Retrograde pancreatocholangiography ndi mayeso omwe amachitika pogwiritsa ntchito wapadera wa radiopaque.
Zizindikiro zowunikira ndikukayikira kukhalapo kwa matenda pamwamba pa chiwalo chodziwikiracho, komanso jaundice yovuta.
Kuzindikira kwadzidzidzi komanso kusapezeka kwa chithandizo chamankhwala oyambitsidwa ndi kapamba kumatha kubweretsa zovuta, monga cholangitis ndi kapamba.
Zolinga zazikulu za kafukufukuyu ndi:
- kukhazikitsa chomwe chimayambitsa jaundice;
- kuzindikira khansa;
- kutsimikiza komwe kuli ma gallstones, komanso malo okhudzana ndi stenotic omwe amapezeka mu kapamba ndi ndulu za bile;
- kuwonekera kwa ziphuphu m'makoma amiyala chifukwa cha zoopsa kapena opaleshoni.
Madotolo amayang'anira zovuta zilizonse zomwe zimachitika m'thupi la wodwalayo komanso kutuluka kwa magazi. Mkhalidwe wabwinobwino ndikumverera kolemetsa, kupweteka kwa spasmodic ndi kutumphukira kwa maola angapo pambuyo pa njirayi, koma ngati pali kupundika kwa kupuma, hypotension, thukuta kwambiri, bradycardia kapena laryngospasm, chithandizo chamankhwala chamtsogolo chofunikira, mayeso owonjezera ndi maphunziro, komanso chithandizo . Zizindikiro zonse zofunikira za thupi la wodwala zimalembedwa mphindi 15 zilizonse ola limodzi litatha, ndiye kuti theka lililonse la ola, ola ndi maola 4 kwa maola 48.
Wodwalayo amaletsedwa kudya chakudya ndi madzi mpaka pakubwezeretsa Reflex. Mukangomva kutengeka kwa makoma a larynx, komwe kumayang'aniridwa ndi spatula, zoletsa zina pazakudya zimachotsedwa. Kuti muchepetse kupweteka kwapakhosi, kumalimbikitsidwa kugwiritsa ntchito zofewa, komanso kupindika ndi njira yapadera.
Kukonzekera njirayi
Endoscopic retrograde pancreatocholangiography, monga njira zina zowunika, zimafunikira kukonzekera asanachitike ndi wodwala. Choyamba muyenera kufotokozera wodwalayo cholinga chachikulu cha phunziroli.
Mwanjira ina, adotolo akufotokozera kuti mothandizidwa ndi kubwezera pancreatocholangiography ndikutheka kudziwa momwe ziwalo zamkati zimayambira, chiwindi, kapamba ndi chikhodzodzo.
Asanatero, wodwalayo ayenera kudya pakatha pakati pausiku. Komanso, adotolo amafotokoza mwatsatanetsatane momwe njirayi ichitikire. Mwachitsanzo, nthawi ya mayeso, odwala amatha kuona kuti ali ndi chidwi chogonana. Kuti tiwumitse, njira yapadera yokongoletsera imagwiritsidwa ntchito. Chimakonda kukhala chosasangalatsa komanso chimapangitsa kutuwa kwa kamkamwa ndi lilime. Chifukwa chake, wodwala amavutika kumeza. Kuphatikiza apo, kuyamwa kwapadera kumagwiritsidwa ntchito, zomwe zimapangitsa kuti malovu achotsere kwaulere.
Njira iliyonse yachipatala imafuna kuti wodwalayo apumule kwambiri. Izi zimachitika osati kungoyesa mayeso omasuka, komanso kuti mudziwe zotsatira zolondola. Chifukwa chake, nthawi zambiri wodwala amapatsidwa mankhwala osokoneza bongo, pomwe amakhala adakali ndi chidwi.
Zotsatira zoyipa ziyeneranso kuchenjezedwa pasadakhale kuti mafunso ochepa azikhala mwachindunji panthawi ya mayeso. Pambuyo pa kufufuza, odwala ena amatha kumva zilonda zapakhosi kwa masiku 3-4.
Asanapemphedwe, ndikofunikira kukhazikitsa chidwi cha zinthu zina ndi zinthu zina za radiopaque, zomwe zingakhudze kwambiri zotsatira ndi njira yoyeserera yokha.
Endoscopic mayeso machitidwe
Endoscopic retrograde pancreatocholangiography ndi njira yovuta kwambiri yomwe imafuna osati kukonzekera koyenera, komanso kutsatira malangizo onse a ndondomekoyi.
Pali mitundu yotsatila ya mayeso, ndipo wodwala aliyense amakhala ndi mwayi wodziwa bwino izi zisanachitike kuti akhale ndi lingaliro la zomwe zikumuyembekezera.
Mwambiri, njirayi pogwiritsa ntchito endoscopy imachitika m'magawo. Poyamba, wodwalayo amapaka jekeseni wamitsempha ndi yankho la 0,9% sodium kolorayidi yambiri 150 ml, pambuyo pake nembanemba amathandizidwa ndi yankho la mankhwala okomoka. Mphamvu yodabwitsayi imayamba kuonekera pakangotha mphindi 10. Pa kuthirira kwa mucous nembanemba wa pakhosi, wodwalayo ayenera kupuma.
Pambuyo pake:
- Wodwalayo wagona kumanzere kwake. Kuphatikiza apo, thireyi imagwiritsidwa ntchito kusanza, komanso thaulo. Kuchepetsa chiopsezo cha chidwi, zotsatira zakumaso siziyenera kulepheretsedwa, zomwe zimagwiritsidwa ntchito pakamwa.
- Wodwala akakhala mosavuta mbali yakumanzere ndipo zida zonse zowonjezera ndi zida zimakonzedwa, amapatsidwa mankhwala monga diazepam kapena midazolam okwanira 5-20 mg. Ngati ndi kotheka, narcotic analgesic imagwiritsidwa ntchito.
- Wodwala akangolowa gawo lakugona, monga momwe akuwonekera kuchokera pakulankhula kosamveka, amapukusa mutu wake ndikumufunsa kuti atsegule pakamwa pake.
- Kenako, dokotala amayambitsa endoscope, pomwe amagwiritsa ntchito chala cholozera mosavuta. Buku la Endoscope limayikidwa kumbuyo kwa larynx ndipo limakankhidwira kumbuyo ndi chala chomwecho kuti lisalowe. Pambuyo popyola khoma lakhoma lanyumba ndikufika kumtunda wam'mero wam'mimba, ndikofunikira kuwongola khosi la wodwalayo kuti apititse patsogolo chida. Dokotala akangodutsa chapamwamba cham'mimba, amapititsa patsogolo chida chake kudzera mwa mphamvu yowoneka.
Mukasuntha endoscope pamimba, ndikofunikira kuti zitsimikizidwe kuti malovu omasuka amatsekedwa.
Kodi njira ikuyenda bwanji?
Kuphatikiza pa zinthu zomwe tafotokozazi, zinthu zingapo zikuchitikabe.
Pambuyo pofika gawo lina la m'mimba pogwiritsa ntchito endoscope, mpweya umayambitsidwa kudzera mwa iye. Kenako, sinthani chidacho ndi kudutsa duodenum. Kupitilira m'matumbo, ndikofunikira kuti mutembenuze kolowera mozungulira, ndikuyika wodwala pamimba yake. Kuti makoma a m'matumbo ndi sphincter apume kwathunthu, mankhwala a anticholinergic kapena glucagon ayenera kuyambitsidwa.
Pambuyo pobweretsa mpweya wocheperako kudzera mu endoscope, imayikidwa kuti mutha kuwona Vater nipple kudzera gawo loyang'ana. Kenako cannula yokhala ndi chinthu chapadera imayambitsidwa kudzera mu njira ya endoscope, yomwe imadutsa nipple yomweyo kudzera mu hepatic-pancreatic ampoule.
Kuwona kwa ma ducts kumachitika motsogozedwa ndi fluoroscope, yomwe imaperekedwa poyambitsa wothandizira wosiyanitsa wina. Mothandizidwa ndi zinthuzi, kuyereketsa m'maganizo ndikofunikira. Pambuyo poti zithunzi zonse zomwe zapezeka zitatengedwa ndikuwunikanso, wodwala amaloledwa kusintha maudindo.
Cannula imachotsedwa atamaliza kulemba mayeso, pomwe zitsanzo zimatengedwa kuti ziyesedwe mwa histological ndi cytological.
Kuunika kumafunikira kuwunika mozama momwe wodwalayo alili, popeza pali kuthekera kwa zovuta. Mwachitsanzo, cholangitis imatha kuchitika, momwe mumawonjezera kutentha, kupezeka kwa kuzizira, matenda oopsa, zina. Pancreatitis yachilengedwe imadziwoneka ngati ululu wam'mimba, kuchuluka kwa amylase, kuchepa kwa hyperbilirubinemia, etc.
Pali ma contraindication ena a endoscopic mayeso. Mwachitsanzo, amayi oyembekezera saloledwa kuchita opareshoni iyi, chifukwa chakuti mwayi wokhala ndi mphamvu ya teratogenic ukuwonjezeka.
Kukhalapo kwa matenda opatsirana, matenda owopsa a kapamba, komanso mtima ndi mapapu, ndi zovuta zina mthupi ndizotsutsana ndi njirayi. Chifukwa chake, MRI ya pancreatic ingafunikire kuti mudziwe momwe thupi lamkati lilili. Ngati mungafune, mutha kuwerengera ndendende kuti mumve bwino.
About matenda ndi mankhwala a kapamba akufotokozedwa mu kanema munkhaniyi.
