I-Retrograde pancreatocholangiography ukuhlolwa okwenziwa kusetshenziswa i-ekhethekile ye-radiopaque.
Izinkomba zokuhlolwa wukusolwa kokuba khona kwezifo ngaphezulu kwesitho esibekiwe, kanye ne-jaundice evimbayo.
Ukuxilongwa okungaziwa kanye nokungabi bikho kokuqokwa kwekhambi elifanele lesifo se-pancreatic kungaholela ezinkingeni, okuyi-cholangitis ne-pancreatitis.
Izinhloso eziphambili zocwaningo yilezi:
- ukusungula imbangela ye-mejice yemishini;
- ukuthola umdlavuza;
- ukunqunywa kwendawo yama-gallstones, kanye nezindawo ezi-stenotic ezisezinhlwini zamanyikwe kanye ne-bile ducts;
- ukutholwa kokuqhekeka ezindongeni zama-ducts okubangelwa usizi noma ukuhlinzwa.
Odokotela baqapha noma yikuphi ukungahambi kahle esimweni sempilo sesiguli nokuba khona kwegazi. Isimo esijwayelekile umuzwa wobunzima, ubuhlungu be-spasmodic kanye ne-flatulence amahora amaningi ngemuva kwenqubo, kepha uma kukhona ukwehluleka kokuphefumula, i-hypotension, ukujuluka ngokweqile, i-bradycardia noma i-laryngospasm, ukunakekelwa kwezokwelashwa ngokushesha kuyodingeka, ukuhlolwa okwengeziwe kanye nezifundo, kanye nokwelashwa . Zonke izinkomba ezibalulekile zesimo somzimba seziguli ziqoshwa njalo ngemizuzu eyi-15 ngehora lokuqala ngemuva kokuphela kwenqubo, bese kuthi njalo isigamu sehora, ihora namahora ama-4 amahora angama-48.
Isiguli sinqatshelwe ukuthatha ukudla noketshezi kuze kufike ukubuyiselwa kwe-Reflex yokuhlanza yemvelo. Lapho nje ukuzwela kwezindonga zezinsimbi ze-larynx kubuya, okungahlolwa nge-spatula, eminye imikhawulo yokudla iyasuswa. Ukunciphisa kancane ubuhlungu obukhuphuka emphinjeni, kunconywa ukusebenzisa ukuthambisa, ukuthambisa kanye nekhambi elikhethekile.
Ukulungiselela inqubo
I-Endoscopic retrograde pancreatocholangiography, njengezinye izindlela zokuhlola, zidinga ukulungiswa kwangaphambili kwesiguli. Okokuqala udinga ukuchaza isiguli inhloso esemqoka yalolu cwaningo.
Ngamanye amagama, udokotela uchaza ukuthi ngosizo lokubuyisa i-pancreatocholangiography kungenzeka ukuthi unqume isimo esivamile sezitho zangaphakathi, okuyisibindi, i-pancreas kanye ne-gallder.
Ngaphambi kwenqubo, isiguli kufanele senqabe ukudla ngemuva kwamabili. Futhi, udokotela uhlinzeka ngencazelo enemininingwane yokuthi inqubo izokwenziwa kanjani. Isibonelo, ngesikhathi sokuhlolwa, iziguli zingathola i-gag Reflex. Ukuyicindezela, kusetshenziswa isisombululo esikhethekile sokubulala izinzwa. Ukunambitha okungathandeki futhi kubangele ukuzwa kokuvuvukala kolimi nolimi. Ngakho-ke, isiguli sinobunzima bokugwinya. Ngaphezu kwalokho, kusetshenziswa isudi ekhethekile, enomthelela ekususweni kwamahala kwamathe.
Noma iyiphi inqubo yezokwelapha idinga ukuphumula okuphezulu kwengxenye yesiguli. Lokhu akwenziwa hhayi nje kuphela ukwenza ukuhlolwa okuntofontofo, kodwa futhi nokuthola umphumela onembile kunayo yonke. Ngakho-ke, kaningi isiguli sinikezwa imishanguzo evusa inkanuko, ngenkathi isaqhubeka nokuqonda.
Imiphumela emibi engaba khona kufanele futhi ixwayiswe kusengaphambili ukuze imibuzo embalwa ivele ngqo ngesikhathi sokuhlolwa. Ngemuva kokuhlolwa, ezinye iziguli zingase zizwe umphimbo obuhlungu wezinsuku ezi-3-4.
Ngaphambi kokuhlolwa, kubalulekile ukusungula ukuzwela kwemikhiqizo ethile kanye nezinto ezithile ze-radiopaque, ezingathinta kakhulu umphumela nenqubo yokuhlolwa uqobo.
Inqubo yokuhlolwa kwe-Endoscopic
I-Endoscopic retrograde pancreatocholangiography inqubo eyinkimbinkimbi edinga hhayi kuphela ukulungela okufanele, kodwa futhi nokuhambisana nakho konke ukuncoma kwenqubo.
Kukhona ukulandelana okuthile kwezivivinyo, futhi isiguli ngasinye sinethuba lokuzijwayela kusenesikhathi ukuze sibe nomqondo walokho okulindelwe.
Ngokuvamile, le nqubo isebenzisa i-endoscopy yenziwa ngezigaba. Kuqala, isiguli sifakwa ngaphakathi emzimbeni ngesisombululo se-0.9% sodium chloride enesilinganiso esingu-150 ml, emva kwalokho ulwelwesi lwe-mucous luphathwa nesixazululo se-anesthetic yendawo. Umphumela wokusebenzisa lobu buciko uyabonakala phakathi kwemizuzu eyi-10. Ngesikhathi sokunisela ulwelwesi lwe-mucous lomphimbo, isiguli kufanele sibambe umoya wakhe.
Ngemuva kwalokho:
- Isiguli silala ngakwesobunxele sakhe. Ngaphezu kwalokho, kusetshenziselwa ugqoko lapho kwenzeka ukugabha, kanye nethawula. Ukwehlisa ubungozi bomphumela wokufisa, ukuphuma kwamathe akumele kuvinjelwe, lapho kusetshenziswa khona isihlwathi somlomo.
- Lapho isiguli sitholakala kalula ohlangothini lwesobunxele futhi wonke amathuluzi awengeziwe namadivayisi elungiselelwe, unikezwa izidakamizwa ezifana ne-diazepam noma i-midazolam ngenani le-5-20 mg. Uma kunesidingo, kusetshenziswa i-narcotic analgesic.
- Lapho nje isiguli singena esiteji sombuso owomileyo, njengoba kungabonakala enkulumeni emfushane, banciphisela ikhanda kuye bese bemcela ukuba avule umlomo.
- Okulandelayo, udokotela wethula i-endoscope, kuyilapho esebenzisa umunwe wenkomba ukuze kube lula. I-endoscope ifakwa ngemuva kwe-larynx futhi icindezelwa emuva ngomunwe ofanayo ukuze ifakwe kalula. Ngemuva kokudlula odongeni lwangemuva lwangemva kwengqondo futhi sifinyelela kuma-sphincter aphezulu we-esophageal, kubalulekile ukuqondisa intamo yesiguli ukuqhubekisela phambili insimbi. Lapho nje udokotela edlula kwe-esophageal sphincter, uphakamisa insimbi ngokulawula okubonakalayo.
Lapho ushukumisela i-endoscope esiswini, kubalulekile ukuthi uqiniseke ukuthi ukuphuma kwamasheya kwamahhala kuyaqinisekiswa.
Ngabe inqubo ihamba kanjani?
Ngaphezu kwezinto ezichazwe ngenhla, kunemicimbi eminingi eseyenziwa.
Ngemuva kokufinyelela engxenyeni ethile yesisu usebenzisa i-endoscope, umoya wethulwa ngayo. Okulandelayo, jikisa ithuluzi bese udabula i-duodenum. Ukuqhubeka nokuya emathunjini, kuyadingeka ukuvula i-endoscope ngokwewashi, ubeke isiguli esiswini sakhe. Ukuze izindonga zamathumbu kanye ne-sphincter ziphumule ngokuphelele, kufanele kwethulwe umuthi we-anticholinergic noma i-glucagon.
Ngemuva kokwethula inani elincane lomoya ngokusebenzisa i-endoscope, ifakwa ukuze ukwazi ukubona i-Vater nipple ngengxenye ye-optical. Ngemuva kwalokho i-cannula enento ekhethekile ingeniswa ngomzila we-endoscope, odluliswa ingono efanayo ngqo kuyi-hepatic-pancreatic ampoule.
Ukubonwa kwemisipha kwenziwa ngaphansi kokuphathwa kwe-fluoroscope, okunikezwa ukwethulwa komenzeli okhethekile ohlukile. Ngokwazisa kwalokhu, ukucabanga kuyadingeka. Kungemva kokuba zonke izithombe ezitholakalayo zithathiwe futhi zahlolwa, isiguli savunyelwa ukuba siguqule isikhundla.
I-cannula isuswa ngemuva kokuphothulwa kokuhlolwa, kuyilapho amasampula athathwa kuqala ukuhlolwa kwe-histological ne-cytological.
Ukuhlolwa kudinga ukubhekwa ngokucophelela ngesimo sesiguli, ngoba kungenzeka ukuthi kube nezinkinga. Isibonelo, i-cholangitis kungenzeka, lapho kunokukhuphuka kwezinga lokushisa, ukuba khona kwezifo ezibandayo, umfutho wegazi ophakeme, njll. I-pancreatitis ye-acute ibonakala ngendlela yobuhlungu besisu, izinga elandayo le-amylase, hyperbilirubinemia yesikhashana, njll.
Kukhona imibiko ethile yokuhlolwa kwe-endoscopic. Isibonelo, abesifazane abakhulelwe benqatshelwe ukwenza lo msebenzi, ngenxa yokuthi amathuba okuba nomphumela we-teratogenic uyanda.
Ukuba khona kwezifo ezithathelwanayo, izifo ezibangelwa kakhulu ama-pancreas, kanye nenhliziyo namaphaphu, kanye nokunye ukuphazamiseka emzimbeni nakho kuwukuphambana kwale nqubo. Ngakho-ke, i-Manc ye-pancreatic ingadingeka ukunquma isimo sesitho sangaphakathi. Uma ufisa, ungafunda izibuyekezo ngenqubo ukuthola isithombe esicacile.
Mayelana nokuxilongwa kanye nokwelashwa kwe-pancreatitis kuchazwe kuvidiyo kule ndatshana.
