Ezigulini ezinama-pseudocysts e-pancreatic, ukusebenza kahle kwe-stent entsha ye-mushroom head metal stent kuyancomeka.

I-Pancreatic pseudocyst ingenye yezinkinga ze-pancreatitis, njengoba izimpawu zayo eziphindaphindayo zinomthelela omkhulu kwikhwalithi yempilo yeziguli. Njengamanje, izindlela zokwelapha i-pancreatic pseudocysts zifaka ukwelashwa kokuhlinzwa, ukubhoboza amanzi nge-percutaneous, kanye ne-endoscopic transluminal drainage. Eminyakeni yamuva nje, i-endoscopic transluminal drainage kancane kancane isiphenduke indlela yokwelapha ejwayelekile, eqondiswa ikakhulukazi i-endoscopic ultrasound (EUS) ukuze kusungulwe umgudu wokugeleza osebenzayo phakathi kwe-cyst nesisu noma i-duodenum, ukuze kuzuzwe ukuphuma kwangaphakathi kwe-cyst. Emisebenzini yomtholampilo, izinhlobo ezahlukene zama-stents zivame ukubekwa phakathi kwamashaneli ukuze kuqinisekiswe isimo sawo esihle sokuvuleka.

Kunezinhlobo ezahlukahlukene zama-stents ekusebenzeni komtholampilo, futhi i-stent ye-pigtail evame ukusetshenziswa kakhulu inengozi ephansi yokususwa kwe-stent. Kodwa-ke, ngenxa yobukhulu bayo bangaphakathi obuncane, ukuvinjelwa kwe-stent kuvame ukwenzeka. Ama-stents ensimbi azinwebayo ambozwe ngokugcwele anezinzuzo ezifana nobubanzi obukhulu bangaphakathi, ubungozi obuphansi bokuvimbeka, kanye nomthelela omuhle wokukhipha amanzi kuma-cyst. Eminyakeni yamuva, iNingizimu Korea ikhiqize uhlobo olusha lwe-stent yekhanda lamakhowe eliphindwe kabili (Umfanekiso 1), onobubanzi nobude obukhulu, futhi ifakwe i-catheter yokulethwa ezinikele. Ucwaningo lwangaphambilini zithole ukuthi le stent entsha inamandla amakhulu emtholampilo.

I-cyst eboniswe ku-MR

I-gastric cavity iyacindezelwa futhi iba mncane

I-pseudocyst ngaphansi kwe-endoscopic ultrasound

Ukuphuma koketshezi ngokushesha ngemva kokubekwa kwe-stent

Research Introduction

Ucwaningo olwenziwa eSouth Korea lubonise ukuthi ezigulini ezinezimpawu ze-pseudocysts ze-pancreatic, ukusetshenziswa kwe-stent yensimbi entsha yamakhowe ekhanda kungadambisa ngempumelelo izimpawu, kuqede ama-pancreatic cysts, futhi kuphephile. I-athikili ishicilelwe kumagazini kaSepthemba we-Gastrointestinal Endoscopy (2019, 90 (3): 507-513).

Lolu cwaningo lwaluhlanganisa iziguli ezinezimpawu ze-pseudocysts ze-pancreatic, ezinobubanzi obukhulu kuno-6 cm, azikho izingxenye zangaphakathi, futhi ziseduze nemigodi yesisu ne-duodenal. Ngaphandle kwabantu abanezingxenye eziqinile kuma-pseudocysts, abantu abashonile abanezilonda ezimboziwe, kanye nabantu abanama-pseudocysts angelashwa ngaphansi kokuqondiswa kwe-EUS. Ezigulini ezibhalisiwe, ukubhoboza kokuqala okuqondiswa yi-EUS kwenziwa ukuze kusungulwe umhubhe odlula emgodini wesisu noma we-duodenal kanye ne-cyst, okulandelwa ukuhlanjululwa nokuhlinzwa kokwakhiwa kabusha nokubekwa kwekhanda elisha lamakhowe eliphindwe kabili. I-CT scan yenziwa amasonto e-4 ngemuva kokwelashwa ukuze kuhlolwe umphumela wokukhipha amanzi we-cyst (Umfanekiso 2).

Umfanekiso wesi-2: Ukwelashwa kwe-pseudocyst ye-pancreatic kusetshenziswa i-stent entsha yensimbi yekhanda lamakhowe amabili: A, CT ikhombisa i-pancreatic pseudocyst enkulu; B. EUS guided transgastric cyst puncture surgery; C. Bheka intambo yomhlahlandlela ingena ngaphakathi kwesimila ngaphansi kwe-X-ray fluoroscopy; D. Ukufakwa kwe-SPAXUS stent ngaphansi kokuqondiswa kwe-EUS; E. Ukubekwa kwe-stent okubonakalayo ngaphansi kwe-X-ray fluoroscopy; F. Ukubuka i-stent efakwe ngempumelelo ngaphansi kwe-endoscopy eqondile; G. CT izithombe zokulandelela ngemva kokuhlinzwa kokubekwa kwe-stent; H. Ngemva kokufakwa kwe-stent, umsebenzi we-stent wabonwa ukuthi muhle ngaphansi kwe-endoscopy; I. Ukukhipha ngempumelelo i-stent ngaphansi kwe-endoscopy

Ingqikithi yeziguli ezingama-34 zibhalise ocwaningweni, okuhlanganisa abesilisa abangama-26 nabesifazane abayisi-8, abaneminyaka yobudala eyi-51.7. Isilinganiso sobubanzi be-pancreatic pseudocysts sasingu-9.23 cm. Ngaphandle kwesiguli esisodwa esihlulekile inqubo yokukhishwa kwe-stent, iziguli ze-33 ezisele zaqeda ngempumelelo ukufakelwa kwe-stent, ngezinga lokuphumelela lobuchwepheshe lika-97.1% (33/34); Ezigulini ezingama-33 ezibeke i-stent ngempumelelo, isiguli esisodwa kuphela esibe nomthelela omubi wokukhipha amanzi, kuyilapho iziguli ezingama-32 ezisele zithole ukukhululeka kwezimpawu zomtholampilo kanye nokunyamalala kwesimila, ngezinga lempumelelo yomtholampilo elingu-94.1% (32/34). Kube nezimo ezi-3 zokutheleleka nge-pseudocyst kanye necala elingu-1 lokungasebenzi kahle kwe-stent phakathi nesikhathi sokusebenza, ngenani lezinkinga lika-11.8% (4/34).

Ukuphawula kochwepheshe

Isazi sokuphawula: Zhang Shutian, Beijing Friendship Hospital Exhumene ne-Capital Medical University

Ngokwesiko, iziguli eziningi ezinama-pseudocysts e-pancreatic zidinga ukwelashwa kokuhlinzwa ukuze kutholakale ukugeleza nokuqedwa kwe-cyst. Ngokuthuthuka kobuchwepheshe be-endoscopic, ukwelashwa kwe-endoscopic kwama-pseudocysts e-pancreatic kancane kancane sekuyindlela yokwelapha ejwayelekile, ngempumelelo nokuphepha okukhulu, kodwa kubuye kube nobunzima obuthile bezobuchwepheshe.

Isinyathelo esiyinhloko sokwelashwa kwe-endoscopic yama-pseudocysts ukusungula umgudu phakathi kwe-lumen ye-digestive tract kanye ne-cyst, futhi ubeke usayizi ofanele ukuze kutholakale ukuphuma kwangaphakathi kwe-cyst. Ububanzi nobude be-stent kokubili kuthinta umphumela wokukhipha amanzi. Njengamanje, i-stent yepulasitiki ye-pigtail evame ukusetshenziswa kabili inobubanzi obuncane futhi ijwayele ukuvinjelwa; I-stent embozwe yensimbi inobude obufushane futhi ijwayele ukufuduka, okuthinta umphumela wokwelapha; Eminyakeni yamuva nje, i-stent yensimbi yekhanda lamakhowe esanda kwethulwa inobukhulu bangaphakathi obukhudlwana futhi ingalungiswa ibe usayizi ofanele ngokuya ngobude bodonga lomgudu wokugaya ukudla kanye nesiteshi se-cyst.

Lolu cwaningo luwucwaningo lokuqala lwe-multicenter olulindelekile oluqondise inoveli i-stent, okuhloswe ngayo ukuhlola ukusebenza kwayo ezigulini ezinama-pseudocysts e-pancreatic symptomatic. Abacwaningi baqale basebenzisa inaliti yokubhoboza engu-19G EUS ukubhoboza i-cyst ngodonga lwesisu noma lwe-duodenal. Ngemva kokuba ibhaluni selinwetshiwe ukuze lenze umgudu olingana nosayizi, kwafakwa i-catheter efanayo kwafakwa ne-stent. Umphumela wokwelapha uhlolwe ngokusekelwe ekukhululekeni kwezimpawu zesiguli kanye nezinguquko kububanzi be-cyst.