōhaku ʻawaʻawa bile intrahepatic (ʻoi aku ka poʻe i loaʻa ma nā wahi mamao e like me ka lobe ʻaoʻao hema a i ʻole lobe hope ʻākau o ke ake) a me nā pōhaku maʻamau bile; nā maʻi me nā pōhaku paʻa i ʻoi aku ma mua o 2 knm ke anawaena ʻaʻole hiki ke wehe ʻia e ERCP wale nō; a me nā poʻe maʻi me nā pōhaku i hoʻopaʻa ʻia i loko o nā auwai bile haiki, e pale ana i ka hele ʻana o nā mea kani ERCP. Ma ka hoʻohana ʻana i ka CTCS hui pū ʻelua, ʻo CTCS "waʻi" i nā pōhaku nui a hoʻomaʻemaʻe i nā pōhaku lālā mai loko mai o ke ake, ʻoiai ʻo ERCP "hoʻomaʻemaʻe" i nā ala haʻahaʻa mai ka ʻōpū e pale aku i nā pōhaku i koe, e loaʻa ai ka "hoʻomaʻemaʻe pōhaku piha."
ʻO ke kiʻekiʻe kiʻekiʻe o ka bile duct strictures: Ke kau ʻia nā ʻawaʻawa bile ma luna o ka hilum hepatic (kahi e hui ai nā aʻa hepatic hema a me ka ʻākau), paʻakikī ke kiʻi ʻana i nā endoscopes ERCP, he mea paʻakikī ke nānā pono i ka paʻakikī a me ke kumu o ke koʻikoʻi. I kēia mau hihia, hiki i ka PTCS ke ʻike pololei i ke koʻikoʻi 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 tumo) i ka manawa like e hana ana i ka baluna dilatation a i ʻole kahi stent. ʻO ka ERCP, ma kekahiʻaoʻao, hiki ke hoʻokomo i kahi stent ma lalo, e hana ana ma keʻano he relay no ka PTCS stent, e hōʻoiaʻiʻo ana i ka hoʻokuʻuʻoleʻia o ka pahu bile holoʻokoʻa.
ʻO nā pilikia ma hope o ka hana ʻana o ka ʻoki biliary: Anastomotic stenosis, bile fistula, a me nā pōhaku koena e hiki mai ma hope o ke kaʻina biliary. Inā loaʻa i ka mea maʻi nā adhesions ʻōpū koʻikoʻi ma hope o ka ʻoki ʻana a ʻaʻole hiki ke ERCP, hiki ke hoʻohana ʻia ka PTCS no ka hoʻokahe a me ka mālama ʻana. Inā he 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 poʻe maʻi ʻaʻole hiki ke ʻae i kahi ʻoki hoʻokahi: No ka laʻana, ʻaʻole hiki i nā poʻe maʻi ʻelemakule a i ʻole nā maʻi me nā maʻi cardiopulmonary koʻikoʻi ke kū i kahi ʻoki lōʻihi. Hiki i ka hui pū ʻana o nā aniani ʻelua ke hoʻokaʻawale i ka hana paʻakikī i ka "minimally invasive + minimally invasive", e hōʻemi ana i nā pilikia o ke kaʻina hana a me ke kaumaha kino.
Ka Manaʻo o ka wā e hiki mai ana: ʻO ka "Hoʻonui i ke kuhikuhi" o Dual-Scope Combination
Me nā holomua ʻenehana, hoʻomau ka hui ʻana o ERCP a me PTCS. Ma ka ʻaoʻao hoʻokahi, ʻo ka holomua o ka ʻenehana kiʻi e hiki ai i nā punctures pololei a me nā kaʻina hana. No ka laʻana, hiki i ka hui pū ʻana o intraoperative endoscopic ultrasound (EUS) a me PTCS ke ʻike i ke ʻano o loko o ka bile duct i ka manawa maoli, e hōʻemi ana i nā pilikia puncture. Ma ka ʻaoʻao ʻē aʻe, ʻoi aku ka maikaʻi o ka mālama ʻana i nā mea hana. No ka laʻana, hiki i nā choledochoscopes maʻalahi, ʻoi aku ka lōʻihi o ka lithotripsy probes, a me nā stents bioresorbable e hiki ai i ka hui ʻana o nā ʻāpana ʻelua e hoʻoponopono i nā ʻeha paʻakikī.
Eia kekahi, ua puka mai ka "robot-assisted dual-scope combined" ma ke ʻano he alakaʻi noiʻi hou: ma ka hoʻohana ʻana i nā ʻōnaehana robotic e hoʻomalu i nā endoscopes a me nā mea puncture, hiki i nā kauka ke hana i nā kaʻina hana maʻalahi i kahi ʻoi aku ka ʻoluʻolu, e hoʻomaikaʻi hou aʻe i ka pololei a me ka palekana. I ka wā e hiki mai ana, me ka hoʻonui nui ʻana o ka multidisciplinary collaboration (MDT), e hoʻohui hou ʻia ʻo ERCP a me PTCS me ka laparoscopy a me nā ʻano lapaʻau interventional, e hāʻawi ana i ka maʻi pilikino a me ke kūlana kiʻekiʻe a me nā koho lapaʻau no nā maʻi me nā maʻi biliary.
ʻO ka hui ʻelua o ka ERCP a me ka PTCS e uhaki i nā palena o kahi ala ala hoʻokahi no ka maʻi biliary a me ka mālama ʻana, e hoʻoponopono ana i nā maʻi biliary paʻakikī me kahi ala liʻiliʻi a pololei. ʻO ka hui pū ʻana o kēia "talented duo" ʻaʻole wale e hōʻike i ka holomua o ka ʻenehana lapaʻau akā hoʻokomo pū kekahi i ke ʻano o ka maʻi maʻi i ka maʻi a me ka mālama ʻana. Hoʻololi ia i ka mea i koi mua ʻia i ka laparotomy nui i nā lāʻau lapaʻau liʻiliʻi liʻiliʻi me ka liʻiliʻi o ka trauma a me ka wikiwiki o ka hoʻihoʻi ʻana, e ʻae ana i nā mea maʻi e lanakila i ko lākou mau maʻi ʻoiai e mālama ana i kahi kūlana kiʻekiʻe o ke ola. Ke manaʻoʻiʻo nei mākou me ka hoʻomau ʻana o ka ʻenehana, ʻo ka hui ʻelua-scope e wehe i nā mana hou aʻe, e lawe mai i nā mea hou i ka maʻi a me ka mālama ʻana i nā maʻi biliary.
ʻO mākou, ʻo Jiangxi Zhuoruihua Medical Instrument Co., Ltd., he mea hana ma Kina i mea kūikawā i nā mea endoscopic consumables, e komo pū me ka laina GI e like mebiopsy forceps, hemoclip, pahele polyp, nila sclerotherapy, pāpaʻi pāpaʻi, cytology brushes, uea alakaʻi, hīnaʻi kiʻi pōhaku, ihu biliary drain catheter, aSphincterotome etc. i hoohana nui ia maEMR, ESD, ERCP.
Ua hōʻoia ʻia kā mākou huahana a me ka FDA 510K apono ʻia, a ʻo kā mākou mea kanu i hōʻoia ʻia ʻo ISO. Ua lawe ʻia kā mākou waiwai i ʻEulopa, ʻAmelika ʻAmelika, Middle East a me kahi hapa o Asia, a loaʻa nui i ka mea kūʻai aku o ka ʻike a me ka hoʻomaikaʻi!
Ka manawa hoʻouna: Nov-14-2025