I-ERCP ubuchwepheshe obubalulekile bokuxilonga nokwelapha izifo zenyongo kanye ne-pancreatic. Uma isiphumile, isinikeze imibono eminingi emisha yokwelapha izifo zenyongo kanye ne-pancreatic. Akugcini nje "eku-radiography". Ishintshe kusukela kubuchwepheshe bokuqala bokuxilonga yaya kolunye uhlobo olusha. Amasu okwelapha afaka phakathi i-sphincterotomy, ukususwa kwamatshe e-bile duct, ukuphuma kwenyongo kanye nezinye izindlela zokwelapha izifo zenyongo kanye ne-pancreatic system.
Izinga lempumelelo lokufakwa kwe-bile duct ekhethiwe ye-ERCP lingafinyelela ngaphezu kuka-90%, kodwa kusenezimo ezithile lapho ukufinyelela okunzima kwe-bileary kubangela ukwehluleka kokufakwa kwe-bile duct ekhethiwe. Ngokusho kwesivumelwano sakamuva mayelana nokuxilongwa nokwelashwa kwe-ERCP, ukufakwa kwe-bile okunzima kungachazwa ngokuthi: isikhathi sokufakwa kwe-bile duct ekhethiwe ye-nipple eyinhloko ye-ERCP evamile singaphezu kwemizuzu eyi-10 noma inani lemizamo yokufaka i-bile duct lingaphezu kwezikhathi ezi-5. Lapho kwenziwa i-ERCP, uma ukufakwa kwe-bile duct kunzima kwezinye izimo, amasu asebenzayo kufanele akhethwe ngesikhathi ukuze kuthuthukiswe izinga lempumelelo lokufakwa kwe-bile duct. Lesi sihloko senza ukubuyekezwa okuhlelekile kwamasu amaningana okufaka i-bile asetshenziswa ukuxazulula ukufakwa kwe-bile duct enzima, ngenhloso yokuhlinzeka ngesisekelo semfundiso yokuthi odokotela be-endoscop abangochwepheshe bezokwelapha bangakhetha isu lokuphendula lapho bebhekene nokufakwa kwe-bile duct okunzima kwe-ERCP.
I. Indlela Yokusebenzisa I-Singleguidewire, i-SGT
Indlela ye-SGT ukusebenzisa i-contrastcatheter ukuze uqhubeke nokuzama ukufaka i-bile duct ngemuva kokuba ucingo oluqondisayo lungene emgudwini we-pancreatic. Ezinsukwini zokuqala zokuthuthukiswa kobuchwepheshe be-ERCP, i-SGT yayiyindlela evamile yokufaka i-bile duct enzima. Inzuzo yayo ukuthi kulula ukuyisebenzisa, ilungisa ingono, futhi ingangena embotsheni yomgudwini we-pancreatic, okwenza kube lula ukuthola umbobo womgudwini we-bile.
Kunemibiko ezincwadini yokuthi ngemva kokwehluleka kokufakwa kwepayipi okuvamile, ukukhetha ukufakwa kwepayipi okusizwa yi-SGT kungaqeda ngempumelelo ukufakwa kwepayipi le-bile duct cishe ku-70%-80% wamacala. Umbiko uphinde waveza ukuthi ezimweni zokwehluleka kwe-SGT, ngisho nokulungiswa nokusetshenziswa kwepayipi eliphindwe kabili.ucingo lokuqondisaubuchwepheshe abuzange buthuthukise izinga lempumelelo lokufakwa kwe-bile duct futhi abuzange bunciphise ukwanda kwe-post-ERCP pancreatitis (PEP).
Ezinye izifundo zikhombisile nokuthi izinga lempumelelo ye-SGT intubation liphansi kunele-doubleucingo lokuqondisaubuchwepheshe kanye nobuchwepheshe be-transpancreatic papillary sphincterotomy. Uma kuqhathaniswa nemizamo ephindaphindwayo ye-SGT, ukusetshenziswa kwasekuqaleni kwe-doubleucingo lokuqondisaubuchwepheshe noma ubuchwepheshe bangaphambi kokusikwa bungaletha imiphumela engcono.
Kusukela ekuthuthukisweni kwe-ERCP, kuye kwasungulwa ubuchwepheshe obusha obuhlukahlukene ukuze kube nobunzima bokufaka i-intubation. Uma kuqhathaniswa ne-singleucingo lokuqondisaubuchwepheshe, izinzuzo zisobala kakhulu futhi izinga lempumelelo liphakeme. Ngakho-ke, umuntu oyedwaucingo lokuqondisaubuchwepheshe okwamanje abusetshenziswa kakhulu kwezokwelapha.
II.Isu lokusebenzisa ucingo lwe-Double-guide,DGT
I-DGT ingabizwa ngokuthi indlela yokusebenza kwentambo yokuqondisa i-pancreatic duct, okuwukushiya intambo yokuqondisa ingena emgudwini we-pancreatic ukuze ilandele futhi ihlale kuyo, bese intambo yesibili yokuqondisa ingafakwa kabusha ngaphezu kwentambo yokuqondisa i-pancreatic duct. Ukufakwa kwe-bile duct okukhethayo.
Izinzuzo zale ndlela yilezi:
(1) Ngosizo lwe-ucingo lokuqondisa, kulula ukuthola indawo evuleka kuyo i-bile duct, okwenza kube lula ukufaka i-bile duct;
(2) Ucingo oluqondisayo lungalungisa ingono;
(3) Ngaphansi kokuqondiswa komsele we-pancreaticucingo lokuqondisa, ukubona ngokuphindaphindiwe umsele we-pancreatic kungagwenywa, ngaleyo ndlela kuncishiswe ukukhuthazwa komsele we-pancreatic okubangelwa ukufakwa kwe-tube okuphindaphindiwe.
UDumonceau nabanye baphawula ukuthi ucingo oluqondisayo kanye ne-contrast catheter kungafakwa emgodini we-biopsy ngesikhathi esifanayo, base bebika icala eliphumelelayo lendlela yocingo oluqondisayo lwe-pancreatic duct, futhi baphetha ngokuthiucingo lokuqondisaUkusebenzisa indlela ye-pancreatic duct kuyaphumelela ekufakweni kwe-bile duct. Izinga linomthelela omuhle.
Ucwaningo olwenziwe ku-DGT olwenziwe nguLiu Deren nabanye luthole ukuthi ngemva kokuba i-DGT yenziwe ezigulini ezine-ERCP bile duct intubation enzima, izinga lempumelelo le-intubation lafinyelela ku-95.65%, okwakuphakeme kakhulu kunezinga lempumelelo elingu-59.09% le-intubation evamile.
Ucwaningo oluzayo olwenziwe nguWang Fuquan nabanye luveze ukuthi lapho i-DGT isetshenziswa ezigulini ezine-ERCP bile duct intubation enzima eqenjini lokuhlola, izinga lempumelelo le-intubation laliphezulu lifinyelela ku-96.0%.
Izifundo ezingenhla zibonisa ukuthi ukusetshenziswa kwe-DGT ezigulini ezine-intubation enzima ye-bile duct ye-ERCP kungathuthukisa ngempumelelo izinga lempumelelo ye-intubation ye-bile duct.
Ukushiyeka kwe-DGT kufaka phakathi amaphuzu amabili alandelayo:
(1) I-pancreaticucingo lokuqondisamhlawumbe ilahleke ngesikhathi sokufakwa kwe-bile duct, noma okwesibiliucingo lokuqondisaingangena futhi emgudwini we-pancreatic;
(2) Le ndlela ayifaneleki ezimweni ezifana nomdlavuza wekhanda le-pancreatic, ukugoba kwe-duct ye-pancreatic, kanye nokuqhekeka kwe-pancreatic.
Ngokombono we-PEP, ukwanda kwe-PEP kwe-DGT kuphansi kunokwe-intubation evamile ye-bile duct. Ucwaningo oluzayo luveze ukuthi ukwanda kwe-PEP ngemuva kwe-DGT kwakungu-2.38% kuphela ezigulini ze-ERCP ezine-intubation enzima ye-bile duct. Ezinye izincwadi zikhomba ukuthi yize i-DGT inezinga eliphezulu lempumelelo ye-intubation ye-bile duct, ukwanda kwe-pancreatitis yangemva kwe-DGT kusephezulu uma kuqhathaniswa nezinye izindlela zokulungisa, ngoba ukuhlinzwa kwe-DGT kungabangela umonakalo ku-pancreatic duct kanye nokuvulwa kwayo. Naphezu kwalokhu, ukuvumelana ekhaya nakwamanye amazwe kusakhomba ukuthi ezimweni ze-intubation enzima ye-bile duct, lapho i-intubation inzima futhi i-pancreatic duct iphazanyiswe kabi ngokuphindaphindiwe, i-DGT iyindlela yokuqala ngoba ubuchwepheshe be-DGT bunobunzima obuncane ekusebenzeni, futhi kulula ukuyilawula. Isetshenziswa kabanzi ekufakweni kwe-intubation okunzima okukhethayo.
III. Umhlahlandlela wentambo i-stent ye-cannulation-pan-creatic, i-WGC-P5
I-WGC-PS ingabizwa nangokuthi indlela yokusebenza kwe-pancreatic duct stent. Le ndlela iwukubeka i-pancreatic duct stent kanyeucingo lokuqondisaokungena ngephutha emgudwini we-pancreatic, bese ukhiphaucingo lokuqondisafuthi wenze ukuthululwa kwe-bile duct ngaphezu kwe-stent.
Ucwaningo lukaHakuta nabanye lubonise ukuthi ngaphezu kokuthuthukisa izinga lempumelelo yokufakwa kwepayipi ngokuqondisa ukufakwa kwepayipi, i-WGC-PS ingavikela nokuvulwa komsele we-pancreatic futhi inciphise kakhulu ukuvela kwe-PEP.
Ucwaningo olwenziwe ku-WGC-PS lukaZou Chuanxin nabanye luveze ukuthi izinga lempumelelo lokufakwa kwe-intubation okunzima kusetshenziswa indlela yesikhashana ye-pancreatic duct stent occupation lifinyelele ku-97.67%, futhi izinga le-PEP linciphe kakhulu.
Ucwaningo olulodwa luthole ukuthi uma i-stent ye-pancreatic duct ibekwe kahle, amathuba okuba ne-pancreatitis enzima ngemva kokuhlinzwa ezimweni ezinzima zokufakwa kwe-intubation ancishiswa kakhulu.
Le ndlela isenamaphutha athile. Isibonelo, i-pancreatic duct stent efakwe ngesikhathi sokuhlinzwa kwe-ERCP ingase isuswe; uma i-stent idinga ukufakwa isikhathi eside ngemva kwe-ERCP, kuzoba nethuba elikhulu lokuvaleka kwe-stent kanye nokuvaleka kwe-duct. Ukulimala nezinye izinkinga kuholela ekwandeni kokusabalala kwe-PEP. Kakade, izikhungo seziqalile ukutadisha ama-pancreatic duct stent esikhashana angaphuma ngokuzenzakalelayo emgudwini we-pancreatic. Inhloso ukusebenzisa ama-pancreatic duct stent ukuvimbela i-PEP. Ngaphezu kokunciphisa kakhulu ukwanda kwezingozi ze-PEP, ama-stents anjalo angagwema neminye imisebenzi yokususa i-stent nokunciphisa umthwalo ezigulini. Nakuba izifundo zikhombisile ukuthi ama-pancreatic duct stent esikhashana anomphumela omuhle ekunciphiseni i-PEP, ukusetshenziswa kwawo emtholampilo kusenemikhawulo emikhulu. Isibonelo, ezigulini ezine-pancreatic ducts ezincane namagatsha amaningi, kunzima ukufaka i-pancreatic duct stent. Ubunzima buzokwanda kakhulu, futhi lokhu kudinga izinga eliphezulu lochwepheshe be-endoscopists. Kubalulekile futhi ukuqaphela ukuthi i-pancreatic duct stent ebekwe akufanele ibe yinde kakhulu ku-lumen ye-duodenal. I-stent ende kakhulu ingabangela ukubhoboka kwe-duodenal. Ngakho-ke, ukukhetha indlela yokusebenza kwe-pancreatic duct stent kusadingeka kuphathwe ngokucophelela.
IV. Ukuhlinzwa kwe-Trans-pancreatocsphincterotomy, i-TPS
Ubuchwepheshe be-TPS buvame ukusetshenziswa ngemva kokuba ucingo oluqondisayo lungene emgudwini we-pancreatic ngephutha. I-septum ephakathi komgudwini we-pancreatic inqunywa eceleni kocingo oluqondisayo lomgudwini we-pancreatic kusukela ngo-11 ekuseni kuya ku-12 ntambama, bese kuthi ipayipi lifakwe eceleni komgudwini we-bile kuze kube yilapho ucingo oluqondisayo lungena emgudwini we-bile.
Ucwaningo olwenziwe nguDai Xin nabanye luqhathanise i-TPS kanye nezinye izindlela ezimbili zobuchwepheshe bokufaka intubhu. Kungabonakala ukuthi izinga lempumelelo lobuchwepheshe be-TPS liphezulu kakhulu, lifinyelela ku-96.74%, kodwa alibonisi imiphumela emihle kakhulu uma liqhathaniswa nezinye izindlela ezimbili zobuchwepheshe bokufaka intubhu. Izinzuzo.
Kubikwe ukuthi izici zobuchwepheshe be-TPS zifaka phakathi amaphuzu alandelayo:
(1) Ukusikwa kuncane kwe-pancreaticobiliary septum;
(2) Izinga lezinkinga zangemva kokuhlinzwa liphansi;
(3) Ukukhetha indlela yokusika kulula ukuyilawula;
(4) Le ndlela ingasetshenziswa ezigulini ezine-pancreatic duct intubation ephindaphindwayo noma ama-nipples ngaphakathi kwe-diverticulum.
Izifundo eziningi zikhombe ukuthi i-TPS ayikwazi nje ukuthuthukisa izinga lempumelelo lokufakwa kwe-bile duct enzima, kodwa futhi ayikhulisi ukwanda kwezinkinga ngemuva kwe-ERCP. Ezinye izazi zisikisela ukuthi uma ukufakwa kwe-pancreatic duct noma i-small duodenal papilla kwenzeka ngokuphindaphindiwe, i-TPS kufanele icatshangelwe kuqala. Kodwa-ke, lapho kusetshenziswa i-TPS, kufanele kuqashelwe ukuthi kungenzeka ukuthi i-pancreatic duct stenosis kanye nokuphindaphinda kwe-pancreatitis, okuyizingozi ezingaba khona zesikhathi eside ze-TPS.
V. I-Precut Sphincterotomy, i-PST
Indlela ye-PST isebenzisa i-papillary arcuate band njengomkhawulo ophezulu we-pre-incision kanye nesiqondiso sehora eli-1-2 njengomngcele wokuvula i-duodenal papilla sphincter ukuthola ukuvulwa kwe-bile kanye ne-pancreatic duct. Lapha i-PST ibhekisela ngqo kwindlela ejwayelekile ye-nipple sphincter pre-incision esebenzisa ummese we-arcuate. Njengesu lokubhekana nokufakwa kwe-bile duct enzima ye-ERCP, ubuchwepheshe be-PST bubhekwa kabanzi njengokukhetha kokuqala kokufakwa kwe-bile duct okunzima. I-Endoscopic nipple sphincter pre-incision ibhekisela ekusikweni kwe-endoscopic kwe-mucosa engaphezulu kwe-papilla kanye nenani elincane lemisipha ye-sphincter ngommese we-incision ukuthola ukuvulwa kwe-bile duct, bese usebenzisaucingo lokuqondisanoma i-catheter yokufaka i-bile duct.
Ucwaningo lwasekhaya lubonise ukuthi izinga lempumelelo ye-PST liphezulu njengo-89.66%, okungahlukile kakhulu ku-DGT kanye ne-TPS. Kodwa-ke, izinga le-PEP ku-PST liphakeme kakhulu kunele-DGT kanye ne-TPS.
Njengamanje, isinqumo sokusebenzisa lobu buchwepheshe sincike ezintweni ezahlukahlukene. Isibonelo, omunye umbiko uthe i-PST isetshenziswa kangcono ezimweni lapho i-duodenal papilla ingajwayelekile noma iphambukile, njenge-duodenal stenosis noma i-malignancy.
Ngaphezu kwalokho, uma kuqhathaniswa namanye amasu okubhekana nesimo, i-PST inezinga eliphezulu lezinkinga ezifana ne-PEP, futhi izidingo zokuhlinzwa ziphezulu, ngakho-ke lokhu kuhlinzwa kwenziwa kangcono ngodokotela be-endoscopist abanolwazi.
VI. Ukuhlinzwa kwe-Papillotomy ngenaliti, NKP
I-NKP iyindlela yokufaka ipayipi ngosizo lommese. Uma ukufaka ipayipi kunzima, ummese wenaliti ungasetshenziswa ukunquma ingxenye ye-papilla noma i-sphincter kusukela ekuvulekeni kwe-duodenal papilla kuya ku-11-12 o'clock, bese usebenzisa i-aucingo lokuqondisanoma i-catheter ukuze kufakwe i-Selective input emgudwini we-bile ovamile. Njengesu lokubhekana nokufakwa kwe-bile duct enzima, i-NKP ingathuthukisa ngempumelelo izinga lempumelelo lokufakwa kwe-bile duct enzima. Esikhathini esidlule, kwakukholelwa ukuthi i-NKP izokwandisa ukwanda kwe-PEP eminyakeni yamuva nje. Eminyakeni yamuva nje, imibiko eminingi yokuhlaziya ebuyekeziwe ikhombe ukuthi i-NKP ayinyusi ingozi yezinkinga zangemva kokuhlinzwa. Kubalulekile ukuqaphela ukuthi uma i-NKP yenziwa esigabeni sokuqala sokufakwa kwe-bile okunzima, izoba usizo olukhulu ekuthuthukiseni izinga lempumelelo lokufakwa kwe-intubation. Kodwa-ke, okwamanje akukho ukuvumelana ngokuthi kufanele isetshenziswe nini i-NKP ukuze kufezwe imiphumela emihle kakhulu. Ucwaningo olulodwa lubike ukuthi izinga lokufakwa kwe-NKP lisetshenziswe ngesikhathiI-ERCPImizuzu engaphansi kwengu-20 yayiphakeme kakhulu kuneye-NKP esetshenziswe kamuva kunemizuzu engu-20 kamuva.
Iziguli ezine-canulation enzima ye-bile duct zizozuza kakhulu kule ndlela uma zinezimbobo zamabele noma zivuleke kakhulu. Ngaphezu kwalokho, kunemibiko yokuthi lapho zibhekene nezimo ezinzima zokufakwa kwe-intubation, ukusetshenziswa okuhlangene kwe-TPS ne-NKP kunesilinganiso sempumelelo esiphezulu kunokufaka zodwa. Ububi ukuthi amasu amaningi okusika asetshenziswa e-nipple azokwandisa ukwenzeka kwezinkinga. Ngakho-ke, kudingeka ucwaningo olwengeziwe ukuze kuqinisekiswe ukuthi kufanele kukhethwe yini ngaphambi kokusika kwangaphambi kokusika ukuze kuncishiswe ukwenzeka kwezinkinga noma kuhlanganiswe izindlela eziningi zokulungisa ukuze kuthuthukiswe izinga lempumelelo lokufakwa kwe-intubation enzima.
VII.Inaliti yommese Fistulotomy,NKE
Indlela ye-NKF ibhekisela ekusebenziseni ummese wenaliti ukubhoboza i-mucosa cishe ngamamilimitha angu-5 ngaphezu kwengono, kusetshenziswa ugesi oxubile ukubhoboza ungqimba ngengqimba ngase-11 kuze kutholakale isakhiwo esifana ne-orifice noma ukugcwala kwe-bile, bese kusetshenziswa ucingo oluqondisayo ukuthola ukuphuma kwe-bile kanye nokusikwa kwezicubu. Ukufakwa kwe-bile duct okukhethiwe kwenziwa endaweni ye-jaundice. Ukuhlinzwa kwe-NKF kusike ngaphezu kokuvulwa kwengono. Ngenxa yokuba khona kwe-bile duct sinus, kunciphisa kakhulu umonakalo wokushisa kanye nomonakalo womshini ekuvulekeni kwe-pancreatic duct, okunganciphisa ukwanda kwe-PEP.
Ucwaningo lukaJin nabanye luveze ukuthi izinga lempumelelo lokufakwa kwe-NK tube lingafinyelela ku-96.3%, futhi ayikho i-PEP yangemva kokuhlinzwa. Ngaphezu kwalokho, izinga lempumelelo le-NKF ekususweni kwamatshe liphezulu njengo-92.7%. Ngakho-ke, lolu cwaningo luncoma i-NKF njengokukhetha kokuqala kokususwa kwamatshe e-bile duct evamile. Uma kuqhathaniswa ne-papillomyotomy evamile, izingozi zokusebenza kwe-NKF zisephezulu, futhi ithambekele ezinkingeni ezifana nokubhoboka nokopha, futhi idinga izinga eliphezulu lokusebenza lama-endoscopists. Indawo efanele yokuvula ifasitela, ukujula okufanele, kanye nendlela eqondile konke kudingeka kufundwe kancane kancane.
Uma kuqhathaniswa nezinye izindlela zangaphambi kokusikwa, i-NKF iyindlela elula kakhulu enezinga eliphezulu lempumelelo. Kodwa-ke, le ndlela idinga ukuzijwayeza isikhathi eside kanye nokuqongelela okuqhubekayo ngumqhubi ukuze abe nekhono, ngakho-ke le ndlela ayifanele abaqalayo.
VIII. Phinda-i-ERCP
Njengoba kushiwo ngenhla, kunezindlela eziningi zokubhekana nokufakwa kwepayipi okunzima. Kodwa-ke, asikho isiqinisekiso sempumelelo eyi-100%. Izincwadi ezifanele zikhombe ukuthi lapho ukufakwa kwepayipi le-bile duct kunzima kwezinye izimo, ukufakwa kwepayipi lesikhathi eside neliphindaphindayo noma umphumela wokungena kokushisa we-pre-cut kungaholela ekuvuvukeni kwe-duodenal papilla. Uma ukuhlinzwa kuqhubeka, ukufakwa kwepayipi le-bile duct ngeke kuphumelele kuphela, kodwa nethuba lezinkinga lizokhula. Uma kwenzeka lesi simo esingenhla, ungacabanga ukuqeda ugesi.I-ERCPqala ngokuhlinza bese wenza i-ERCP yesibili ngesikhathi ongazikhethela sona. Ngemva kokuba i-papilloedema isiphelile, ukusebenza kwe-ERCP kuzoba lula ukufeza ukufakwa kwepayipi ngempumelelo.
UDonnellan nabanye benze okwesibiliI-ERCPukuhlinzwa kweziguli ezingu-51 okwahluleka yi-ERCP ngemva kokusikwa kommese wenaliti, kanti amacala angu-35 aphumelele, futhi izehlakalo zezinkinga azizange zikhule.
UKim nabanye benze ukuhlinzwa kwesibili kwe-ERCP ezigulini ezingu-69 ezahlulekaI-ERCPngemva kokusikwa ngaphambi kokusikwa kwenaliti, kanti amacala angu-53 aphumelele, ngesilinganiso sempumelelo esingu-76.8%. Amacala asele angaphumelelanga nawo ahlinzwa okwesithathu kwe-ERCP, ngesilinganiso sempumelelo esingu-79.7%., futhi ukuhlinzwa okuningi akuzange kwandise ukwenzeka kwezinkinga.
U-Yu Li nabanye benze i-secondary yokuzikhethelaI-ERCPezigulini ezingu-70 ezihlulekile ukwenza i-ERCP ngemva kokusikwa ngaphambi kokusika inaliti, kanti amacala angu-50 aphumelele. Izinga lempumelelo iyonke (i-ERCP yokuqala + i-ERCP yesibili) lenyuke laya ku-90.6%, futhi izehlakalo zezinkinga azizange zikhuphuke kakhulu. . Nakuba imibiko ifakazele ukusebenza kahle kwe-ERCP yesibili, isikhathi esiphakathi kokusebenza okubili kwe-ERCP akufanele sibe side kakhulu, futhi kwezinye izimo ezikhethekile, ukuphuma kwe-bile okulibazisekile kungenza isimo sibe sibi kakhulu.
IX. Ukudonsa amanzi kwenyongo okuqondiswa yi-Endoscopicultrasound, i-EUS-BD
I-EUS-BD inqubo ehlaselayo esebenzisa inaliti yokubhoboza ukubhoboza inyongo esiswini noma e-duodenum lumen ngaphansi kwesiqondiso se-ultrasound, ingena e-duodenum nge-duodenal papilla, bese yenza i-biliary intubation. Le ndlela ihlanganisa kokubili izindlela zangaphakathi kwesibindi kanye nezangaphandle kwesibindi.
Ucwaningo olubukeziwe lubike ukuthi izinga lempumelelo ye-EUS-BD lifinyelele ku-82%, kanti ukwanda kwezinkinga zangemva kokuhlinzwa kwakuyi-13% kuphela. Esifundweni sokuqhathanisa, i-EUS-BD uma iqhathaniswa nobuchwepheshe bangaphambi kokusika, izinga lempumelelo yayo yokufaka ipayipi laliphezulu, lifinyelela ku-98.3%, okwakuphakeme kakhulu kune-90.3% yokusika kwangaphambi kokusika. Kodwa-ke, kuze kube manje, uma kuqhathaniswa nezinye ubuchwepheshe, kusenokuntuleka kocwaningo mayelana nokusetshenziswa kwe-EUS kwezinkinga ezinzima.I-ERCPukufakwa kwepayipi. Akukho idatha eyanele yokufakazela ukusebenza kahle kobuchwepheshe bokubhoboza i-bile duct obuqondiswa yi-EUS ngenxa yobunzimaI-ERCPukufakwa kwepayipi. Ezinye izifundo zibonise ukuthi kunciphile. Indima ye-PEP yangemva kokuhlinzwa ayigculisi.
X. Ukuphuma kwamanzi kwe-transhepatic cholangial nge-percutaneous, i-PTCD
I-PTCD ingenye indlela yokuhlola engavamile engasetshenziswa kanye ne-I-ERCPekufakweni kwepayipi le-bile duct okunzima, ikakhulukazi ezimweni zokuvaleka kwe-bile duct okuyingozi. Le ndlela isebenzisa inaliti yokubhoboza ukuze ingene nge-percutaneously emgudwini we-bile duct, ibhoboze umgungundlovu nge-papilla, bese ifaka umgungundlovu emuva ngomgungundlovu ogciniwe.ucingo lokuqondisaUcwaningo olulodwa luhlaziye iziguli ezingu-47 ezazinobunzima bokufaka i-bile duct ezisebenzisa ubuchwepheshe be-PTCD, futhi izinga lempumelelo lafinyelela ku-94%.
Ucwaningo olwenziwe nguYang nabanye luveze ukuthi ukusetshenziswa kwe-EUS-BD kusobala ukuthi kunqunyelwe uma kukhulunywa nge-hilar stenosis kanye nesidingo sokubhoboza i-bile duct efanele yesibindi, kuyilapho i-PTCD inezinzuzo zokuhambisana ne-bile duct axis kanye nokuba nezimo eziguquguqukayo kumadivayisi aqondisayo. I-Bile duct intubation kufanele isetshenziswe ezigulini ezinjalo.
I-PTCD iwumsebenzi onzima odinga ukuqeqeshwa okuhlelekile kwesikhathi eside kanye nokuqedwa kwenani elanele lamacala. Kunzima ngabaqalayo ukuqeda lo msebenzi. I-PTCD ayinzima nje kuphela ukuyisebenzisa, kodwa futhiucingo lokuqondisakungalimaza nomsele we-bile ngesikhathi sokukhula.
Nakuba lezi zindlela ezingenhla zingathuthukisa kakhulu izinga lempumelelo yokufakwa kwe-bile duct enzima, ukukhetha kudinga ukucatshangelwa ngokuphelele.I-ERCP, SGT, DGT, WGC-PS kanye nezinye izindlela zingacatshangelwa; uma izindlela ezingenhla zingaphumeleli, odokotela be-endoscopist abaphezulu nabanolwazi bangenza izindlela zangaphambi kokusikwa, njenge-TPS, NKP, NKF, njll.; uma kusesenjalo Uma ukufakwa kwe-bile duct ekhethiwe kungenakuqedwa, i-elective secondaryI-ERCPingakhethwa; uma kungekho zindlela ezingenhla ezingaxazulula inkinga yokufakwa kwepayipi okunzima, ukuhlinzwa okungafuneki njenge-EUS-BD kanye ne-PTCD kungazanywa ukuxazulula inkinga, futhi ukwelashwa ngokuhlinzwa kungakhethwa uma kudingeka.
Thina, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumkhiqizi eShayina ogxile ezintweni ezisetshenziswayo ze-endoscopic, njenge-biopsy forceps, i-hemoclip, i-polyp snare, inaliti ye-sclerotherapy, i-spray catheter, amabhulashi e-cytology,ucingo lokuqondisa, ubhasikidi wokuthola amatshe, i-catheter yokukhipha amanzi ekhaleninjll. ezisetshenziswa kabanzi ku-EMR, ESD,I-ERCPImikhiqizo yethu inesitifiketi se-CE, kanti izitshalo zethu zinesitifiketi se-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi kanye nengxenye ye-Asia, futhi zithola ukuqashelwa nokunconywa kakhulu ngamakhasimende!
Isikhathi sokuthunyelwe: Jan-31-2024