I-ERCP iwubuchwepheshe obubalulekile ekuxilongeni nasekwelapheni izifo ze-biliary kanye ne-pancreatic.Lapho isiphumile, inikeze imibono eminingi emisha yokwelashwa kwezifo ze-biliary kanye ne-pancreatic.Ayikhawulelwe ku-"radiography".Ishintshile isuka kubuchwepheshe bokuqala bokuxilonga yaba ohlotsheni olusha.Izindlela zokwelapha zihlanganisa i-sphincterotomy, ukukhishwa kwamatshe e-bile duct, i-bile drainage nezinye izindlela zokwelapha izifo ze-bile kanye ne-pancreatic system.
Izinga lempumelelo le-elective bile duct intubation ye-ERCP lingafinyelela ngaphezu kwama-90%, kodwa kusenezimo ezithile lapho ukufinyelela okunzima kwe-biliary kubangela ukwehluleka ukukhetha kwe-bile duct intubation.Ngokuvumelana kwakamuva mayelana nokuxilongwa nokwelashwa kwe-ERCP, intubation enzima ingachazwa ngokuthi: isikhathi sokukhetha i-bile duct intubation yengono eyinhloko ye-ERCP evamile singaphezu kwemizuzu eyi-10 noma inombolo yemizamo yokufaka i-intubation izikhathi ezingaphezu kwezingu-5.Lapho wenza i-ERCP, uma i-bile duct intubation inzima kwezinye izimo, amasu asebenzayo kufanele akhethwe kusenesikhathi ukuze kuthuthukiswe izinga lempumelelo ye-bile duct intubation.Lesi sihloko senza ukubuyekezwa okuhlelekile kwamasu amaningana asizayo e-intubation asetshenziselwa ukuxazulula intubation enzima ye-bile duct, ngenhloso yokuhlinzeka ngesisekelo sethiyori kuma-endoscopists emtholampilo ukuze bakhethe isu lokuphendula lapho bebhekene ne-bile duct intubation enzima ye-ERCP.
I.Singleguidewire Technique,SGT
Isu le-SGT ukusebenzisa i-contrastcatheter ukuze uqhubeke nokuzama ukufaka i-bile duct ngemva kokuba intambo eqondisayo ingene kumgudu we-pancreatic.Ezinsukwini zokuqala zokuthuthukiswa kobuchwepheshe be-ERCP, i-SGT yayiyindlela evamile yokufaka i-biliary intubation enzima.Inzuzo yayo ukuthi kulula ukuyisebenzisa, ilungisa ingono, futhi ingangena ekuvulekeni kwe-pancreatic duct, okwenza kube lula ukuthola ukuvulwa kwe-bile duct.
Kunemibiko encwadini yokuthi ngemuva kokwehluleka kwe-intubation evamile, ukukhetha intubation esizwa yi-SGT kungaqeda ngempumelelo i-bile duct intubation cishe ku-70% -80% wamacala.Umbiko uphinde waveza ukuthi ezimweni zokwehluleka kwe-SGT, ngisho nokulungiswa kanye nokusetshenziswa okuphindwe kabiliguidewireubuchwepheshe abuzange buthuthuke izinga lokuphumelela kwe-bile duct intubation futhi akwehlisanga ukwenzeka kwe-post-ERCP pancreatitis (PEP).
Ezinye izifundo ziphinde zakhombisa ukuthi izinga lempumelelo le-SGT intubation liphansi kunalelo eliphindwe kabiliguidewireubuchwepheshe kanye nobuchwepheshe be-transpancreatic papillary sphincterotomy.Uma kuqhathaniswa nemizamo ephindaphindiwe ye-SGT, ukuqaliswa kwangaphambi kwesikhathi kokuphindwe kabiliguidewireubuchwepheshe noma ubuchwepheshe bokusika ngaphambili bungathola imiphumela engcono.
Selokhu kwathuthukiswa i-ERCP, kuye kwathuthukiswa izinhlobo zobuchwepheshe obusha ukuze kufakwe intubation enzima.Uma kuqhathaniswa nengashadileguidewireubuchwepheshe, izinzuzo zisobala kakhulu futhi izinga lempumelelo liphezulu.Ngakho-ke, ongashadileguidewireubuchwepheshe okwamanje abuvamile ukusetshenziswa emtholampilo.
II.Isu lokusebenzisa ucingo lwe-Double-guide,DGT
I-DGT ingabizwa ngokuthi i-pancreatic duct guide wire occupation method, okuwukushiya ucingo oluqondisayo olungena epayipini le-pancreatic ukuze luyilandele futhi ihlale kulo, bese kuthi intambo yesibili engumhlahlandlela iphinde ifakwe ngaphezu kwentambo yomhlahlandlela we-pancreatic duct.I-intubation ye-bile duct ekhethiwe.
Izinzuzo zale ndlela yilezi:
(1) Ngosizo aguidewire, ukuvuleka kwe-bile duct kulula ukuthola, okwenza i-bile duct intubation ibe bushelelezi;
(2) Intambo yokuqondisa ingalungisa ingono;
(3) Ngaphansi kokuqondiswa kwe-pancreatic ductguidewire, ukubonwa okuphindaphindiwe kwe-pancreatic duct kungagwenywa, ngaleyo ndlela kuncishiswe ukugqugquzelwa komgudu we-pancreatic okubangelwa ukuphindaphinda okuphindaphindiwe.
Dumonceau et al.ibone ukuthi i-guidewire kanye ne-contrast catheter ingafakwa emgodini we-biopsy ngesikhathi esifanayo, bese ibika udaba oluyimpumelelo lwe-pancreatic duct guidewire occupying method, futhi yaphetha ngokuthiguidewireukusebenzisa indlela ye-pancreatic duct kuphumelela ekungeneni kwe-bile duct.isilinganiso sinomthelela omuhle.
Ucwaningo ku-DGT ngu-Liu Deren et al.ithole ukuthi ngemva kokuthi i-DGT yenziwe ezigulini ezine-ERCP ezinzima ze-bile duct intubation, izinga lokuphumelela kwe-intubation lifinyelele ku-95.65%, elaliphakeme kakhulu kunezinga lempumelelo elingu-59.09% lokungena okuvamile.
Ucwaningo oluzokwenzeka olwenziwe nguWang Fuquan et al.waveza ukuthi ngenkathi i-DGT isetshenziswa ezigulini ezine-ERCP bile duct intubation enzima eqenjini lokuhlola, izinga lokuphumelela lokusebenzisa intubation laliphezulu kakhulu lafika ku-96.0%.
Ucwaningo olungenhla lukhombisa ukuthi ukusetshenziswa kwe-DGT ezigulini ezine-bile duct intubation enzima ye-ERCP kungathuthukisa ngempumelelo izinga lempumelelo ye-bile duct intubation.
Amaphutha e-DGT ikakhulukazi afaka amaphuzu amabili alandelayo:
(1) I-pancreaticguidewiremhlawumbe ilahleke ngesikhathi sokufakwa kwe-bile duct, noma okwesibiliguidewireingaphinda ingene kumgudu we-pancreatic;
(2) Le ndlela ayifaneleki ezimweni ezinjengomdlavuza wekhanda le-pancreatic, i-pancreatic duct tortuosity, kanye ne-pancreatic fission.
Ngokombono wesigameko se-PEP, izehlakalo ze-PEP ze-DGT ziphansi kunalezo zokufakwa kwe-bile duct intubation.Ucwaningo oluzokwenzeka luveze ukuthi izehlakalo ze-PEP ngemuva kwe-DGT zazingu-2.38% kuphela ezigulini ze-ERCP ezine-bile duct intubation enzima.Ezinye izincwadi zikhomba ukuthi nakuba i-DGT inezinga eliphezulu lempumelelo le-bile duct intubation, izehlakalo ze-post-DGT pancreatitis zisephezulu uma ziqhathaniswa nezinye izindlela zokulungisa, ngoba ukusebenza kwe-DGT kungase kubangele ukulimala komgudu we-pancreatic kanye nokuvulwa kwawo.Naphezu kwalokhu, ukuvumelana ekhaya nakwamanye amazwe kusaveza ukuthi ezimeni ezinzima ze-bile duct intubation, lapho intubation inzima futhi i-pancreatic duct iphathwa kabi ngokuphindaphindiwe, i-DGT iyisinqumo sokuqala ngoba ubuchwepheshe be-DGT bunobunzima obuncane ekusebenzeni, futhi kulula kakhulu. ukulawula.Isetshenziswa kakhulu ekukhetheni intubation enzima.
III.I-Wire guide cannulation-pan-creatic stent,WGC-P5
I-WGC-PS ingabuye ibizwe ngokuthi i-pancreatic duct stent occupation method.Le ndlela iwukubeka i-pancreatic duct stent ne-guidewireelingena ngephutha kumgudu we-pancreatic, bese likhiphaguidewirefuthi wenze i-bile duct cannulation ngaphezu kwe-stent.
Ucwaningo olwenziwa nguHakuta et al.wabonisa ukuthi ngaphezu kokuthuthukisa izinga lokuphumelela jikelele lokungena nge-intubation ngokuqondisa, i-WGC-PS ingaphinde ivikele ukuvulwa kwe-pancreatic duct futhi inciphise kakhulu ukwenzeka kwe-PEP.
Ucwaningo ku-WGC-PS nguZou Chuanxin et al.waveza ukuthi izinga lokuphumelela lokungena okunzima kusetshenziswa indlela yesikhashana ye-pancreatic duct stent occupation lifinyelele ku-97.67%, kanti izehlakalo ze-PEP zehla kakhulu.
Olunye ucwaningo lwathola ukuthi lapho i-pancreas duct stent ibekwe ngendlela efanele, amathuba okuba i-pancreatitis enzima yangemva kokuhlinzwa ezimweni ezinzima zokungeniswa anciphe kakhulu.
Le ndlela isenokushiyeka okuthile.Isibonelo, i-pancreatic duct stent efakwe ngesikhathi sokusebenza kwe-ERCP ingase isuswe;uma i-stent idinga ukubekwa isikhathi eside ngemva kwe-ERCP, kuzoba nethuba elikhulu lokuvaleka kwe-stent kanye nokuvinjwa kwepayipi.Ukulimala nezinye izinkinga kuholela ekwandeni kwezigameko ze-PEP.Kakade, izikhungo seziqalile ukufunda ama-stents esikhashana e-pancreatic duct angaphuma ngokuzenzakalelayo emgudwini we-pancreatic.Inhloso ukusebenzisa ama-pancreas duct stents ukuvimbela i-PEP.Ngaphezu kokunciphisa ngokuphawulekayo izehlakalo zezingozi ze-PEP, ama-stents anjalo angaphinde agweme okunye ukuhlinzwa ukuze kususwe isitenti futhi kunciphise umthwalo ezigulini.Nakuba ucwaningo luye lwabonisa ukuthi ama-pancreas duct stents anomphumela omuhle ekwehliseni i-PEP, ukusetshenziswa kwawo emtholampilo kusenemikhawulo emikhulu.Isibonelo, ezigulini ezinamapayipi amancane e-pancreatic namagatsha amaningi, kunzima ukufaka i-pancreatic duct stent.Ubunzima buzokhula kakhulu, futhi lokhu kusebenza kudinga izinga eliphezulu lochwepheshe be-endoscopists.Kumele futhi kuqashelwe ukuthi i-pancreatic duct stent ebekwe akufanele ibe yinde kakhulu ku-lumen ye-duodenal.I-stent eside ngokweqile ingabangela ukubhobozwa kwe-duodenal.Ngakho-ke, ukukhetha indlela yokusebenza kwe-pancreatic duct stent kusadingeka kuphathwe ngokuqapha.
IV.Trans-pancreatocsphincterotomy,TPS
Ubuchwepheshe be-TPS ngokuvamile busetshenziswa ngemva kokuba ucingo oluqondisayo lungene ngephutha epayipini le-pancreatic.I-septum ephakathi nendawo ye-pancreatic duct icutshungulwa ngasendleleni yocingo lomhlahlandlela we-pancreatic duct kusuka ngehora le-11 kuya kwele-12, bese ishubhu ifakwa ngasendleleni ye-bile duct kuze kube intambo yomhlahlandlela ingena enyongweni. umgudu.
Ucwaningo lukaDai Xin et al.kuqhathanise i-TPS nobunye ubuchwepheshe obusizayo bokutholwa.Kungabonakala ukuthi izinga lokuphumelela lobuchwepheshe be-TPS liphezulu kakhulu, lifinyelela ku-96.74%, kodwa alibonisi imiphumela evelele uma liqhathaniswa nobunye ubuchwepheshe obusizayo bokutholwa kwe-intubation.Izinzuzo.
Kubikwe ukuthi izici zobuchwepheshe be-TPS zifaka amaphuzu alandelayo:
(1) Ukusika kuncane kwe-pancreaticobiliary septum;
(2) Izehlakalo zezinkinga zangemva kokuhlinzwa ziphansi;
(3) Ukukhethwa kwesiqondiso sokusika kulula ukulawula;
(4) Le ndlela ingasetshenziselwa iziguli ezine-pancreatic duct intubation noma izingono ngaphakathi kwe-diverticulum.
Ucwaningo oluningi luye lwabonisa ukuthi i-TPS ayikwazi nje ukuthuthukisa ngempumelelo izinga lempumelelo ye-bile duct intubation enzima, kodwa futhi ayikhulisi izehlakalo zezinkinga ngemva kwe-ERCP.Ezinye izazi ziphakamisa ukuthi uma i-pancreatic duct intubation noma i-duodenal papilla encane ivela ngokuphindaphindiwe, i-TPS kufanele icatshangelwe kuqala.Kodwa-ke, lapho kusetshenziswa i-TPS, kufanele kuqashelwe ukuthi kungenzeka kube khona i-pancreatic duct stenosis kanye nokuphinda kwe-pancreatitis, okungaba yingozi yesikhathi eside ye-TPS.
V.Precut Sphincterotomy,PST
Indlela ye-PST isebenzisa ibhande le-papillary arcuate njengomkhawulo ongaphezulu we-pre-incision kanye nesiqondiso sehora elingu-1-2 njengomngcele wokuvula i-duodenal papilla sphincter ukuthola ukuvuleka kwe-bile kanye ne-pancreatic duct.Lapha i-PST iqondise ngokuqondile kunqubo evamile ye-nipple sphincter pre-incision isebenzisa ummese we-arcuate.Njengesu lokubhekana ne-bile duct intubation enzima ye-ERCP, ubuchwepheshe be-PST buye babhekwa kabanzi njengendlela yokuqala yokufaka intubation enzima.I-endoscopic nipple sphincter pre-incision ibhekisela ekusikeni kwe-endoscopic kwe-papilla surface mucosa kanye nenani elincane lomsipha we-sphincter ngommese wokusika ukuze kutholwe ukuvuleka komgudu wenyongo, bese usebenzisaguidewirenoma i-catheter yokufaka i-bile duct.
Ucwaningo lwasekhaya lubonise ukuthi izinga lempumelelo le-PST liphezulu njengo-89.66%, elingahlukile kakhulu ku-DGT ne-TPS.Nokho, izehlakalo ze-PEP ku-PST ziphezulu kakhulu kune-DGT ne-TPS.
Njengamanje, isinqumo sokusebenzisa lobu buchwepheshe sincike ezintweni ezihlukahlukene.Ngokwesibonelo, omunye umbiko wathi i-PST isetshenziswa kangcono ezimweni lapho i-duodenal papilla ingajwayelekile noma ihlanekezelwe, njenge-duodenal stenosis noma i-malignancy.
Ukwengeza, uma kuqhathaniswa namanye amasu okubhekana nesimo, i-PST inezinga eliphezulu lezinkinga ezifana ne-PEP, futhi izidingo zokusebenza ziphezulu, ngakho-ke lokhu kusebenza kwenziwa kangcono kakhulu yi-endoscopists abanolwazi.
VI.Inaliti yommese iPapillotomy,NKP
I-NKP iyindlela yokusiza ngenaliti ngommese.Uma intubation inzima, ummese wenaliti ungasetshenziselwa ukusika ingxenye ye-papilla noma i-sphincter kusukela ekuvuleni kwe-duodenal papilla ekuqondeni kwehora le-11-12, bese usebenzisaguidewirenoma i-catheter ekufakweni Okukhethiwe kumgudu we-bile ovamile.Njengesu lokubhekana ne-bile duct intubation enzima, i-NKP ingathuthukisa ngempumelelo izinga lempumelelo ye-bile duct intubation enzima.Esikhathini esedlule, bekukholelwa ukuthi i-NKP izonyusa izehlakalo ze-PEP eminyakeni yamuva nje.Eminyakeni yamuva, imibiko eminingi yokuhlaziya i-retrospective ibonise ukuthi i-NKP ayinyusi ingozi yezinkinga zangemva kokuhlinzwa.Kuyaqapheleka ukuthi uma i-NKP yenziwa ekuqaleni kwe-intubation enzima, kuyoba usizo olukhulu ukuthuthukisa izinga lokuphumelela lokungena.Nokho, okwamanje akukho ukuvumelana kokuthi kufanele kusetshenziswe nini i-NKP ukuze kuzuzwe imiphumela engcono kakhulu.Ucwaningo olulodwa lubike ukuthi izinga lokungena le-NKP lisetshenziswe ngesikhathiI-ERCPngaphansi kwemizuzu engama-20 yayiphezulu kakhulu kunaleyo ye-NKP esetshenziswe kamuva kunemizuzu engama-20 kamuva.
Iziguli ezinobunzima be-bile duct cannulation zizozuza kakhulu kule ndlela uma zinezingono eziqhumayo noma ukunwebeka okubalulekile kwe-bile duct.Ukwengeza, kunemibiko yokuthi lapho uhlangabezana namacala okufaka intubation anzima, ukusetshenziswa okuhlangene kwe-TPS ne-NKP kunezinga eliphezulu lempumelelo kunokusebenzisa kuphela.Ububi ukuthi izindlela eziningi zokusika ingono zizokwandisa ukuvela kwezinkinga.Ngakho-ke, ucwaningo olwengeziwe luyadingeka ukuze kufakazele ukuthi kufanele yini ukhethe ukusika ngaphambi kwesikhathi ukuze kuncishiswe ukuvela kwezinkinga noma kuhlanganiswe izinyathelo eziningi zokulungisa ukuze kuthuthukiswe izinga lempumelelo le-intubation enzima.
VII.Inaliti yommese Fistulotomy,NKE
Inqubo ye-NKF ibhekisela ekusebenziseni ummese wenaliti ukubhoboza ulwelwesi lwamafinyila cishe ngo-5mm ngaphezu kwengono, kusetshenziswa ingxube yamanje ukusika ungqimba ngongqimba oluya maqondana nehora le-11 kuze kutholakale isakhiwo esifana ne-orifice noma ukuchichima kwebile, bese usebenzisa. ucingo oluqondisayo ukuthola ukuphuma kwe-bile kanye nokusikeka kwezicubu.Ukukhethwa kwe-bile duct intubation kwenziwa endaweni ye-jaundice.Ukuhlinzwa kwe-NKF kusikeka ngaphezu kokuvuleka kwengono.Ngenxa yokuba khona kwe-bile duct sinus, kunciphisa kakhulu ukulimala okushisayo kanye nokulimala kwemishini ekuvulekeni kwe-pancreatic duct, okunganciphisa ukwenzeka kwe-PEP.
Ucwaningo lukaJin et al.uveze ukuthi izinga lokuphumelela kwe-NK tube intubation lingafinyelela ku-96.3%, futhi ayikho i-PEP yangemva kokuhlinzwa.Ukwengeza, izinga lempumelelo ye-NKF ekukhishweni kwamatshe liphezulu njenge-92.7%.Ngakho-ke, lolu cwaningo luncoma i-NKF njengenketho yokuqala yokususwa kwetshe le-bile duct..Uma kuqhathaniswa ne-papillomyotomy evamile, izingozi zokusebenza kwe-NKF zisephezulu, futhi ijwayele ukuba nezinkinga ezifana nokubhoboza nokopha, futhi idinga izinga eliphezulu lokusebenza lama-endoscopists.Iphoyinti elilungile lokuvula iwindi, ukujula okufanele, kanye namasu anembayo konke kudinga ukufundwa kancane kancane.inkosi.
Uma kuqhathaniswa nezinye izindlela zangaphambi kokusika, i-NKF iyindlela elula kakhulu enezinga eliphezulu lempumelelo.Kodwa-ke, le ndlela idinga umkhuba wesikhathi eside kanye nokuqoqwa okuqhubekayo ngu-opharetha ukuze abe nekhono, ngakho le ndlela ayifanele abaqalayo.
VIII.Repeat-ERCP
Njengoba kushiwo ngenhla, kunezindlela eziningi zokubhekana ne-intubation enzima.Nokho, asikho isiqinisekiso sokuphumelela okungu-100%.Izincwadi ezifanele ziye zabonisa ukuthi lapho i-bile duct intubation inzima kwezinye izimo, intubation yesikhathi eside neningi noma umphumela wokungena oshisayo we-pre-cut ungaholela ku-edema ye-duodenal papilla.Uma ukuhlinzwa kuqhubeka, ngeke kube yimpumelelo kuphela i-bile duct intubation, kodwa amathuba okuba nezinkinga nawo azokhula.Uma isimo esingenhla senzeka, ungacabanga ukunqamula umsingaI-ERCPngihlinze kuqala futhi ngenze i-ERCP yesibili ngesikhathi sokuzikhethela.Ngemva kokunyamalala kwe-papilloedema, ukusebenza kwe-ERCP kuzoba lula ukufeza ukungena okuphumelelayo.
UDonnelan et al.wenze okwesibiliI-ERCPukuhlinzwa ezigulini ezingu-51 ezazo i-ERCP ihlulekile ngemva kokuhlinzwa ngommese inaliti, futhi amacala angu-35 aphumelele, futhi izehlakalo zezinkinga azizange zikhule.
UKim et al.wenze ukuhlinzwa kwesibili kwe-ERCP ezigulini ezingama-69 ezihlulekileI-ERCPngemva kokusikwa kwangaphambili kommese wenaliti, futhi amacala angu-53 aphumelele, nezinga lempumelelo lika-76.8%.Amacala asele angaphumelelanga aphinde ahlinzwa okwesithathu kwe-ERCP, ngezinga lempumelelo lika-79.7%., futhi ukusebenza okuningi akuzange kwenyuse ukuvela kwezinkinga.
Yu Li et al.wenze ukukhetha kwesibiliI-ERCPezigulini ezingu-70 ezahluleka i-ERCP ngemva kokusikwa ngaphambi kokusikwa ngommese wenaliti, kanti amacala angu-50 aphumelele.Izinga lempumelelo lilonke (i-ERCP yokuqala + i-ERCP yesibili) lenyuke laya ku-90.6%, futhi izehlakalo zezinkinga azikhulanga kakhulu..Nakuba imibiko ikufakazele ukuphumelela kwe-ERCP yesibili, isikhawu phakathi kokusebenza kwe-ERCP okubili akufanele sibe side kakhulu, futhi kwezinye izimo ezikhethekile, ukulibaziseka kokukhishwa kwe-biliary kungase kubhebhethekise isimo.
IX.I-Endoscopicultrasound-guided biliary drainage,EUS-BD
I-EUS-BD iyinqubo ehlaselayo esebenzisa inaliti yokubhoboza ukuze ibhoboze inyongo isuka esiswini noma i-duodenum lumen ngaphansi kokuqondisa kwe-ultrasound, ingene ku-duodenum nge-duodenal papilla, bese yenza i-biliary intubation.Le nqubo ihlanganisa kokubili izindlela ze-intrahepatic kanye ne-extrahepatic.
Ucwaningo olwedlule lubike ukuthi izinga lokuphumelela kwe-EUS-BD lifinyelele ku-82%, kanti izehlakalo zezinkinga zangemva kokuhlinzwa zaziyi-13 kuphela%.Ocwaningweni oluqhathaniswayo, i-EUS-BD uma iqhathaniswa nobuchwepheshe bangaphambi kokusika, izinga layo lokuphumelela lokusikeka laliphezulu, lafinyelela ku-98.3%, elaliphezulu kakhulu kunama-90.3% wokusika ngaphambi kwesikhathi.Kodwa-ke, kuze kube manje, uma kuqhathaniswa nobunye ubuchwepheshe, kusenokuntuleka kocwaningo mayelana nokusetshenziswa kwe-EUS kobunzima.I-ERCPintubation.Kukhona idatha eyanele ukufakazela ukusebenza kahle kobuchwepheshe bokubhoboza imigudu yenyongo eqondiswa yi-EUS ukuze kube nzimaI-ERCPintubation.Olunye ucwaningo lubonise ukuthi lwehlile Indima ye-PEP yangemva kokuhlinzwa ayigculisi.
X.Percutaneous transhepatic cholangial drainage,PTCD
I-PTCD ingenye indlela yokuhlola ehlaselayo engasetshenziswa ngokuhambisana nayoI-ERCPku-bile duct intubation enzima, ikakhulukazi ezimeni ezimbi zokuvinjwa kwe-biliary.Le nqubo isebenzisa inaliti yokubhoboza ukuze ingene nge-percutaneously i-bile duct, ibhoboze i-bile duct ngokusebenzisa i-papilla, bese ijoba umgudu we-bile ibuyele emuva ngokusebenzisa igodliwe.guidewire.Ucwaningo olulodwa lwahlaziya iziguli ezingama-47 ezine-bile duct intubation enzima ezathola indlela ye-PTCD, futhi izinga lempumelelo lafinyelela ku-94%.
Ucwaningo lukaYang et al.waveza ukuthi ukusetshenziswa kwe-EUS-BD ngokusobala kunomkhawulo uma kukhulunywa nge-hilar stenosis kanye nesidingo sokubhoboza umgudu ofanele we-intrahepatic bile, kuyilapho i-PTCD inezinzuzo zokuhambisana ne-axis ye-bile duct kanye nokuba nezimo eziguquguqukayo kumadivayisi okuqondisa.I-bile duct intubation kufanele isetshenziswe ezigulini ezinjalo.
I-PTCD umsebenzi onzima odinga ukuqeqeshwa okuhlelekile kwesikhathi eside kanye nokuqedwa kwenani elanele lamacala.Kunzima kwabaqalayo ukuqedela lo msebenzi.I-PTCD akunzima ukuyisebenzisa kuphela, kodwa futhiguidewireingase futhi ilimaze i-bile duct ngesikhathi sokuthuthuka.
Nakuba lezi zindlela ezingenhla zingathuthukisa kakhulu izinga lempumelelo yokufakwa kwe-bile duct intubation, ukukhetha kudinga ukucutshungulwa ngokuphelele.Uma wenzaI-ERCP, SGT, DGT, WGC-PS kanye nezinye izindlela zingabhekwa;uma amasu angenhla ehluleka, ochwepheshe be-endoscopist abadala nabanolwazi bangenza amasu angaphambi kokusika, njenge-TPS, NKP, NKF, njll.;uma ingakashintshiI-ERCPingakhethwa;uma engekho kulezi zindlela ezingenhla ezingaxazulula inkinga ye-intubation enzima, imisebenzi ehlaselayo efana ne-EUS-BD ne-PTCD ingazanywa ukuxazulula inkinga, futhi ukwelashwa kokuhlinzwa kungakhethwa uma kunesidingo.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., singumkhiqizi e-China ogxile ezintweni ezisetshenziswayo ze-endoscopic, njenge-biopsy forceps, i-hemoclip, i-polyp snare, inaliti ye-sclerotherapy, i-spray catheter, amabhulashi e-cytology,guidewire, ubhasikidi wokubuyisa amatshe, i-catheter ye-nasal biliary drainagenjll. ezisetshenziswa kakhulu ku-EMR, ESD,I-ERCP.Imikhiqizo yethu iqinisekiswe yi-CE, futhi izitshalo zethu ziqinisekiswe yi-ISO.Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi nasengxenyeni ye-Asia, futhi zithola kabanzi ikhasimende lokuqashelwa nokudumisa!
Isikhathi sokuthumela: Jan-31-2024