Ukuqonda Ukuxilongwa Nokunakekelwa Kwezimiso Zesibili
I-MRCP Versus ERCP ye-Biliary Obstruction
Ukuze uqonde ngempela ukuthi i-Magnetic Resonance Cholangio-Pancreatography (MRCP) ne-Endoscopic Retrograde Cholangio-Pancreatography yiyo, kufanele uqale uqonde ukuthi yisiphi isithiyo se-biliary nokuthi yini ebangela lolu hlobo lwenkinga.
Nakuba izigulane zivame ukubangela ukuvinjelwa kwezibambiso, kunezizathu eziningi zokuthi kungani kungase kube khona isithiyo sebhaliary nezindlela eziningi zokwelapha lezo zinkinga ezizoxhomeka eminyakeni yobugulane, impilo yonke, i-anatomy, umlando wezinkinga zesistimu yokugaya nokunye okungafani umuntu ngomuntu.
Ukukhishwa Kwebhilidi Kuchazwe
Ake siqale ngendlela uhlelo lokusebenza lokugaya lusebenza ngayo. Ukuze uthole izakhi ezingcono kakhulu ezivela ekudleni, ukudla kumele kuphulwe yi-tract digestive ngakho wonke amavithamini, amaminerali, amaprotheni, amafutha, kanye nama-carbohydrate angangena emathunjini amancane. Le nqubo iqala ngokuhlafuna ukudla, ilandelwa isisu isebenzisa ama-acids futhi igxila ukudla okuzungezile ukuze kusize ukuyidiliza. Ngemuva kwalokho, i-bile yengezwe ekudleni ukuze ihlule ingxenye edlalayo yokudla.
Ibheyi ijusi lokugaya elenziwe esibindi futhi lingasetshenziswa ngokushesha noma ligcinwe ukuze lisetshenziswe kamuva. Uma i-bile izosetshenziswa ngokuhamba kwesikhathi, iyohamba isuka esibindi ibe yi-gallbladder ngokusebenzisa enye ye-tuby-tubes-tubes ehambisa ibhala kude nesibindi kuya lapho isetshenziselwa khona ukusiza ukugaya.
Uma i-bile izosetshenziselwa ngokushesha ngemuva kokushiya isibindi, iyogeleza isuka esibindi ngokuqondile engxenyeni yokuqala yamathumbu amancane (i-duodenum) nge-buct evamile.
Cishe amaphesenti angamashumi amahlanu we-bile asetshenziselwa ngokushesha ngale ndlela ngenkathi enye isigamu ilinda egulini, lapho amanzi amaningi asuswa khona futhi ibhala liba ngaphezulu.
Ngenkathi i-bile ingakwazi ukudlula kwenye yezinyathi ze-bile ezivela esibindi noma gallbladder ngenxa yenkinga ngamadada, lokhu kubizwa ngokuthi yi-biliary obstruction.
Uhlobo oluvame kakhulu lokuvinjelwa kwamabhilidi yi-gallstone, okuyinto ibhola le-bile elikhuni phakathi nenqubo yokukhipha amanzi ebhodini, enye yemisebenzi ye-gallbladder. Lawa amatshe amancane abanjwe e-gallbladder noma emgwaqeni othatha i-bile kusuka ku-gallbladder kuya kwe-duodenum.
Izimbangela Ezivamile Zokuqashwa KwamaBiliary
- Ama-gallstones (lokhu kuyimbangela evamile kakhulu yokuvimbela amabhiliyali)
- Ukunciphisa okungavamile kwesinye sezinyosi ze-bile, esivame ukubizwa ngokuthi i-biliary stenosis
- Ukuvuvukala komgwaqo
- Ukwakhiwa kwe-cyst kwelinye lamadada
- Ukwandiswa kwe-lymph node ephoqelela ukuhamba ngaphandle
- I-Pancreatitis, ikakhulukazi ephindaphindiwe noma engapheliyo
- Ukulimala / ukuhlukumezeka okubandakanya isibindi, gallbladder, pancreas noma bile ducts
- Izicubu, umdlavuza noma unobungozi
- Ukwelashwa kwe-gallbladder, i-bile ducts noma ama-pancreas
- Isifo sesibindi
Izingozi Zengozi Yokuvimbela Biliary
Kunezizathu eziningi zokuthi kungani umuntu engase abe nesithiyo sezinsizakalo, ezinye zezimbangela ezivame kakhulu:
- Umlando wama-gallstones
- Umlando wokuhlinzwa okuthinta ama-bin ducts
- Umlando wesifo somdlavuza we-biliary
- Umlando wesifo somdlavuza wesibindi noma isifo
- Umlando womdlavuza we-pancreatic noma isifo
- Umlando wezinkinga ze- gallbladder
- Umlando wakamuva wokuhlinzwa ukukhipha i-gallbladder
- I- pancreatitis engapheli
- Ukukhuluphala
- Ukulahlekelwa kwesisindo ngokushesha
Izimpawu Nezibonakaliso Zokuvinjelwa Kwamabhilidi
Izimpawu nezimpawu zesithiyo se-biliary zizohlukahluka kumuntu ngamunye, kodwa ngokuvamile zihlanganisa eyodwa noma ngaphezulu kokulandelayo:
- Ubuhlungu besisu, ngokuvamile kwesisu esisenhla kwesokudla
- Itching
- I-jaundice (i-yellowing yesikhumba)
- I-Nausea ne-Vomiting
- Ukunyakaza kwamathumbu amhlophe noma amhlophe
- Umchamo omnyama
Ukuthola ukuvinjelwa kweBiliary
Uma kukhishwa isithiyo se-biliary, kukhona ukuhlolwa kwegazi, izifundo zokucabanga, kanye nezinqubo ezingenziwa ukuze kuqinisekiswe ukuthi kutholakala yini.
Ukuhlolwa kwegazi okuvamile okuyobonisa ukuthi inkinga ye-bile duct ingase ihlanganise nezinga eliphakeme le-alkali phosphatase, izinga eliphakeme le-bilirubin, nokwanda kwama-enzyme yesibindi.
Inkinga ebangela ibhala ukuba ibuyele esiqebeni izodala izinguquko ezinkulu ekuhlolweni kwegazi okuhlola ukusebenza kwesibindi.
Ukuhlolwa okungeziwe okungenziwa ukuxilonga isithiyo sebhilidi kuhlanganisa:
- I-Ultrasound yesisu
- I-CT scan yesisu
- I-percutaneous cholangiogram ye-transhepatic (PTCA)
- I-Magnetic Resonance Cholangio-Pancreatography (MRCP)
- I-Endoscopic Retrograde ye-Cholangio-Pancreatography (ERCP)
Ukwelashwa okungenziwa ukuze ukhiphe ukuvinjelwa kwamabhilidi kuxhomeke ekubambeni nendawo yenkinga. Isizathu esivamile kunazo zonke i-gallstone, futhi ukwelashwa kufaka i-Endoscopic Retrograde Cholangio-Pancreatography (ERCP) nokuhlinzeka ukususa i-gallbladder (cholecystectomy).
Uma imbangela yokuvimbela yinto engelona i-gallstone, ukwelashwa kungashintsha kabanzi kusuka komuntu kuya komuntu. Isibonelo, umuntu obhekene nokuvinjelwa kwamabhilidi ngenxa yomdlavuza uzophathwa ngendlela ehluke kakhulu kunomuntu obhekana nenkinga efanayo ngenxa yokutheleleka. Isiguli esisebekhulile esinama-gallstones singathola ukwelashwa okuhlukile kunowesifazane oneminyaka engu-30 ubudala obhekene nezibonakaliso nezimpawu ezifanayo, njengoba isiguli esidala singase sikwazi ukubekezelela ukwelashwa okufanayo njengelomncane.
Ngokuvamile, indlela encane engavamile yokuxilonga nokuphatha iyona yokuqala yokuzama-njenge-MRCP-ngenkathi inqubo eningi engavamile njenge-ERCP noma ukuhlinzwa kwe-gallbladder kwenziwa kuphela uma kunesidingo. Lokho kusho ukuthi ukuhlinzeka nge-gallbladder, eyaziwa ngokuthi i-cholecystectomy, ingenye yezinhlinzeko ezivame kakhulu ezenziwa e-United States.
Iyini i-Magnetic Resonance Cholangio-Pancreatography (MRCP)
I-Magnetic Resonance Cholangio-Pancreatography, eyaziwa ngokuthi i-MRCP, isilingo esingenasidingo esinjenge- MRI ejwayelekile. Lokhu kuhlolwa kusetshenziselwa ukuhlola isibindi, ama-pancreas, gallbladder, ne-bile ducts ukuze kutholakale ukuthi kukhona yini ukuvimbela. Ukuhlolwa kungasiza ekutholeni ukuvimbela, futhi kungasiza ekunqumeni imbangela yokuvimba, okungaqondisa indlela okufanele ukwelashwa ngayo.
Ngabe i-MRCP Yenzani?
I-MRCP yenziwa uma kukhona ukusola ukuthi ukuvinjelwa kwe-bile yokudoba kukhona futhi kubangele inkinga. Akukhona nje kuphela ukuthi lesi sivivinyo singanquma uma ukuvinjelwa kwe-bile kungabikho, lesi sivivinyo singase sibone ukuthi yini ebangela inkinga. Ngeshwa, ngenkathi i-MRCP iyindlela enhle yokuxilonga inkinga, lokhu kuhlolwa kungasiza kuphela ukunquma indlela yokuphatha kahle le nkinga-i-MRCP ngokwalo ayikwazi ukuphatha ukuvimbela.
Kwenzekani Phakathi neM MRCP?
Ngesikhathi i-MRCP isiguli sidingeka ukuba sisese embhedeni ohamba ngaphakathi nangaphandle komshini ofana ne-MRI. Ukuhlolwa akuyona into engavamile, okusho ukuthi akukho okubekiwe noma emzimbeni. Njengo-x-ray, umshini akudingeki uthinte wena ukuhlola ngaphakathi komzimba. Ukuhlolwa kuyisimanga futhi ngokuvamile kuthatha amahora amaningana.
Izingozi ze-MRCP
Izingozi ze-MRCP azizincane. Iziguli ezithola i-claustrophobia noma ezisindayo zingadinga umshini ovulekile ovulekile we-MRI wokutadisha kwawo kunomshini wendabuko ofana nethubhu, kodwa azikho izingozi ezibalulekile ngalolu hlobo lokutadisha. Uma kuqhathaniswa isisetshenziswa, kunobungozi obuncane bokuphendula, futhi umehluko kufanele usetshenziswe ngokucophelela ezigulini ezinezinkinga zezinso.
Iziguli ezinezimpembe zensimbi zingenayo i-MRCP kuphela uma ukufakelwa kwazo kuyi-MRI ephephile, njengoba inqubo isebenzisa umlenze onamandla kakhulu ukudala izithombe zangaphakathi komzimba. Akukho ukuchayeka kwemisebe ngesikhathi se-MRI.
I-ERCP ichazwe
I-Endoscopic Retrograde I-Cholangio-Pancreatography, eyaziwa ngokuthi i-ERCP, iyindlela encane lapho i- endoscope ekhanyayo ifakwe emlonyeni futhi ngokucophelela iphoqa isisu esiswini, bese ingena engxenyeni yokuqala yamathumbu amancane okuthiwa i-duodenum.
I-endoscope inokukhanya kanye nekhamera ekupheleni, okuvumela udokotela ukuba ahlole ngokuqondile ngaphakathi kwegciwane lokugaya. Lokhu kungenzeka ngoba i-bony ejwayelekile ye-bile idlulela kwi-duodenum, futhi uma i-gallstone noma esinye isithiyo singekho emgodini we-bile, i-gastroenterologist enekhono ingasusa lelo tshe ngethuluzi ngokusebenzisa i-endoscope yocingo, ibhasikidi noma ibhaluni.
Ngabe i-ERCP eyenziwe nini?
I-ERCP yenzelwa esinye sezizathu ezimbili. Isizathu sokuqala ukwenza ukuxilongwa-ukucacisa ukuthi ngabe kukhona yini ukuvimbela amabhiliyali okubonakalayo ngokuhlola ngeso lengqondo umgwaqo. Isizathu sesibili i-ERCP eyenziwa yilapho ezinye izifundo, ezifana nokuhlolwa kwegazi noma i-MRCP, zibonisa ukuthi ukuvimbela amabhiliyali akukhona nje kuphela, kodwa inkinga ingahle ibekwe ngokubeka i-stent noma isuse i-gallstone e-bile duct.
Ngokungafani ne-MRCP, enikeza izithombe zalokho okwenzeka emzimbeni, i-ERCP ingayiphatha ngempela inkinga.
Izingozi ze-ERCP
Ngenkathi i-ERCP ibhekwa njengendlela encane engozini, njenganoma iyiphi inqubo engavamile kukhona izinkinga ezingase zibe khona okufanele zixoxwe ngazo. Ngaphandle kwezingozi ezihlobene ne-anesthesia , i-ERCP ingabangela ukucindezeleka, ukutheleleka, nokukhipha igazi.
Ukucindezeleka okunzima kunazo zonke kuwuphawu lokushaya imoto-emangcwabeni noma kwezinye izindawo lapho i-ERCP ihlola khona. Ingozi ye-perforation iphansi ezandleni ze-gastroenterologist enekhono, kodwa noma kunjalo kungenzeka.
I-Anesthesia ne-ERCP
Inqubo ye-ERCP eyenziwa ngesiguli esithola i- anesthesia jikelele ukuze ingazi ukuthi inqubo isenziwa kanjani. Isiguli sizofakwa futhi sibeke endaweni yokuphuza umoya futhi silele yonke inqubo.
Uma inqubo isuphelile, imithi izonikezwa ukuyeka i-sedation futhi isiguli sizovuka kancane kancane. Lapho isiguli sikwazi ukuphefumula sodwa, i-tube endotracheal isuswe futhi isiguli ngokuvamile sithathwa ku-Post Anesthesia Care Unit ( PACU ) noma egumbini lazo esibhedlela ukuze liphinde liphume .
Le nqubo ingenziwa njengesifo sofuba noma inqubo yokwelapha. Uma isiguli singaguli kakhulu, bangabuyela ekhaya ngosuku olufanayo, kanti iziguli ezigulayo zingadinga ukuphola esibhedlela.
> Umthombo:
> Ukwakhiwa Kwezingcingo Zomgwaqo. Kufinyelelwe ngoFebhuwari, 2017. http://www.nytimes.com/health/guides/disease/bile-duct-obstruction/overview.html