Kwa odwala omwe ali ndi pancreatic pseudocysts, mphamvu ya stent yatsopano ya mutu wa bowa ndi yayikulu.

Pancreatic pseudocyst ndi amodzi mwazovuta za kapamba, chifukwa zizindikiro zake zobwerezabwereza zimakhudza kwambiri moyo wa odwala. Pakadali pano, njira zochizira ma pancreatic pseudocysts ndi monga chithandizo cha opaleshoni, ngalande yoboola m'mitsempha, ndi endoscopic transluminal drainage. M'zaka zaposachedwapa, endoscopic transluminal ngalande pang'onopang'ono wakhala muyezo mankhwala njira, makamaka motsogozedwa ndi endoscopic ultrasound (EUS) kukhazikitsa bwino ngalande ngalande pakati chotupa ndi m'mimba kapena duodenum, kuti tikwaniritse ngalande mkati mwa chotupa. Pazachipatala, mitundu yosiyanasiyana ya ma stents nthawi zambiri imayikidwa pakati pa mayendedwe kuti awonetsetse kuti ali otseguka.

Pali mitundu yosiyanasiyana ya ma stents pazachipatala, ndipo stent yomwe imagwiritsidwa ntchito kwambiri pawiri pigtail ili ndi chiopsezo chochepa chothamangitsidwa. Komabe, chifukwa cha kukula kwake kochepa mkati, kutsekeka kwa stent kumachitika nthawi zambiri. Zovala zachitsulo zodzikutira bwino zili ndi zabwino monga kukula kwamkati mkati, kutsika kwachiwopsezo chotsekeka, komanso kutulutsa bwino kwa cysts. M'zaka zaposachedwa, South Korea yatulutsa mtundu watsopano wa stent wa mutu wa bowa (Chithunzi 1), womwe uli ndi mainchesi ndi kutalika kwake, ndipo uli ndi catheter yodzipereka yoperekera. Kafukufuku wam'mbuyomu adapeza kuti stent yatsopanoyi imakhala yothandiza kwambiri pachipatala.

Cyst akuwonetsedwa pa MR

Chapamimba patsekeke ndi wothinikizidwa ndi kukhala ang'onoang'ono

Pseudocyst pansi pa endoscopic ultrasound

Kutuluka kwamadzi mwachangu pambuyo poyika stent

Research In kuyambitsa

Kafukufuku ku South Korea wawonetsa kuti kwa odwala omwe ali ndi zizindikiro za pancreatic pseudocysts, kugwiritsa ntchito chitsulo chatsopano chabowa pawiri kumatha kuchepetsa zizindikiro, kuchotsa pancreatic cysts, ndipo ndikotetezeka. Nkhaniyi idasindikizidwa mu Seputembala ya Gastrointestinal Endoscopy (2019, 90 (3): 507-513).

Phunziroli linaphatikizapo odwala omwe ali ndi zizindikiro za pancreatic pseudocysts, omwe ali ndi mainchesi oposa 6 cm, opanda magawo amkati, ndipo ali pafupi ndi chapamimba ndi duodenal cavities. Kupatula anthu omwe ali ndi zigawo zolimba mu ma pseudocysts, anthu akufa omwe ali ndi zilonda zam'mimba, komanso anthu omwe ali ndi ma pseudocysts omwe sangathe kuthandizidwa motsogozedwa ndi EUS. Kwa odwala omwe adalembetsa, puncture yoyamba yoyendetsedwa ndi EUS imapangidwa kuti ikhazikitse njira yodutsa m'mimba kapena mmatumbo ammimba ndi chotupa, ndikutsatiridwa ndi dilation ndi kukonzanso opaleshoni ndikuyika stent yatsopano iwiri ya mutu wa bowa. Kujambula kwa CT kunachitika masabata a 4 pambuyo pa chithandizo kuti awone momwe cyst imayendera (Chithunzi 2).

Chithunzi 2: Chithandizo cha pancreatic pseudocyst pogwiritsa ntchito bowa watsopano wapawiri mutu zitsulo stent: A, CT imasonyeza pancreatic pseudocyst; B. EUS motsogozedwa ndi opaleshoni ya transgastric cyst puncture; C. Yang'anani waya wowongolera akulowa mkati mwa chotupa pansi pa X-ray fluoroscopy; D. Kuyika kwa SPAXUS stent motsogozedwa ndi EUS; E. Kuyika kwa stent pansi pa X-ray fluoroscopy; F. Kuwona stent yokhazikitsidwa bwino pansi pa endoscopy yolunjika; Zithunzi zotsatila za G. CT pambuyo pa opaleshoni yoyika stent; H. Pambuyo pa kuyika kwa stent, ntchito ya stent inawoneka bwino pansi pa endoscopy; I. Chotsani bwino stent pansi pa endoscopy

Odwala a 34 adalembetsa nawo phunziroli, kuphatikiza amuna 26 ndi akazi 8, omwe ali ndi zaka zapakati pa 51.7. Avereji awiri a pancreatic pseudocysts anali 9.23 cm. Kupatula wodwala m'modzi yemwe adalephera kutulutsa stent, odwala 33 otsalawo adamaliza kuyika kwa stent, ndi luso laukadaulo la 97.1% (33/34); Mwa odwala 33 omwe adayika bwino stent, wodwala m'modzi yekha ndiye anali ndi vuto la ngalande, pomwe odwala 32 otsala adapeza mpumulo wazizindikiro zachipatala komanso kutha kwa chotupa, ndi chiwopsezo chachipatala cha 94.1% (32/34). Panali milandu ya 3 ya matenda a pseudocyst ndi vuto limodzi la stent kukanika panthawi ya opaleshoni, ndi chiwerengero cha 11.8% (4/34).

Ndemanga za akatswiri

Katswiri wazofotokozera: Zhang Shutian, Beijing Friendship Hospital Yogwirizana ndi Capital Medical University

Mwachizoloŵezi, odwala ambiri omwe ali ndi pancreatic pseudocysts amafunika chithandizo cha opaleshoni kuti athetse madzi a cyst ndikuchotsa. Ndi chitukuko chaukadaulo wa endoscopic, chithandizo cha endoscopic cha pancreatic pseudocysts pang'onopang'ono chakhala njira yodziwika bwino yochizira, yogwira ntchito komanso yotetezeka, koma palinso zovuta zina zaukadaulo.

Cholinga chachikulu cha chithandizo cha endoscopic kwa ma pseudocysts ndikukhazikitsa njira pakati pa lumen ya m'mimba ndi chotupa, ndikuyika stent yokwanira kuti cyst ilowe mkati. M'mimba mwake ndi kutalika kwa stent zonse zimakhudza mphamvu ya ngalande. Pakali pano, stent ya pulasitiki yomwe imagwiritsidwa ntchito kawiri kawiri ya pigtail imakhala ndi m'mimba mwake yaying'ono ndipo imakonda kutsekeka; Chitsulo chophimbidwa ndi stent chimakhala ndi kutalika kwaufupi ndipo chimakonda kusamuka, chomwe chimakhudza chithandizo chamankhwala; M'zaka zaposachedwa, stent yomwe yangoyambitsidwa kumene pawiri ya bowa imakhala ndi mainchesi okulirapo ndipo imatha kusinthidwa kukhala yoyenera malinga ndi kutalika kwa khoma la m'mimba komanso njira yotupa.

Kafukufukuyu ndiye kafukufuku woyamba woyembekezeredwa wamitundu yambiri wolunjika ku stent yatsopano, yomwe ikufuna kuwunika momwe imagwirira ntchito kwa odwala omwe ali ndi zizindikiro za pancreatic pseudocysts. Ofufuzawo adagwiritsa ntchito singano yoboola ya 19G EUS kuti ibowole mu chotupa kudzera m'mimba kapena khoma la duodenal. Baluniyo itatambasulidwa kuti ipange kanjira kakulidwe koyenera, katheta wofananirako amalowetsedwa ndikuyikidwa chotchingira. The mankhwala zotsatira adawunikidwa potengera mpumulo wodwala chizindikiro ndi kusintha chotupa m`mimba mwake.