I-ERCP yiteknoloji ebalulekileyo yokuxilonga nokunyanga izifo zenyongo kunye nepancreas. Yakuba iphumile, inike iingcamango ezininzi ezintsha zokunyanga izifo zenyongo kunye nepancreas. Ayipheleli nje kwi "radiography". Itshintshe ukusuka kubuchwepheshe bokuqala bokuxilonga ukuya kuhlobo olutsha. Iindlela zonyango ziquka i-sphincterotomy, ukususwa kwamatye e-bile duct, ukuphuma kwamanzi enyongo kunye nezinye iindlela zokunyanga izifo zenyongo kunye nepancreas.
Izinga lempumelelo lokufakwa kwe-bile duct ekhethiweyo kwi-ERCP linokufikelela ngaphezulu kwe-90%, kodwa kusekho iimeko apho ukufikelela kwi-bile duct enzima kubangela ukungaphumeleli kokufakwa kwe-bile duct ekhethiweyo. Ngokwesivumelwano samva nje malunga nokuchongwa kunye nonyango lwe-ERCP, ukufakwa kwe-bile duct enzima kunokuchazwa ngolu hlobo: ixesha lokufakwa kwe-bile duct ekhethiweyo kwi-nipple ephambili ye-ERCP eqhelekileyo lingaphezulu kwemizuzu eli-10 okanye inani lemizamo yokufakwa kwe-bile duct lingaphezulu kwezihlandlo ezi-5. Xa kusenziwa i-ERCP, ukuba ukufakwa kwe-bile duct kunzima kwezinye iimeko, kufuneka kukhethwe amaqhinga asebenzayo ngexesha ukuphucula izinga lempumelelo lokufakwa kwe-bile duct. Eli nqaku lenza uphononongo olucwangcisiweyo lweendlela ezininzi zokufakelwa kwe-bile duct ezisetyenziswa ukusombulula ukufakwa kwe-bile duct enzima, ngenjongo yokubonelela ngesiseko sethiyori kwiingcali ze-endoscopists zeklinikhi ukuba zikhethe icebo lokuphendula xa zijongene nokufakwa kwe-bile duct enzima kwi-ERCP.
I. Indlela ye-Singleguidewire, i-SGT
Indlela ye-SGT kukusebenzisa i-contrastcatheter ukuqhubeka nokuzama ukufaka i-bile duct emva kokuba ucingo olukhokelayo lungene kwi-pancreatic duct. Kwimihla yokuqala yophuhliso lwetekhnoloji ye-ERCP, i-SGT yayiyindlela eqhelekileyo yokufaka i-bile duct enzima. Inzuzo yayo kukuba kulula ukuyisebenzisa, ilungisa ingono, kwaye ingathatha indawo evulekileyo ye-pancreatic duct, okwenza kube lula ukufumana indawo evulekileyo ye-bile duct.
Kukho iingxelo kwiincwadi ezithi emva kokuba i-intubation eqhelekileyo ingaphumeleli, ukukhetha i-intubation encediswa yi-SGT kunokugqiba ngempumelelo i-intubation ye-bile duct kwiimeko ezimalunga ne-70%-80%. Ingxelo ikwabonise ukuba kwiimeko zokungaphumeleli kwe-SGT, kwanokulungiswa nokusetyenziswa kwe-doubleucingo lwesikhokeloubuchwepheshe abuzange buphucule izinga lempumelelo yokufakwa kwe-bile duct kwaye abuzange bunciphise ukwanda kwe-post-ERCP pancreatitis (PEP).
Ezinye izifundo zikwabonise ukuba izinga lempumelelo ye-SGT intubation liphantsi kunele-doubleucingo lwesikhokeloubuchwepheshe kunye neteknoloji ye-transpancreatic papillary sphincterotomy. Xa kuthelekiswa nemizamo ephindaphindiweyo ye-SGT, ukuphunyezwa kwangoko kwe-doubleucingo lwesikhokeloubuchwepheshe okanye ubuchwepheshe bangaphambi kokusikwa bunokufezekisa iziphumo ezingcono.
Ukususela ekuphuhlisweni kwe-ERCP, kuye kwaveliswa iindlela ezahlukeneyo zobuchwepheshe ezintsha ukuze kube nzima ukufaka ityhubhu. Xa kuthelekiswa ne-singleucingo lwesikhokeloiteknoloji, iingenelo zicacile ngakumbi kwaye izinga lempumelelo liphezulu. Ke ngoko, umntu omnyeucingo lwesikhokeloubuchwepheshe obusetyenziswa rhoqo kwiklinikhi okwangoku abusetyenziswa rhoqo.
II.Ubuchule bocingo lwesikhokelo esiphindwe kabini,DGT
I-DGT ingabizwa ngokuba yindlela yokusebenza kwentambo yesikhokelo se-pancreatic duct, eyokushiya intambo yesikhokelo ingena kwi-pancreatic duct ukuze ilandele kwaye ihlale kuyo, kwaye emva koko intambo yesibini yesikhokelo ingaphinda isetyenziswe ngaphezulu kwentambo yesikhokelo se-pancreatic duct. I-Selective bile duct intubation.
Iingenelo zale ndlela zezi:
(1) Ngoncedo lweucingo lwesikhokelo, kulula ukuyifumana indawo evulekayo yombhobho wenyongo, nto leyo eyenza ukuba i-bile duct intubation ibe lula;
(2) Ucingo olukhokelayo lungayilungisa ingono;
(3) Phantsi kwesikhokelo sombhobho wepancreaticucingo lwesikhokelo, ukubona ngokuphindaphindiweyo umjelo wepancreas kunokuthintelwa, ngaloo ndlela kuncitshiswe ukukhuthazwa komjelo wepancreas okubangelwa kukufakwa kwetyhubhu ngokuphindaphindiweyo.
UDumonceau nabanye baqaphele ukuba intambo yokubonisa kunye ne-contrast catheter zinokufakwa kumngxuma we-biopsy ngaxeshanye, baze baxela ukuba intambo yokubonisa i-pancreatic duct iphumelele, baza bagqiba kwelokubaucingo lwesikhokeloUkusebenzisa indlela ye-pancreatic duct kuyaphumelela ekufakweni kwe-bile duct. Isantya sinempembelelo entle.
Uphononongo lwe-DGT olwenziwe nguLiu Deren nabanye lufumanise ukuba emva kokuba i-DGT yenziwe kwizigulana ezine-ERCP bile duct intubation enzima, izinga lempumelelo ye-intubation lifikelele kwi-95.65%, elingaphezulu kakhulu kunezinga lempumelelo le-59.09% le-intubation eqhelekileyo.
Uphononongo olulindelekileyo olwenziwe nguWang Fuquan et al. lubonise ukuba xa i-DGT yayisetyenziswa kwizigulane ezine-ERCP bile duct intubation enzima kwiqela lovavanyo, izinga lempumelelo ye-intubation yayiphezulu ukuya kwi-96.0%.
Izifundo ezingentla zibonisa ukuba ukusetyenziswa kwe-DGT kwizigulane ezine-bile duct intubation enzima kwi-ERCP kunokuphucula ngempumelelo izinga lempumelelo ye-bile duct intubation.
Iintsilelo ze-DGT ziquka ikakhulu la manqaku mabini alandelayo:
(1) I-pancreaticucingo lwesikhokelomhlawumbi ilahleke ngexesha lokufakwa kwe-bile duct, okanye okwesibiniucingo lwesikhokeloingangena kwakhona kwi-pancreatic duct;
(2) Le ndlela ayifanelekanga kwiimeko ezifana nomhlaza wentloko yepancreatic, ukudumba kwe-pancreatic duct, kunye nokuqhekeka kwe-pancreatic.
Ngokwembono yokwenzeka kwe-PEP, ukwenzeka kwe-PEP ye-DGT kuphantsi kuneyokufakwa kwe-bile duct eqhelekileyo. Uphononongo olucwangcisiweyo lubonise ukuba ukwenzeka kwe-PEP emva kwe-DGT yayiyi-2.38% kuphela kwizigulane ze-ERCP ezine-bile duct enzima. Ezinye iincwadi zibonisa ukuba nangona i-DGT inezinga eliphezulu lempumelelo yokufakwa kwe-bile duct, ukwenzeka kwe-post-DGT pancreatitis kusephezulu xa kuthelekiswa nezinye iindlela zokulungisa, kuba utyando lwe-DGT lunokubangela umonakalo kwi-pancreatic duct kunye nokuvulwa kwayo. Nangona kunjalo, ukuvumelana ekhaya nakwamanye amazwe kusabonisa ukuba kwiimeko zokufakwa kwe-bile duct enzima, xa ukufakwa kwe-intubation kunzima kwaye i-pancreatic duct iphindaphindwa kakubi, i-DGT lukhetho lokuqala kuba ubuchwepheshe be-DGT bunobunzima obuncinci ekusebenzeni, kwaye kulula ukuyilawula. Isetyenziswa kakhulu kwi-intubation enzima ekhethiweyo.
III. Isikhokelo sentambo i-cannulation-pan-creatic stent, i-WGC-P5
I-WGC-PS ikwabizwa ngokuba yindlela yokusebenza kwe-pancreatic duct stent. Le ndlela kukubeka i-pancreatic duct stent kunyeucingo lwesikhokeloengene ngempazamo kwi-pancreatic duct, ize ikhupheucingo lwesikhokelokwaye wenze i-bile duct cannulation ngaphezulu kwe-stent.
Uphononongo olwenziwe nguHakuta et al. lubonise ukuba ukongeza ekuphuculeni izinga lempumelelo yokufakwa kwetyhubhu ngokukhokela ukufakwa kwetyhubhu, i-WGC-PS inokukhusela nokuvulwa kombhobho wepancreas kwaye inciphise kakhulu ukuvela kwe-PEP.
Uphononongo lwe-WGC-PS oluqhutywe nguZou Chuanxin nabanye lubonise ukuba izinga lempumelelo lokufakwa kwe-intubation enzima kusetyenziswa indlela ye-pancreatic duct stent occupation yesikhashana lifikelele kwi-97.67%, kwaye ukuxhaphaka kwe-PEP kunciphile kakhulu.
Olunye uphando lufumanise ukuba xa i-pancreatic duct stent ibekwe ngokuchanekileyo, amathuba okuba ne-pancreatitis enzima emva kotyando kwiimeko ezinzima zokufakwa kwetyhubhu ancitshiswa kakhulu.
Le ndlela isenezinye iingxaki. Umzekelo, i-pancreatic duct stent efakwe ngexesha lokusebenza kwe-ERCP isenokususwa; ukuba i-stent kufuneka ibekwe ixesha elide emva kwe-ERCP, kuya kubakho amathuba aphezulu okuvaleka kwe-stent kunye nokuvaleka kwe-duct. Ukulimala kunye nezinye iingxaki zikhokelela ekwandeni kokwenzeka kwe-PEP. Sele, amaziko sele eqalile ukufunda ii-pancreatic duct stent zexeshana ezinokuphuma ngokuzenzekelayo kwi-pancreatic duct. Injongo kukusebenzisa ii-pancreatic duct stents ukuthintela i-PEP. Ukongeza ekunciphiseni kakhulu ukwanda kwengozi ze-PEP, ezi stents zinokuphepha neminye imisebenzi yokususa i-stent kunye nokunciphisa umthwalo kwizigulana. Nangona uphando lubonise ukuba ii-pancreatic duct stent zexeshana zinempembelelo entle ekunciphiseni i-PEP, ukusetyenziswa kwazo kweklinikhi kusenemida emikhulu. Umzekelo, kwizigulana ezine-pancreatic ducts ezincinci kunye namasebe amaninzi, kunzima ukufaka i-pancreatic duct stent. Ubunzima buya kwanda kakhulu, kwaye olu tyando lufuna i-endoscopists yobungcali ephezulu. Kwakhona kubalulekile ukuqaphela ukuba i-pancreatic duct stent ebekweyo akufuneki ibe nde kakhulu kwi-duodenal lumen. I-stent ende kakhulu inokubangela ukugqobhoka kwe-duodenal. Ke ngoko, ukukhetha indlela yokusebenza kwe-pancreatic duct stent kusafuneka kuphathwe ngononophelo.
IV. I-Trans-pancreatocsphincterotomy, i-TPS
Itekhnoloji ye-TPS isetyenziswa ngokubanzi emva kokuba ucingo olukhokelayo lungene kwi-pancreatic duct ngempazamo. I-septum ephakathi kwe-pancreatic duct inqunyulwa kwicala le-pancreatic duct guide wire ukususela ngentsimbi ye-11 ukuya kweye-12, ize emva koko ityhubhu ifakwe kwicala le-bile duct ide ucingo olukhokelayo lungene kwi-bile duct.
Uphononongo olwenziwe nguDai Xin nabanye luthelekise i-TPS kunye nezinye iiteknoloji ezimbini zokungenisa umoya. Kuyabonakala ukuba izinga lempumelelo yetekhnoloji ye-TPS liphezulu kakhulu, lifikelela kwi-96.74%, kodwa alibonisi ziphumo zibalaseleyo xa lithelekiswa nezinye iiteknoloji ezimbini zokungenisa umoya. Iingenelo.
Kuye kwaxelwa ukuba iimpawu zobuchwepheshe be-TPS ziquka la manqaku alandelayo:
(1) I-incision incinci kwi-pancreaticobiliary septum;
(2) Ukuxhaphaka kweengxaki emva kotyando kuphantsi;
(3) Ukukhetha indlela yokusika kulula ukuyilawula;
(4) Le ndlela ingasetyenziselwa izigulana ezine-pancreatic duct intubation ephindaphindayo okanye ii-nipples ngaphakathi kwe-diverticulum.
Izifundo ezininzi zibonise ukuba i-TPS ayinakuphucula kuphela izinga lempumelelo ye-bile duct intubation enzima, kodwa ayinyusi nokwanda kweengxaki emva kwe-ERCP. Ezinye iingcali zicebisa ukuba ukuba i-pancreatic duct intubation okanye i-small duodenal papilla yenzeka ngokuphindaphindiweyo, kufuneka kuqwalaselwe i-TPS kuqala. Nangona kunjalo, xa kusetyenziswa i-TPS, kufuneka kuqwalaselwe ukuba kunokwenzeka ukuba i-pancreatic duct stenosis kunye nokuphinda kuvele i-pancreatitis, ezinokuba yingozi yexesha elide ye-TPS.
V. Precut Sphincterotomy, PST
Indlela ye-PST isebenzisa i-papillary arcuate band njengomda ophezulu we-pre-incision kunye ne-1-2 o'clock direction njengomda wokuvula i-duodenal papilla sphincter ukuze kufunyanwe ukuvulwa kwe-bile kunye ne-pancreatic duct. Apha i-PST ibhekisa ngokukodwa kwindlela eqhelekileyo ye-nipple sphincter pre-incision esebenzisa imela ye-arcuate. Njengecebo lokujongana ne-bile duct intubation enzima ye-ERCP, iteknoloji ye-PST ithathwa ngokubanzi njengokhetho lokuqala lwe-bil duct intubation enzima. I-Endoscopic nipple sphincter pre-incision ibhekisa kwi-endoscopic incision ye-papilla surface mucosa kunye nenani elincinci lemisipha ye-sphincter ngemela ye-incision ukuze kufunyanwe ukuvulwa kwe-bile duct, uze usebenzise i-ucingo lwesikhokelookanye i-catheter yokufaka i-bile duct kwi-tube.
Uphononongo lwasekhaya lubonise ukuba izinga lempumelelo ye-PST liphezulu njenge-89.66%, nto leyo engahlukanga kakhulu kwi-DGT kunye ne-TPS. Nangona kunjalo, izinga le-PEP kwi-PST liphezulu kakhulu kunelo le-DGT kunye ne-TPS.
Okwangoku, isigqibo sokusebenzisa obu buchwephesha sixhomekeke kwizinto ezahlukeneyo. Umzekelo, enye ingxelo ithi i-PST isetyenziswa kakuhle kwiimeko apho i-duodenal papilla ingaqhelekanga okanye igqwethekile, njenge-duodenal stenosis okanye i-malignancy.
Ukongeza, xa kuthelekiswa nezinye iindlela zokuhlangabezana neengxaki, i-PST inezinga eliphezulu leengxaki ezifana ne-PEP, kwaye iimfuno zotyando ziphezulu, ngoko ke olu tyando lwenziwa ngcono ziingcali ze-endoscopist ezinamava.
VI. I-Papillotomy yenaliti, i-NKP
I-NKP yindlela yokufaka intubhu encediswa yimela. Xa intubhu inzima, imela yenaliti ingasetyenziselwa ukunqumla inxalenye ye-papilla okanye i-sphincter ukusuka ekuvulekeni kwe-duodenal papilla ukuya kwicala le-11-12, uze usebenzise i-aucingo lwesikhokelookanye i-catheter ukuya kwi-Selective insertion kwi-common bile duct. Njengecebo lokujongana ne-hard bile duct intubation, i-NKP inokuphucula ngempumelelo izinga lempumelelo ye-hard bile duct intubation. Kwixesha elidlulileyo, bekukholelwa ngokubanzi ukuba i-NKP iya kwandisa ukwanda kwe-PEP kwiminyaka yakutshanje. Kwiminyaka yakutshanje, iingxelo ezininzi zohlalutyo olubuyela umva zibonise ukuba i-NKP ayinyusi umngcipheko weengxaki emva kotyando. Kubalulekile ukuqaphela ukuba ukuba i-NKP yenziwe kwinqanaba lokuqala le-hard tuberation, kuya kuba luncedo kakhulu ekuphuculeni izinga lempumelelo ye-intubation. Nangona kunjalo, okwangoku akukho sivumelwano malunga nokuba kufuneka isetyenziswe nini i-NKP ukuze kufezekiswe iziphumo ezilungileyo. Olunye uphando lubike ukuba izinga le-intubation ye-NKP lisetyenziswe ngexeshaI-ERCPngaphantsi kwemizuzu engama-20 yayiphezulu kakhulu kuneye-NKP esetyenzisiweyo emva kwemizuzu engama-20.
Izigulane ezine-bile duct enzima ziya kuxhamla kakhulu kule ndlela ukuba zine-nipple bulges okanye i-bile duct enkulu. Ukongeza, kukho iingxelo zokuba xa zidibana neemeko ezinzima zokufaka ityhubhu, ukusetyenziswa okudibeneyo kwe-TPS kunye ne-NKP kunezinga eliphezulu lempumelelo kunokufaka zodwa. Ingxaki kukuba iindlela ezininzi zokusika ezisetyenziswa kwi-nipple ziya kwandisa ukwenzeka kweengxaki. Ke ngoko, uphando oluthe kratya luyafuneka ukuze kuqinisekiswe ukuba kukhethwe na ngaphambi kokusika kwangethuba ukunciphisa ukwenzeka kweengxaki okanye kudityaniswe amanyathelo amaninzi okulungisa ukuphucula izinga lempumelelo yokufaka ityhubhu enzima.
VII.Inaliti-imela Fistulotomy,NKE
Indlela ye-NKF ibhekisa ekusebenziseni imela yenaliti ukubhoboza i-mucosa malunga ne-5mm ngaphezulu kwe-nipple, kusetyenziswa umbane oxutyiweyo ukutyumza umaleko ngokulandelelana kwentsimbi ye-11 de kufunyanwe isakhiwo esifana ne-orifice okanye ukugcwala kwe-bile, uze usebenzise ucingo olukhokelayo ukubona ukuphuma kwe-bile kunye nokusikwa kwezicubu. Ukufakwa kwe-bile duct ekhethiweyo kwenziwe kwindawo ye-jaundice. Utyando lwe-NKF lusika ngaphezulu kokuvulwa kwe-nipple. Ngenxa yokubakho kwe-bile duct sinus, kunciphisa kakhulu umonakalo wobushushu kunye nomonakalo woomatshini ekuvulekeni kwe-pancreatic duct, nto leyo enokunciphisa ukwanda kwe-PEP.
Uphononongo lukaJin nabanye lubonise ukuba izinga lempumelelo yokufakwa kwetyhubhu ye-NK linokufikelela kwi-96.3%, kwaye akukho PEP emva kotyando. Ukongeza, izinga lempumelelo ye-NKF ekususweni kwamatye liphezulu njenge-92.7%. Ke ngoko, olu phononongo lucebisa i-NKF njengokhetho lokuqala lokususwa kwamatye e-bile duct eqhelekileyo. . Xa kuthelekiswa ne-papillomyotomy eqhelekileyo, umngcipheko wotyando lwe-NKF usephezulu, kwaye inokuba neengxaki ezifana nokugqobhoka nokopha, kwaye ifuna amanqanaba aphezulu okusebenza kwee-endoscopists. Indawo evulekileyo yefestile echanekileyo, ubunzulu obufanelekileyo, kunye nendlela echanekileyo zonke ezi zinto kufuneka zifundwe kancinci kancinci.
Xa kuthelekiswa nezinye iindlela zangaphambi kokusikwa, i-NKF yindlela elula ngakumbi enezinga eliphezulu lempumelelo. Nangona kunjalo, le ndlela ifuna ukuziqhelanisa ixesha elide kunye nokuqokelelana okuqhubekayo ngumqhubi ukuze abe nobuchule, ngoko ke le ndlela ayifanelekanga kwabaqalayo.
VIII. Phinda-i-ERCP
Njengoko kukhankanyiwe apha ngasentla, kukho iindlela ezininzi zokujongana nokufakwa kwe-bile duct okunzima. Nangona kunjalo, akukho siqinisekiso sempumelelo eyi-100%. Uncwadi olufanelekileyo lubonise ukuba xa ukufakwa kwe-bile duct kunzima kwezinye iimeko, ukufakwa kwe-bile duct ixesha elide neliphindaphindiweyo okanye isiphumo sokungena kobushushu se-pre-cut kunokukhokelela kwi-duodenal papilla edema. Ukuba utyando luyaqhubeka, ukufakwa kwe-bile duct akuyi kuphumelela kuphela, kodwa nethuba leengxaki liya kwanda. Ukuba imeko engentla iyenzeka, ungacinga ngokuphelisa umbane.I-ERCPUtyando kuqala uze wenze i-ERCP yesibini ngexesha ongazikhethela lona. Emva kokuba i-papilloedema iphelile, utyando lwe-ERCP luya kuba lula ukufikelela kwi-intubation ephumelelayo.
UDonnellan nabanye benze okwesibiniI-ERCPutyando kwizigulana ezingama-51 ezingakhange ziphumelele emva kokusikwa kwemela yenaliti, kwaye amatyala angama-35 aphumelele, kwaye ukuvela kweengxaki akuzange kwande.
UKim nabanye benze utyando lwesibini lwe-ERCP kwizigulana ezingama-69 ezingaphumelelangaI-ERCPemva kokusikwa kwemela yenaliti, kwaye amatyala angama-53 aphumelele, kunye nezinga lempumelelo eliyi-76.8%. Amatyala aseleyo angaphumelelanga nawo adlule kutyando lwesithathu lwe-ERCP, kunye nezinga lempumelelo eliyi-79.7%., kwaye utyando oluninzi aluzange lonyuse ukwenzeka kweengxaki.
UYu Li nabanye benze ukhetho lwesibiniI-ERCPkwizigulane ezingama-70 ezingaphumelelanga kwi-ERCP emva kokusikwa kwemela yenaliti, kwaye amatyala angama-50 aphumelele. Izinga lempumelelo iyonke (i-ERCP yokuqala + i-ERCP yesibini) inyuke yaya kwi-90.6%, kwaye ukuvela kweengxaki akwandi kakhulu. . Nangona iingxelo zibonakalise ukusebenza kakuhle kwe-ERCP yesibini, ixesha eliphakathi kwemisebenzi emibini ye-ERCP akufuneki libe lide kakhulu, kwaye kwezinye iimeko ezikhethekileyo, ukuphuma kwe-biliary okulibazisekileyo kunokuyenza mandundu imeko.
IX. Ukukhupha amanzi e-biliary okukhokelwa yi-Endoscopicultrasound, i-EUS-BD
I-EUS-BD yinkqubo ehlaselayo esebenzisa inaliti yokubhoboza ukubhoboza inyongo esiswini okanye kwi-duodenum lumen phantsi kwesikhokelo se-ultrasound, ingene kwi-duodenum nge-duodenal papilla, ize emva koko yenze i-biliary intubation. Le ndlela ibandakanya zombini iindlela ze-intrahepatic kunye neze-extrahepatic.
Uphononongo olujonga emva lubike ukuba izinga lempumelelo ye-EUS-BD lifikelele kwi-82%, kwaye ukuvela kweengxaki emva kotyando yayiyi-13% kuphela. Kwisifundo esithelekisayo, i-EUS-BD xa ithelekiswa netekhnoloji yangaphambi kokusika, izinga lempumelelo yayo yokufakelwa ityhubhu laliphezulu, lifikelela kwi-98.3%, elingaphezulu kakhulu kune-90.3% yokusika kwangaphambili. Nangona kunjalo, ukuza kuthi ga ngoku, xa kuthelekiswa nezinye iiteknoloji, kusekho ukunqongophala kophando malunga nokusetyenziswa kwe-EUS kwiingxaki ezinzima.I-ERCPukufakwa kwetyhubhu. Akukho datha yaneleyo yokubonisa ukusebenza kakuhle kwetekhnoloji yokubhoboza i-bile duct ekhokelwa yi-EUS kwiingxaki ezinzimaI-ERCPUkufakwa kwetyhubhu. Ezinye izifundo zibonise ukuba inciphile. Indima ye-PEP emva kotyando ayiqinisekisi.
X. Ukuphuma kwamanzi nge-transhepatic cholangial drainage, i-PTCD
I-PTCD yenye indlela yokuhlola engafunekiyo engasetyenziswa kunyeI-ERCPxa kufakwe ityhubhu enzima ye-bile duct, ingakumbi xa kukho ukuvaleka kwenyongo. Le ndlela isebenzisa inaliti yokubhoboza ukuze ingene ngecala kwi-bile duct, ibhoboze i-bile duct nge-papilla, ize ifake ityhubhu yenyongo ngasemva ngendlela ebekelwe yona.ucingo lwesikhokeloOlunye uphando luhlalutye izigulane ezingama-47 ezine-bile duct intubation enzima ezasebenzisa ubuchule be-PTCD, kwaye izinga lempumelelo lafikelela kwi-94%.
Uphononongo olwenziwe nguYang nabanye lubonise ukuba ukusetyenziswa kwe-EUS-BD ngokucacileyo kunqongophele xa kufikwa kwi-hilar stenosis kunye nesidingo sokubhoboza i-duct ye-bile duct echanekileyo ye-intrahepatic, ngelixa i-PTCD ineenzuzo zokuhambelana ne-axis ye-duct ye-bile kunye nokuba nokuguquguquka ngakumbi kwizixhobo zokuqondisa. I-intubation ye-duct ye-bile kufuneka isetyenziswe kwizigulane ezinjalo.
I-PTCD ngumsebenzi onzima ofuna uqeqesho olucwangcisiweyo lwexesha elide kunye nokugqitywa kwenani elaneleyo lamatyala. Kunzima kwabo baqalayo ukugqiba lo msebenzi. I-PTCD ayinzima nje kuphela ukuyisebenzisa, kodwaucingo lwesikhokeloinokonakalisa nombhobho wenyongo ngexesha lokuqhubela phambili.
Nangona ezi ndlela zingasentla zinokuphucula kakhulu izinga lempumelelo yokufakwa kwe-bile duct enzima, ukhetho kufuneka luqwalaselwe ngokupheleleyo.I-ERCP, SGT, DGT, WGC-PS kunye nezinye iindlela zinokuqwalaselwa; ukuba ezi ndlela zingasentla ziyasilela, iingcali ze-endoscopist eziphezulu nezinamava zinokwenza iindlela zokusika ngaphambi kotyando, ezifana ne-TPS, NKP, NKF, njl.njl.; ukuba zisasebenza Ukuba i-selective bile duct intubation ayinakugqitywa, i-elective secondaryI-ERCPingakhethwa; ukuba akukho nanye kwezi ndlela zingasentla enokuyisombulula ingxaki yokufakwa kwetyhubhu enzima, utyando olungena emzimbeni olufana ne-EUS-BD kunye ne-PTCD lunokuzanywa ukusombulula ingxaki, kwaye unyango lotyando lunokukhethwa ukuba kuyimfuneko.
Thina, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumvelisi eTshayina ogxile kwizinto ezisetyenziswayo ze-endoscopic, ezifana ne-biopsy forceps, i-hemoclip, i-polyp snare, inaliti ye-sclerotherapy, i-spray catheter, iibhrashi ze-cytology,ucingo lwesikhokelo, ibhaskithi yokuqokelela amatye, i-catheter yokukhupha amanzi empumlweninjl. ezisetyenziswa kakhulu kwi-EMR, ESD,I-ERCPIimveliso zethu ziqinisekisiwe yi-CE, kwaye izityalo zethu ziqinisekisiwe yi-ISO. Iimpahla zethu zithunyelwe eYurophu, eMntla Melika, eMbindi Mpuma nakwinxalenye yeAsia, kwaye zifumana umthengi udumo nodumo!
Ixesha leposi: Jan-31-2024