I-ECCP ubuchwepheshe obubalulekile bokuxilongwa kanye nokwelashwa kwezifo ezihamba phambili kanye ne-pancreatic. Uma sekuvele, inikeze imibono eminingi emisha yokwelashwa kwezifo ezihamba phambili kanye ne-pancreatic. Akukhawulelwe ku- "Radiology". Iguqulwe kusuka kubuchwepheshe bokuxilonga kwasekuqaleni kohlobo olusha. Amasu okulashwa afaka i-sphiinctetertomy, ukususwa kwamatshe e-bile duct, ukudonsa kwethayela nezinye izindlela zokwelapha izifo ze-bile ne-pancreatic.
Izinga lokuphumelela le-Okhethiwe Duct Ounturation ye-ECCP ingafinyelela ngaphezu kwama-90%, kepha kusenezinye izimo lapho kunzima khona ukufinyeleleka kwe-bile duction. Ngokusho kokuvumelana kwakamuva kokuxilongwa kanye nokwelashwa kwe-ercp, i-ingubation enzima ingachazwa njenge: isikhathi sokuqashelwa kwe-bile duct ye-audive angono ye-arcp eyinhloko ye-ercp evamile ye-ercp evamile noma inani lemizamo yokuguga lingaphezulu kwezikhathi ezi-10. Lapho wenza i-ercp, uma i-bile ductubation inzima kwezinye izimo, amasu asebenzayo kufanele akhethwe ngesikhathi ukuze athuthukise inani lempumelelo ye-bile duct Orubation. Le ndatshana yenza ukubuyekezwa okuhleliwe kwamasu ambalwa wokukhuthaza okusetshenziselwa ukuxazulula ukuxazulula i-turve duction enzima, ngenhloso yokuhlinzeka ngesisekelo sethiyori se-endoscopists ukuze ukhethe i-ntamba ye-ntamba
I.Singleguidestique, Sgt
Inqubo ye-SGT ukusebenzisa i-adversatheter ukuze uqhubeke nokuzama ukufukula i-bile duct ngemuva kocingo lwenkomba engena i-pancreatic duct. Ezinsukwini zokuqala zokwakhiwa kobuchwepheshe be-ERCP, i-SGT kwakuyindlela ejwayelekile yokufutheka okunzima kwamabhulukwe. Inzuzo yayo ukuthi kulula ukusebenza, ukulungisa ingono, futhi ingahlala ukuvulwa kwe-pancreatic duct, okwenza kube lula ukuthola ukuvulwa kwe-bile duct.
Kunemibiko e-Thelitereture yokuthi ngemuva kokukhuthalwa okujwayelekile kwehluleka, ukukhetha i-SGT-assistmus Intubation kungaqeda ngempumelelo i-bile ductubation kuma-70% -80% amacala. Lo mbiko futhi waveza ukuthi ezimweni zokwehluleka kwe-SGT, ngisho nokulungiswa nokusetshenziswa okuphindwe kabiliUmhlahlandlelaUbuchwepheshe bebengakuthuthukisi isilinganiso sokuphumelela kwe-bile ducturation futhi bengakunciphisi izehlakalo ze-Pancreatitis ye-APRCP (PEP).
Ezinye izifundo zibonise nokuthi izinga lokuphumelela le-SGT Intubation liphansi kunaleso eliphindwe kabiliUmhlahlandlelaubuchwepheshe kanye ne-transpancreatic papillary splicctetertomy technology. Qhathanisa nemizamo ephindaphindwayo ye-SGT, ukuqaliswa kokuqala kokuphinda kabiliUmhlahlandlelaUbuchwepheshe noma ubuchwepheshe bangaphambi kokukhanya bungathola imiphumela engcono.
Selokhu kwathuthukiswa kwe-ECRP, kwenziwe ubuchwepheshe obusha obuhlukahlukene bokuqonda okunzima. Qhathanisa noyedwaUmhlahlandlelaUbuchwepheshe, izinzuzo zisobala kakhulu futhi isilinganiso sempumelelo siphakeme. Ngakho-ke, singleUmhlahlandlelaUbuchwepheshe okwamanje bungasetshenziswa emtholampilo.
I-II.Duble-Umhlahlandlela Woure Technique, DGT
I-DGT ingabizwa ngokuthi yi-pancreatic duct Guide Fireyint Method, okuwukushiya ucingo lomhlahlandlela Ukufaka i-pancreatic duct ukulandelela nokuyisebenzisa, bese kuthi ucingo lwesibili lungafakwa ngenhla komhlahlandlela we-pancreatic duct umhlahlandlela. Ukukhetha okukhethiwe kwe-bile duction.
Izinzuzo zale ndlela yilezi:
(1) ngosizo lwe-aUmhlahlandlela, ukuvulwa kwe-bile duct kulula ukuyithola, okwenza i-bile duction ye-butwoother ebushelelezi;
(2) I-Filali wire ingalungisa ingono yensimbi;
(3) Ngaphansi kokuholwa kwe-pancreatic ductUmhlahlandlela, ukubonwa okuphindaphindiwe kwe-pancreatic duct kungagwenywa, ngaleyo ndlela kuncishiswe ukukhuthaza kwe-pancreatic duct okubangelwa ukufundwa okuphindaphindiwe.
Dumonceau et al. uqaphele ukuthi i-taperast ye-aurantwire anda afakwe emgodini we-biopsy ngasikhathi sinye, bese ibika icala eliphumelelayo le-pancreatic duct umhlahlandlela ohlala kuyo, futhi waphetha ngokuthiUmhlahlandlelaUkuhlala kwe-pancreatic duct indlela kuphumelele kwi-bile duct yokuquubation. isilinganiso sinomthelela omuhle.
Ucwaningo ku-DGT nguLiu Deren et al. Kutholakale ukuthi ngemuva kokuthi i-DGT yenziwa ezigulini ezinzima ze-ErcP bile duct intubation, isilinganiso sempumelelo ye-Intubation sifinyelele ku-95.65%, esasiphakeme kakhulu kunezinga lokufunga elijwayelekile.
Isifundo Esifanele nguWang Fuquan et al. Kukhombe ukuthi lapho i-DGT isetshenziswa ezigulini ezine-ercp bile duction elukhuni eqenjini le-Experimental, isilinganiso sempumelelo ye-Intubation sasiphakeme njenge-96.0%.
Izifundo ezingenhla zibonisa ukuthi ukusetshenziswa kwe-DGT ezigulini ezine-bile duct yokugulation ye-verc ye-ercp kungathuthukisa ngempumelelo isilinganiso sempumelelo ye-bile duct Orubation.
Ukushiyeka kwe-DGT ikakhulukazi kufaka amaphuzu amabili alandelayo:
(1) I-pancreaticUmhlahlandlelaMhlawumbe elahlekile ngesikhathi se-bile duct yokugubation, noma okwesibiliUmhlahlandlelaingangena futhi i-pancreatic duct futhi;
.
Ngokombono wezigameko ze-PEP, izehlakalo ze-PEP ze-DGT ziphansi kunalezo ze-bile duction evamile. Isifundo esizayo siveze ukuthi izehlakalo ze-PEP ngemuva kokuthi i-DGT yayingu-2.38% kuphela ezigulini ze-ECCPP ezinezinto ezinzima ze-bile duct '. Ezinye izincwadi ziveza ukuthi yize i-DGT inezinga eliphakeme lempumelelo ye-bile ductubation, izehlakalo ze-post-DGT Pancreatitis ziphakeme ngokuqhathaniswa nezinye izindlela zokulungisa, ngoba ukusebenza kwe-DGT kungadala ukulimala kwe-pancreatic duct nokuvula kwayo. Ngaphandle kwalokhu, ukuvumelana ekhaya nakwamanye amazwe kukhombisa ukuthi ezimweni ezinzima ze-bile ductubation, lapho i-lubrubation inzima futhi ubuchwepheshe be-DGT bunobunzima obuncane bokusebenza, futhi kulula kakhulu ukulawula i-infubation enzima.
I-III.Wire Guide Cancation-Pan-Creating Stent, WGC-P5
I-WGC-PS nayo ingabizwa ngokuthi yi-ThePancreatic Duct Stent Hurkhents Meyi. Le ndlela ukubeka i-pancreatic duct eqinile ngeUmhlahlandlelalokho ngephutha kungena nge-pancreatic duct, bese ukhiphaUmhlahlandlelafuthi wenze ukwenziwa kwe-bile duct anction ngaphezulu kwesiteshini.
Ucwaningo nge-hakuta et al. Kubonise lokho ngaphezu kokwenza ngcono inani lempumelelo ye-Intubation ephelele ngokuqondisa intubation, i-WGC-PS kungavikela ukuvulwa kwe-pancreatic duct futhi kuncishiswe kakhulu ukwenzeka kwe-PEP.
Ucwaningo ku-WGC-PS nguZou Chuanxin et al. Uveze ukuthi izinga lokuphumelela lokuqonda okunzima kusetshenziswa indlela yesikhashana ye-pancreatic duct Stent ifinyelelwe i-97.67%, futhi izehlakalo ze-PEP zincishiswe kakhulu.
Isifundo esisodwa sathola ukuthi lapho i-pancreatic duct ebekwe kahle, ithuba le-pancreatititititititititititititititititititititititititititititititititititititititi letinhle emacaleni letinchungechungetfu letinchungechungechungechungechungechungechungechungechuna lincishiswa kakhulu.
Le ndlela isekhona ukushiyeka okuthile. Isibonelo, i-pancreatic duct Stent ifakwe ngesikhathi sokusebenza kwe-erchp kungahle kuchithwe; Uma i-STEN idinga ukubekwa isikhathi eside ngemuva kwe-ercp, kuzoba nethuba eliphakeme lokuvinjwa okuqinile nokuvinjwa kwe-duct. Ukulimala nezinye izinkinga ekukhuphukeni kwezigameko ze-PEP. Kakade, izikhungo seziqale ukutadisha iziteshi zesikhashana ze-pancreatic duct ezingasuka ngokuzenzakalelayo ziphume e-pancreatic duct. Inhloso ukusebenzisa ama-pancreatic duct stunt ukuvikela i-PEP. Ngaphezu kokunciphisa kakhulu izehlakalo zengozi ye-PEP, iziteshi ezinjalo zingagwema neminye imisebenzi yokususa i-stent futhi inciphise umthwalo ezigulini. Yize izifundo zikhombisile ukuthi iziteshi zesikhashana ze-pancreatic zinomphumela omuhle ekunciphiseni i-PEP, uhlelo lwazo lomtholampilo lusamikhawulo enkulu. Isibonelo, ezigulini ezinama-pancreatic ama-pancreatic namagatsha amaningi, kunzima ukufaka i-pancreatic duct Stent. Ubunzima buzokwanda kakhulu, futhi lo msebenzi udinga izinga eliphezulu le-endoscopists. Kuhle futhi ukungamangali ukuthi i-pancreatic duct ebekwe kufakwe akufanele ibe yinde kakhulu ku-duodenal lumen. I-dent ende ngokweqile ingadala ukugcotshwa kwe-duodenal. Ngakho-ke, ukukhethwa kwendlela yokuhlala e-pancreatic Duct Stent isadinga ukuphathwa ngokuqapha.
I-IV.Trans-PancreatocShinterToMy, TPS
Ubuchwepheshe be-TPS buvame ukusetshenziswa ngemuva kokuthi ucingo lomhlahlandlela lungena kwi-pancreatic duct ngephutha. I-Septum maphakathi ne-pancreatic duct ifakwa eceleni kwe-pancreatic duct Guide Wire kusuka ngehora le-11 kuye kwehora le-12 kuye kwehora le-12, bese kufakwa ishubhu eceleni kwe-bile duct kuze kube yilapho ucingo lwe-bile.
Ucwaningo nguDai Xin et al. qhathanisa i-TPS kanye nezinye ubuchwepheshe obubili bokuzihlukanisa ukuzenta. Kungabonakala ukuthi inani lempumelelo lobuchwepheshe be-TPS liphezulu kakhulu, lifinyelela kuma-96.74%, kepha alikhombisi imiphumela emihle uma liqhathaniswa nobunye obubili bokuthi buttubation ubuchwepheshe. Izinzuzo.
Kubikwe ukuthi izici zobuchwepheshe be-TPS zifaka amaphuzu alandelayo:
(1) I-incision incane nge-pancreaticobilialy
(2) izehlakalo zezinkinga zokuphatha kabi ziphansi;
(3) Ukukhethwa kwesiqondisi sokusika kulula ukulawula;
.
Izifundo eziningi ziveze ukuthi i-TPS ayikwazi ukuthuthukisa ngempumelelo isilinganiso sempumelelo ye-divay enzima ye-bile ductubation, kodwa futhi ayikhuphuli izehlakalo zezinkinga ngemuva kwe-ercp. Ezinye izazi zisikisela ukuthi uma i-papcreatic duct enubation noma i-duodenal papilla encane yenzeka kaninginingi, i-TPS kufanele ibhekwe kuqala. Kodwa-ke, lapho kusebenza i-TPS, kufanele kubhekwe ukuthi kungenzeka ukuthi kube yi-pancreatic duct stenosis nokuphindaphindwa kwe-pancreatitis, okungenzeka ukuthi izingozi zesikhathi eside ze-TPS.
V.precut Sphiinctetertomy, PST
I-PST Technique isebenzisa i-papillary arcuate band njengomkhawulo ophezulu we-pre-incion kanye nesiqondisi se-1-2 esiseduze komngcele ukuvula i-duodenal Papilla Sphinctor ukuthola ukuvulwa kwe-bile kanye ne-pancreatic duct. Lapha i-PST ngqo ibhekisa kwinqubo evamile ye-NincIncter Pre-incision evamile usebenzisa ummese we-arcuate. Njengecebo lokubhekana ne-vear bile duct buttubation ye-ercp, ubuchwepheshe be-PST bubhekwe kabanzi njengokukhetha kokuqala kokuqonda okunzima. I-Endoscopic Indon SphIncter Pre-incision isho incoscopic incision ye-Papilla Surface Mucosa nenani elincane lemisipha ye-sphincter ngokusebenzisa ummese we-fenision ukuthola ukuvulwa kwe-bile duct, bese usebenzisa aUmhlahlandlelanoma i-catheter ukuze ikhuphukele i-bile duct.
Ucwaningo lwasekhaya lubonise ukuthi izinga lokuphumelela le-PST liphakeme ngo-89.66%, elingehluke kakhulu ku-DGT naku-TPS. Kodwa-ke, izehlakalo ze-PEP ku-PST ziphakeme kakhulu kunalezo ze-DGT ne-TPS.
Njengamanje, isinqumo sokusebenzisa lobu buchwepheshe kuncike ezintweni ezahlukahlukene. Isibonelo, omunye umbiko othile wathi i-PST isetshenziswa kangcono ezimweni lapho i-duodenal Papilla ingajwayelekile noma ihlanekezelwe, njenge-duodenal stenosis noma ubuhlanya.
Ngaphezu kwalokho, uma kuqhathaniswa namanye amasu okukopisha, i-PST inezigameko eziphakeme zezinkinga ezifana ne-PEP, futhi izidingo zokusebenza ziphezulu, ngakho-ke lokhu kusebenza kungcono kakhulu okwenziwa yi-endoscopists enolwazi.
Vi.needle-knife papillotomy, Nkp
I-NKP iyindlela yokuqonda enesinaliti-osizwanga. Lapho i-Intubation inzima, ingasetshenziselwa inaliti-ummese ukuthola ingxenye ye-papilla noma i-sphincter kusukela ekuvuleni kwe-duodenal papilla ohlangothini lwe-11-12. Bese usebenzisa aUmhlahlandlelanoma i-catheter ukufakwa kokufakwa ku-duct evamile. Njengecebo lokukopisha le-bile duct burtubation, i-NKP ingathuthukisa ngempumelelo isilinganiso sempumelelo ye-bile duction yokugugela. Esikhathini esedlule, ngokuvamile kwakukholelwa ukuthi i-NKP izokhulisa izehlakalo ze-PEP eminyakeni yamuva. Eminyakeni yamuva nje, imibiko eminingi yokuhlaziya ebuyisayo iveze ukuthi i-NKP ayikhuphuli ubungozi bezinkinga zokusebenzisa imali. Kuyaqapheleka ukuthi uma i-NKP yenziwa ekuqaleni kwe-Intubation Enzima, izosiza kakhulu ukuthuthukisa izinga lokuphumelela. Kodwa-ke, okwamanje akukho ukuvumelana lapho kufanele ngisebenzise khona i-NKP ukufeza imiphumela emihle. Isifundo esisodwa sibike ukuthi izinga lokukhuthalwa le-NKP lisetshenziswa ngesikhathiI-ERCPPNgaphansi kwemizuzu engama-20 bekuphakeme kakhulu kunalokho kwe-NKP kusetshenziswe ngemuva kwemizuzu engama-20.
Iziguli ezine-bile duct canclition zizozuzisa kakhulu kule ndlela uma zinama-bulges ezingosi Ngaphezu kwalokho, kunemibiko yokuthi lapho uhlangabezana namacala okuqonda okubucayi, ukusetshenziswa okuhlanganisiwe kwe-TPS ne-NKP kunezinga lempumelelo ephezulu kunokusebenzisa lodwa. Okubi yilokho amasu amaningi okuqala asetshenziswayo engonweni azokwandisa ukuvela kwezinkinga. Ngakho-ke, kudingeka ucwaningo olwengeziwe ukufakazela ukuthi ukhetha ukuvela kusenesikhathi ukunciphisa ukwenzeka kwezinkinga noma ukuhlanganisa izindlela zokulungisa eziningi zokuthuthukisa izinga lokuphumelela.
Vii.needle-knime fistulomy, nke
Indlela ye-NKF isho ukuthi isebenzisa ummese wenaliti ukubhoboza i-mucosa cishe nge-5mm ngaphezulu kwengono, i-bile achichima i-ormaise Ukufundwa kwe-bile duct yokukhetha kwenziwa esizeni saseJaundice. Ukuncishiswa kokuhlinzwa kwe-NKF ngaphezulu kokuvulwa kwengono. Ngenxa yobukhona be-bile duct Sinus, kunciphisa kakhulu ukulimala okushisayo nomonakalo owenziwe ngomshini wokuvulwa kwe-pancreatic duct, okunganciphisa izehlakalo ze-PEP.
Ucwaningo ngoJin et al. Ikhombe ngaphandle kwezinga lempumelelo ye-NK Tube Omuration ingafinyelela kuma-96.3%, futhi alikho i-PEP ye-PEPORATION. Ngaphezu kwalokho, inani lempumelelo le-NKF ekususweni kwamatshe liphakeme njenge-92.7%. Ngakho-ke, lolu cwaningo lutusa i-NKF njengokukhethwa kokuqala kokususwa kwamatshe ajwayelekile. . Uma kuqhathaniswa ne-papillomyotomy evamile, ubungozi bokusebenza kwe-NKF busephakeme, futhi buthambekele ezinkingeni ezinjengomdlandla kanye nokopha, futhi kudinga izinga eliphakeme lokusebenza kwe-endoscopists. Iphuzu elifanele lokuvula ewindini, ukujula okufanele, kanye nenqubo eqondile konke kudinga ukufundwa kancane kancane. master.
Uma kuqhathaniswa nezinye izindlela zangaphambi kokuvela, i-NKF yindlela elula enesilinganiso sempumelelo ephezulu. Kodwa-ke, le ndlela idinga umkhuba wesikhathi eside futhi ukuqongelela okuqhubekayo yi-opharetha ukuthi ibe nekhono, ngakho-ke le ndlela ayifanelekile kubaqalayo.
Viii.repeat-ercp
Njengoba kushiwo ngenhla, zikhona izindlela ze-areMany zokubhekana nokufunwa okunzima. Kodwa-ke, asikho isiqinisekiso sempumelelo eyi-100%. Izincwadi ezifanele ziveze ukuthi lapho i-bile ductubation inzima kwezinye izimo, i-ingubation yesikhathi eside neyesikhashana noma umphumela wokungena we-thermal wokusikwa kwangaphambilini kungaholela eDuodenal Papilla edema. Uma umsebenzi uqhubeka, hhayi kuphela ukuthi i-bile duction yokufutheka ingaphumelelanga, kepha ithuba lezinkinga lizokhula futhi. Uma kwenzeka lesi simo esingenhla, ungacabanga ukuqeda okwamanjeI-ERCPPUkusebenza kuqala nokwenza i-ercp yesibili ngesikhathi sokuzikhethela. Ngemuva kokuthi i-papilloede Monyama inyamalale, ukusebenza kwe-erchp kuzoba lula ukufeza i-Intubation ephumelelayo.
UDonnellan et al. yenziwe umzuzwanaI-ERCPPUkusebenza ezigulini ezingama-51 ze-Ercp ezihlulekile ngemuva kokuba inaliti-i-knise Preaserion, futhi amacala angama-35 aphumelele, futhi izehlakalo zezinkinga azizange zikhule.
Kim et al. wenza umsebenzi wesibili we-ercp ezigulini ezingama-69 ezahlulekileI-ERCPPNgemuva kweselitha-Knife Pre-incision, futhi amacala angama-53 aphumelele, anezinga lempumelelo elingu-76.8%. Amacala asele angaphumelelanga nawo athola ukusebenza kwe-erchp yesithathu, ngesilinganiso sempumelelo engama-79.7%. , futhi imisebenzi eminingi ayizange yandise ukwenzeka kwezinkinga.
Yu Li et al. Kwenziwe ngobuholiI-ERCPPEzigulini ezingama-70 ezihlulekile i-ercp ngemuva kwenalishi-Knife Pre-incision, kanti amacala angama-50 aphumelele. Izinga lempumelelo eliphelele (i-ERCPP yokuqala + ye-ECCP yesibili) lenyuka laya ku-90.6%, futhi izehlakalo zezinkinga azizange zikhuphuke kakhulu. . Yize imibiko ifakazele ukusebenza ngempumelelo kwe-ECCP yesibili, isikhathi esiphakathi kwemisebenzi emibili ye-ECCPP akufanele ibe yinde kakhulu, nakwamanye amacala akhethekile, ama-drainage abambezayo angenza abe ngokwanele isimo.
I-ix.endoscopicultrasoundtrasoundrasoundrasound, eus-bd
I-EUS-BD iyinqubo yokuhlasela esebenzisa inalithi yokubhoboza ukubhoboza i-gallbladder kusuka esiswini noma i-duodenum lumen ngaphansi kwemihlahlandlela ye-ultrasound, faka i-duodenal papilla, bese wenza i-burebation ye-ly. Le ndlela ifaka phakathi izindlela ezingemuva nezingemuva.
Ucwaningo olubuyiselwe emuva lubike ukuthi inani lempumelelo le-EUS-BD lifinyelele kuma-82%, kanti izehlakalo zezinkinga zokuphatha kabi zazingu-13% kuphela. Esifundweni sokuqhathanisa, e-eus-bd uma kuqhathaniswa nobuchwepheshe bokuqala, isilinganiso sayo se-Intubation Decience bekuphezulu, kufinyelela ama-98.3%, okwakuphakeme kakhulu kune-90.3% yokuphuma kwangaphambili. Kodwa-ke, kuze kube manje, uma kuqhathaniswa nobunye ubuchwepheshe, kusekhona ukuntuleka kocwaningo ekusetshenzisweni kwe-ES kunzimaI-ERCPPIntubation. Ayikho idatha enganele ukufakazela ukusebenza kobuchwepheshe be-EUS-Quided bile ducture technology for nzimaI-ERCPPIntubation. Ezinye izifundo zikhombisile ukuthi kunciphise indima ye-PEP ye-PROOperationational ayikholeki.
I-X.Percutaous transhepatic drainage ye-cholangial drainage, PTCD
I-PTCD ingenye indlela yokuhlola engahlangene engasetshenziswa ngokuhlanganiswa nayoI-ERCPPNge-bile ducturation enzima, ikakhulukazi ezimweni zokuvinjwa okulimazayo. Le ndlela isebenzisa inalithi yokubhoboza ngokufaka i-bile duct, ukubhoboza i-bile duct nge-papilla, bese ikhuthaza i-duct ye-bile ngokuqondile ngokusebenzisa okugodliweUmhlahlandlela. Olunye ucwaningo luhlaziye iziguli ezingama-47 nge-bile ductulwation enzima ye-bile dubation etholwa inqubo ye-PTCD, kanti izinga lokuphumelela lifinyelele kuma-94%.
Ucwaningo nguYang et al. Uveze ukuthi ukusetshenziswa kwe-EUS-BD kuvame ukukhawulelwa uma kukhulunywa nge-hilar stenosis kanye nesidingo sokubhoboza i-intraepatic bile duct, ngenkathi i-PTCD inezinzuzo zokuvumelana ne-axis ye-bile duct kanye nokuvumelana nezimo kumadivayisi aholayo. I-Bile Duct Onubation kufanele isetshenziswe ezigulini ezinjalo.
I-PTCD ukusebenza okunzima okudinga ukuqeqeshwa isikhathi eside okuhlelekile nokuphothulwa kwenani elanele lamacala. Kunzima ngama-novices ukuqedela lo msebenzi. I-PTCD akunzima nje ukusebenza, kephaUmhlahlandlelaKwangathi kungalimaza ne-bile duct ngesikhathi sokuthuthuka.
Yize izindlela ezingenhla zingathuthukisa kakhulu inani lempumelelo ye-bile duction yokuqunjelwa, ukukhetha kudinga ukucatshangelwa ngokuphelele. Lapho wenzaI-ERCPP, SGT, DGT, WGC-PS namanye amasu angabhekwa; Uma amasu angenhla ehluleka, ama-endoscopist aphezulu futhi anolwazi angenza amasu okuqala acashuniso, njenge-TPS, NKP, NKF, njll; Uma kusesekhona uma ukhetha i-bile duction ungaqediwe, i-Electory SecondartI-ERCPPkungakhethwa; Uma kungekho nalelo amasu angenhla angaxazulula inkinga yokuthambisa okunzima, imisebenzi yokuhlasela efana ne-EUS-BD ne-PTCD kungaqulwa ukuxazulula inkinga, futhi ukwelashwa kokuhlinzwa kungakhethwa uma kunesidingo.
We, Jiangxi Zhuorubuihua Medical Incument Co, Ltd.Umhlahlandlela, I-Stone Retrieval Basket, I-Catheter ye-Nasal Buily Catheternjll. Okusetshenziswa kabanzi e-EMR, i-ESD,I-ERCPP. Imikhiqizo yethu iqinisekisiwe, futhi izitshalo zethu ziqinisekisiwe ze-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi nendawo nengxenye ye-Asia, futhi zithola amakhasimende wokuqashelwa nokudumisa!
Isikhathi Seposi: Jan-31-2024