Ukungenelela kwe-Vascular & Non-Vascular Hepatobiliary

Ukungenelela kwe-Vascular & Non-Vascular Hepatobiliary

I-Interventional radiology iyindawo ekhula ngokushesha yezokwelapha. Izazi ze-radiologist ezingenelela zisebenzisa izinqubo ezingavamisile kancane kanye neziqondiso zesithombe ukuze zenze ukuhlinzwa. Kwezokwelapha, izinqubo ze-radiology zokungenelela ngokuvamile zithatha indawo yezinqubo zokuhlinzwa. Zilula ezigulini njengoba zingabandakanyi ukusikwa okukhulu, ingozi, ubuhlungu obuncane futhi zinikeza isikhathi esifushane sokululama. 

Izazi ze-radiologist ezingenelela zisebenzisa ubuchwepheshe bazo ukufunda ama-X-reyi, i-ultrasound nezinye izithombe zezokwelapha ukuze ziqondise ishubhu elincane noma i-catheter emithanjeni yegazi ukwelapha lesi sifo. Lezi zinqubo azihlaseli futhi zibiza kakhulu uma ziqhathaniswa nokuhlinzwa okuvamile. 

Ezibhedlela ze-CARE, kunezinhlobonhlobo zezinqubo zokungenelela kwesibindi kanye ne-biliary, kokubili ukwelashwa nokuxilonga. Ngokuvamile sisebenzisa isiqondiso se-CT noma isiqondiso se-ultrasound ukuze sihlonze lesi sifo. 

Izinhlobo zokungenelela kwe-hepatobiliary 

• Ukungenelela kwe-Vascular

• Ukungenelela okungezona i-vascular noma percutaneous

Ukungenelela Kwemithambo

Ngokuvamile kufaka phakathi ukungenelela kwe-Transjugular intrahepatic portosystemic shunt (TIPS). Ukwelashwa kwe-portal hypertension. Kulokhu, ukuxhumana okuqondile kuyasungulwa phakathi kwegatsha le-portal vein kanye ne-hepatic vein. Lokhu kuvumela ukugeleza kwe-portal ukuthi kudlule esibindi. Ukungenelela kwe-TIPS kunconyelwe kulezi zimo ezilandelayo:

• Okokopha kwe-variceal acute.

• I-Hepatic hydrothorax

• I-Hepatorenal syndrome

• Ukucindezelwa okuyingozi kwe-Hepatic. 

Inqubo ayenziwa uma isiguli sinemibandela elandelayo. 

• Right yokumelwa yinhliziyo

• Isifo se-cystic hepatic

• I-Polycystic isifo sezinso

• I-Hepatic malignancy

Yonke inqubo yokuhlinzwa inezinkinga ezithile. Ubungozi obuhambisana nokungenelela kwe-TIPS bumi kanje:

• Ukubhoboza inyongo

• Ukulimala kwezinso okukhulu

• I-Hepatic infarction

Inqubo 

Ezibhedlela ze-CARE, silandela inqubo enikeziwe yama-TIPS. 

• Izithombe ze-Ultrasound zisetshenziselwa ukufaka i-vascular sheath ku-atrium efanele ukulinganisa ingcindezi ekuqaleni. 

• I-angiographic catheter ifakwa emithanjeni ye-hepatic eqondisiwe bese kwenziwa i-hepatic venography. 

• Inalithi yokubhoboza egobile ye-TIPS ifakwa emthanjeni we-hepatic nomgodla wawo owuzungezile. 

• Esimeni se-hepatic vein engakwesokudla kuya ku-portal vein beach stent yesokudla, i-TIPS izungeziswa ngaphambili futhi ifakwe ngaphansi ngezicubu zesibindi kusayithi okuhlosiwe. 

• I-portal venogram yenziwa ukuze kuqinisekiswe ukukhanselwa kwe-portal vein. 

• I-guidewire ishuthekwa ngenaliti ethi TIPS emthanjeni we-splenic noma we-mesenteric ukuze kuqinisekiswe ukufinyelela kwe-portal vein. 

• I-angiographic catheter ifakwa emthanjeni we-portal ukuze kulawulwe ingcindezi. 

• I-catheter yebhaluni isetshenziselwa ukunweba isikhala ngezicubu zesibindi. 

• I-vascular sheath ifakwa esikhaleni segatsha le-portal vein. 

• Izingcindezi zephothali ziyalinganiswa ukuze kutholwe ukwehliswa okufiswayo kwegradient ye-portosystemic. 

• I-Venography yenzelwe ukubheka izinkinga. 

Percutaneous (Non-vascular) Ukungenelela 

Kuhlanganisa i-percutaneous biopsy yesibindi. Lokhu kwenziwa ngokusebenzisa i-ultrasound noma isiqondiso sesithombe se-CT. Lena indlela enembile nethembekile yokuthola izicubu zesibindi ukuze kuhlolwe izifo. I-biopsy yesibindi ihlukaniswa futhi ibe;

• I-non-focal or non-target biopsy yesibindi

• I-focal or targeted biopsy yesibindi. 

Abantu abaphethwe yizimo ezilandelayo bangaya ekungeneleleni nge-percutaneous. 

• I-cirrhosis

• Isifo sesibindi esinamafutha e-non-alcoholic (NAFLD). 

• I-steatohepatitis engeyona utshwala. 

• I-cirrhosis yamabhilidi ayisisekelo 

• Ukusebenza kwesibindi okungavamile

• Ukuphazamiseka kokugcinwa kwesibindi njengesifo sikaWilson kanye ne-hemochromatosis. 

• Ukulimala kwesibindi okungapheli. 

• I-metastasis yesibindi 

Inqubo ayenziwa ngaphansi kwezimo ezilandelayo. 

• Isiguli esingabambisani nabo

• Izinkomba ze-coagulation ezingavamile

• Ama-Ascites

• Ukuvinjelwa kwe-biliary Extrahepatic 

Izinkinga noma izingozi ezihlobene ne-biopsy yesibindi zibalwe ngezansi:

• Ubuhlungu

• Ukutheleleka

• Ukuvuza kwebile 

• Ukuvinjwa kwe-catheter 

Inqubo

Inqubo ye-Liver Biopsy elandelwa odokotela be-CARE Hospitals inikezwe ngezansi:

Ngaphambi Kwenqubo

• Odokotela bathatha ifomu lemvume elibhaliwe nelisayiniwe esigulini.

• Ngaphambi kokuthi baqale ngale ndlela, odokotela bahlola isiguli ngokwenza izivivinyo zaselabhorethri ezifana ne-Complete Blood Count (CBC) nangokubona iphrofayili yokuhlangana.

Ngesikhathi Senqubo

• I-Ultrasound iyindlela esetshenziswayo ekuqondiseni i-biopsy yesibindi. 

• Ngaphambi kwenqubo, isibindi sihlolwa nge-ultrasound ukuze kunqunywe indawo yokungena kanye nokuma kwenaliti.

• I-wedge isetshenziswa ngemuva komhlane wesiguli ukuze kumiswe i-oblique.

• Ukumakwa kwendawo yokungena esikhumbeni kusiza ekuhlanzeni nasekugqokeni isikhumba.

• Odokotela babe sebeqapha indawo ngosizo lokuqapha i-haemodynamic.

• Ngalesi sigaba, isikhathi sokuvala siyenziwa.

• Ukuqinisekisa i-asepsis, indawo yesikhumba idonswa futhi ilungiselelwe.

• Local i-anesthesia ingena ngaphansi kodonga lwesisu lwesikhumba.

• Indawo yokungena yenziwa ngosizo lwe-scalpel.

• Inqubo yamahhala isetshenziswa lapho inaliti ithuthukisiwe ekuqondisweni kwe-ultrasound ngesikhathi se-biopsy. 

• Ukuhlolwa kwe-ultrasound kwe-perihepatic haemorrhage kwenziwa ngemva kwenqubo.

Ngemva Kwenqubo

• Ngemuva kwenqubo, isiguli sigcinwa ngaphansi kokubhekwa futhi ukuphumula okuphelele kombhede kuyalulekwa kuye.

• Imibuzo esebenzayo mayelana nobuhlungu nokopha kwesiguli kwenziwa njalo ngemva kwesigamu sehora.

• Ngalesi sikhathi sokubheka, odokotela bathola ithuba elanele lokuhlonza nokwelapha noma iyiphi inkinga engenzeka ngemva kokuphothulwa kwenqubo.

• Isiguli siyadedelwa uma kunokubhekwa okuzinzile. Akufanele kube nobufakazi bokungazinzi kwe-haemodynamic, ubuhlungu, ukuphefumula kanye nokopha ngenkathi ukhipha uketshezi esigulini. 

Izibhedlela ZOKUNAKEKELA Zingasiza Kanjani?

Ithimba lodokotela abanolwazi ezibhedlela ze-CARE lisebenzisa izinqubo zokuhlinzwa zesimanje nezithuthukisiwe ze-Vascular and Non-vascular hepatobiliary Interventions. Silandela izinqubo zokwelapha zamazwe ngamazwe ukuze sinikeze imiphumela engcono kakhulu ezigulini. Abasebenzi abaqeqeshiwe bahlinzeka ngokunakekelwa kokugcina ezigulini ukuze zilulame kangcono futhi ngokushesha. Isibhedlela siphinde sinikeze iziguli izindlela zokwelapha eziqondene nawe futhi sisebenzisa izinqubo ezingavamisile kakhulu ngesikhathi sokwelashwa kwazo.