Ukuqonda ukuxilongwa kunye nokuPhathwa kweziNcediso zeBiliary
I-MRCP Versus ERCP ye-Biliary Obstruction
Ukuqonda ngokwenene ukuba yi-Magnetic Resonance Cholangio-Pancreatography (MRCP) kunye ne-Endoscopic Retrograde ye-Cholangio-Pancreatography yile nto, kufuneka uqale uqonde ukuba yintoni isithintelo sebhiliyari kwaye yintoni ebangela ukuba le ngxaki ibangele.
Nangona ama-gallstones edla ngokubangela ukuba kubekho ukukhutshwa kwebhiliyari, zikho izizathu ezininzi zokuba isithintelo sebhiliyari senzeke kwaye ezininzi iindlela zokunyanga le micimbi exhomekeka kwixesha lempilo, impilo yonke, i-anatomy, imbali yokusetyenziswa kwemizimba yokutya kunye nezinye izinto ezinokuthi zitshintshe umntu kumntu.
Ukuqeshiswa kweBiliary kuchazwe
Masiqale ngokusetyenziswa kwenkqubo yokutya. Ukuze kufumaneke izondlo ezinokubakho kwiindawo zokutya, ukutya kufuneka kuphulwe yimizila yokutya ukuze zonke iivithamini, amaminerali, iiprotheni, amafutha kunye ne-carbohydrate zingabanjwa ngumathumbu omncinci. Le nkqubo iqala ngokutya okutshiza, ilandelwa sisisu sisasebenzisa i-acids kunye nesondlo sokutya ukuze kusize ukuyidiliza. Emva koko, i-bile yongezwa kukutya ukuze iphule inxalenye yesonka esidla.
I-bile yimizi yokugaya eyenziwa esibindi kwaye ingasetyenziswa ngokukhawuleza okanye igcinwe ukusetyenziswa kamva. Ukuba i-bile iya kusetyenziswa kamva, iya kuphuma esibindi ukuya kwi-gallbladder ngokusebenzisa enye ye-tubid-tubes-tubes ezithutha i-bile kude nesibindi ukuya apho isetyenziselwa ukunceda ukugaya.
Ukuba i-bile iya kusetyenziswa ngokukhawuleza emva kokushiya isibindi, iya kuphuma kwibindi ngokuthe ngqo kwinxalenye yokuqala yesisu esincinci (i-duodenum) nge-buct ye-bony efanayo.
Phantse iikhosenti ezingama-50 ze-bile isetyenziswe ngokukhawuleza ngale ndlela ngelixa esinye isiqingatha silinde kwi-gallbladder, apho ininzi yamanzi isuswe kwaye i-bile ibonakala ingakumbi.
Xa i-bile ingakwazi ukuhamba ngenye yee-ducts ezivela esibindi okanye gallbladder ngenxa yengxaki ngamadada, oku kubizwa ngokuba ngumqobo wendlela yokusebenza.
Uhlobo oluqhelekileyo lwe-biliary obstruction yi-gallstone, leyo ibhola ye-bile enzima ngexesha lokususa amanzi kwi-bile, yenye yenye yemisebenzi ye gallbladder. La matye amancinci athathwe kwi-gallbladder okanye kwi-duct ethatha i-bile kwi-gallbladder ukuya kwi-duodenum.
Izizathu eziqhelekileyo zokuLawulwa kweBiliary
- I-Gallstones (le yona nto ibangelwa yinto engavumelekanga yebhiliyari)
- Ukunciphisa okungavumelekanga kwesinye se-bile ducts, esibizwa ngokuba yi-biliary stenosis
- Ukugqithisa kwesibalo
- Ukwakhiwa kwe-cyst kwelinye lala mathupha
- Ukwandiswa kwe-lymph node eyenza i-duct iphumelele ngaphandle
- I-Pancreatitis, ngokukodwa ngokuphindaphindiweyo okanye engapheliyo
- Ukulimala / ukulimala okubandakanya isibindi, gallbladder, pancreas okanye i-bile ducts
- Izidumbu, umdlavuza okanye unobungozi
- Usulelo lwe-gallbladder, i-bile ducts okanye i-pancreas
- Isifo sesibindi
Izinto Zingozi Zokuvalwa Kwebhilidi
Kukho izizathu ezininzi zokuba kutheni umntu abe ne-biliary obstruction, ezinye zezizathu eziqhelekileyo zilandelayo:
- Imbali ye-gallstones
- Imbali yokuhlinzwa echaphazela i-bile ducts
- Imbali yesifo somhlaza
- Imbali yesifo somhlaza okanye isifo
- Imbali yomdlavuza we-pancreatic okanye isifo
- Imbali yeengxaki ze gallbladder
- Imbali yamva yonyango yokususa i gallbladder
- I- pancreatitis engapheliyo
- Ukunyanya
- Ukulahleka kwesisindo
Iimpawu kunye neMpawu zoLungiso lweBiliary
Imiqondiso kunye neempawu ze-biliary obstruction ziyahlukahluka kumntu ngamnye, kodwa ngokuqhelekileyo ziquka enye okanye ngaphezulu kwezi zinto zilandelayo:
- Iintlungu zesisu, ngokuqhelekileyo kwisigxina esingaphezulu kwesisu
- Ukutshiza
- I-jaundice (ukuphuka okwephuzi)
- Isihlunu kunye nokuvuthwa
- Ukunyuka kwebala okanye kumhlophe
- Umchamo omnyama
Ukuchonga ukuvalwa kweBiliary
Ukuba kukho ukukhankanywa kwebhiliyari, kukho ukuhlolwa kwegazi, izifundo zokucinga, kunye neenkqubo ezingenziwa ukuze kuqinisekiswe ukuxilongwa.
Iimvavanyo zegazi eziqhelekileyo eziza kubonisa ukuba ingxaki ye-bile duct ingabandakanya izinga le-alkaline phosphatase, inqanaba le-bilirubin eliphakamileyo, kunye ne-enzyme ezinobindi.
Ingxaki ebangela ibhala ukuya kwisibindi iya kubangela ukuba utshintsho oluphawulekayo kwiimvavanyo zegazi luhlola umsebenzi wesibindi.
Iimvavanyo ezongeziweyo ezinokuthi zenzelwe ukuxilonga isithintelo sebhaliary ziquka:
- I-Ultrasound yesisu
- I-CT scan yesisu
- I-cholangiogram ye-Percutaneous transhepatic (PTCA)
- I-Magnetic Resonance Cholangio-Pancreatography (MRCP)
- I-Endoscopic Retrograde ye-Cholangio-Pancreatography (ERCP)
Unyango olwenziwe kunyango lwezityalo luxhomekeke kwisizathu kunye nendawo yengxaki. Isizathu esona siqhelo sisilongwe, kwaye unyango lubandakanya i-Endoscopic Retrograde ye-Cholangio-Pancreatography (ERCP) kunye nokuhlinzwa ukuze kususwe i-gallbladder (cholecystectomy).
Ukuba isisombululo siyinto enye ngaphandle kwegolstone, unyango luyahlukahluka ukusuka kumntu kumntu. Umzekelo, umntu ojongene nesithintelo se-biaryary ngenxa yomhlaza uya kunyangwa ngokugqithisileyo kunomntu ojongene nengxaki efanayo ngenxa yokusuleleka. Umguli osekhulile onama-gallstones unokufumana unyango oluhlukile kunowesifazane oneminyaka engama-30 ubudala ofumana iimpawu kunye neempawu ezifanayo, njengoko isiguli esipheleleyo singenako ukunyamezela unyango olufanayo njengelona selula.
Ngokuqhelekileyo, indlela encinci yokuphazamiseka nokuphatha yileyokuqala ukuzama-njenge-MRCP-ngelixa inkqubo enokungenwa yinkqubo efana ne-ERCP okanye i-gallbladder ukuhlinzwa yenziwa kuphela xa kuyimfuneko. Oko kwathiwa, ukuhlinzwa okwenziwe nge-gallbladder, eyaziwa nangokuthi yi-cholecystectomy, yenye yezinto eziqhelekileyo zonyango ezenziwa eMelika.
Yintoni i-Magnetic Resonance Cholangio-Pancreatography (MRCP)
I-Magnetic Resonance Cholangio-Pancreatography, eyaziwa ngokuba yi-MRCP, luvavanyo olungenangxamnye ne- MRI . Olu vavanyo lisetyenziselwa ukuhlolisisa isibindi, i-pancreas, gallbladder, kunye ne-bile ducts ukuchonga ukuba kukho umqobo. Uvavanyo luyakunceda ukufumanisa ukuphazamiseka, kwaye lunokukunceda ekufumaneni imbangela yokukhutshwa, okuya kunika indlela ekufuneka iphathwe ngayo.
Ngabe i-MRCP yenza ntoni?
I-MRCP yenziwa xa kukho isikrokreko sokuthi ukukhutshwa kwe-bile ukukhupha kubakho kwaye kubangela umba. Akunakukuphela nje ukuba lo vavanyo luza ukuba ngaba i-buct ye-buct isithintelo, ukuvavanywa oku kudla ngokubangela ukuba yintoni edala imbangela. Ngelishwa, ngelixa i-MRCP yindlela enhle yokuxilonga ingxaki, lo vavanyo lunokukunceda kuphela ukujonga indlela yokuphatha kakuhle umcimbi-i-MRCP ngokwayo ayinakuyiphatha ingxaki.
Yintoni eyenzekayo kwi-MRCP?
Ngethuba le-MRCP isigulane sifuna ukuba sisise kwibhedeni ehambayo nangaphandle komshini ofana ne-MRI. Uvavanyo aluyi-invasive, oku kuthetha ukuba akukho nto ibeka kuyo okanye emzimbeni. Njenga-x-ray, umatshini akufuneki ukukuchaphazela ukuba uhlolisise ngaphakathi emzimbeni. Uvavanyo luvakala kwaye luthatha iiyure eziliqela.
Mngcipheko we MRCP
Ingozi ye-MRCP ayincinci. Izigulane ezinama-claustrophobia okanye ezinzima kakhulu zinokufuna umshini oqhelekileyo ovulekileyo we-MRI ukufundisisa kunokuba umatshini wendabuko onjenge-tube, kodwa akukho mingcipheko ebalulekileyo kulolu hlobo lwesifundo. Ukuba isetyenzisiwe sisetyenzisiwe, kukho umngcipheko omncinci wokuphendulwa komzimba, kwaye ukuhlukana kufuneka kusetyenziswe ngokuqaphela kwizigulane ezineengxaki zeengtso.
Izigulane ezinezitshixo zetsimbi zinokuphela kwe-MRCP ukuba i-MRI ikhuselekile, njengoko inkqubo isebenzisa i-magnet enamandla ukudala imifanekiso yangaphakathi yomzimba. Akukho ukukhanya kweemitha ngexesha leMRI.
ERCP ichazwe
I-Endoscopic Retrograde I-Cholangio-Pancreatography, eyaziwayo ngokubanzi njenge-ERCP, yinkqubo engenayo apho i- endoscope ekhanyayo ifakwe emlonyeni kwaye iphoswe ngokukhawuleza kwi-esisopha kwisisu, ize ibe yingxenye yokuqala yamathumbu amancinci okuthiwa i-duodenum.
I-endoscope inokukhanya kunye nekhamera ekupheleni, evumela ukuba ugqirha ukuba ahlolisise ngaphakathi kwindlela yokugaya. Oku kunokwenzeka ngenxa yokuba i-beng ye-bheng efana nayo ingena kwi-duodenum, kwaye ukuba i-gallstone okanye enye ingqongqo ikhona kwi-buct ye-bile, i-gastroenterologist enekhono iyakususa ilitye ngokusebenzisa i-wireless, ibhasikidi okanye ibhaluni kwi-endoscope.
Xa i-ERCP eyenziwe?
I-ERCP yenzelwa esinye sezizathu ezibini. Isizathu sokuqala kukuba ufumane ukuxilongwa-ukuchonga ukuba ngaba isithintelo sebhiliyali sikhona ngokujonga ngokuhlola i-trap. Isizathu sesibini i-ERCP yenziwa xa ezinye iinjongo, ezifana nokuhlolwa kwegazi okanye i-MRCP, zibonisa ukuba ukukhutshwa kwebhaliary akukhona nje kuphela, kodwa ingxaki ingagqitywa ngokubeka i-stent okanye isusa i-gallstone kwi-bile duct.
Ngokungafani ne-MRCP, enika imifanekiso yento eyenzekayo emzimbeni, i-ERCP ingayiphatha ingxaki.
Iingozi ze-ERCP
Ngelixa i-ERCP ithathwa njengenkqubo ephantsi kwengozi, njengalowo naluphi na inkqubo enomngcipheko kukho iingxaki ezinokuthi zixoxwe ngazo. Ukongeza kwimingcipheko enxulumene ne-anesthesia , i-ERCP inokubangela ukuba i-pancreatitis, intsholongwane kunye nokuphuma.
Inkxalabo enzima kunazo zonke i-perforation-engozini eyenza ingxuma-emathunjini okanye kwezinye iindawo apho i-ERCP ihlola khona. Umngcipheko we-perforation uphantsi ezandleni zegastroenterologist enezakhono, kodwa akunakwenzeka.
Anesthesia kunye ne-ERCP
Inkqubo ye-ERCP eyenziwa ngesigulane esithola i-anesthesia jikelele ukuze bangakwazi ukuba inkqubo iya kwenziwa. Isigulane siza kutyhulwa kwaye sifakwe kwi-ventilator kwaye silele kulo lonke inkqubo.
Xa inkqubo igqityiwe, unyango luya kunikwa ukuyeka udideko kwaye isiguli siya kuvuka ngokukhawuleza. Xa isigulane sikwazi ukuphefumula ngokwabo, i-tube endotracheal isuswe kwaye isigulane sithathwa rhoqo kwi-Unit Anesthesia Care Unit ( PACU ) okanye kwigumbi lokubhedlele.
Le nqubo inokuthi iyenziwe njengesigulana okanye inkqubo yokugulisa. Ukuba isiguli singagula kakhulu, banokubuyela ekhaya ngaloo mini, ngelixa izigulane ezigulayo zifuna ukuba zibuyele esibhedlele.
> Umthombo:
> Ukuvalwa kweDuct Duct. Kufumaneka ngoFebruwari, 2017. http://www.nytimes.com/health/guides/disease/bile-duct-obstruction/overview.html