I-ERCP iteknoloji ebalulekileyo yokuxilongwa kunye nokunyangwa kwezifo ze-biliary kunye ne-pancreatic.Emva kokuba iphumile, inikezele ngeengcamango ezininzi ezintsha zonyango lwezifo ze-biliary kunye ne-pancreatic.Ayiphelelanga kwi "radiography".Itshintshile ukusuka kwi-teknoloji yokuqala yokuxilonga ukuya kuhlobo olutsha.Iindlela zonyango ziquka i-sphincterotomy, ukususwa kwamatye e-bile duct, i-bile drainage kunye nezinye iindlela zokunyanga izifo ze-bile kunye ne-pancreatic system.
Izinga lokuphumelela lokukhetha intubation ye-bile duct ye-ERCP inokufikelela ngaphezulu kwe-90%, kodwa kusekho ezinye iimeko apho ukufikelela kunzima kwe-biliary kubangela ukungaphumeleli kwe-bile duct intubation.Ngokutsho kwemvumelwano yamva nje malunga nokuxilongwa kunye nokunyangwa kwe-ERCP, intubation enzima inokuchazwa njenge: ixesha lokukhetha i-bile duct intubation ye-ERCP eqhelekileyo ingaphezu kwemizuzu eyi-10 okanye inani lokuzama intubation lingaphezulu kwamaxesha e-5.Xa wenza i-ERCP, ukuba i-bile duct intubation inzima kwezinye iimeko, izicwangciso ezisebenzayo kufuneka zikhethwe ngexesha lokuphucula izinga lokuphumelela kwe-bile duct intubation.Eli nqaku liqhuba uphononongo olucwangcisiweyo lweendlela ezininzi zokuncedisa intubation ezisetyenziselwa ukusombulula ingxaki ye-bile duct intubation, ngenjongo yokubonelela ngesiseko sethiyori kwii-endoscopists zeklinikhi ukukhetha isicwangciso sokuphendula xa sijongene nobunzima be-bile duct intubation ye-ERCP.
I.Singleguidewire Technique,SGT
Ubuchule be-SGT kukusebenzisa i-contrastcatheter ukuqhubeka nokuzama ukufaka i-bile duct emva kokuba ucingo lwesikhokelo lungene kwi-pancreatic duct.Kwiintsuku zokuqala zophuhliso lwetekhnoloji ye-ERCP, i-SGT yayiyindlela eqhelekileyo yokufakwa kwe-biliary intubation enzima.Inzuzo yayo kukuba kulula ukuyisebenzisa, ilungisa i-nipple, kwaye iyakwazi ukuhlala ekuvulekeni kwe-pancreatic duct, okwenza kube lula ukufumana ukuvulwa kwe-bile duct.
Kukho iingxelo kwincwadi yokuba emva kokungaphumeleli kwe-intubation eqhelekileyo, ukukhetha intubation encediswa yi-SGT inokugqiba ngempumelelo intubation ye-bile duct malunga ne-70% -80% yamatyala.Ingxelo iphinde yabonisa ukuba kwiimeko zokungaphumeleli kwe-SGT, nokuba ukulungiswa kunye nokusetyenziswa kabiniguidewireiteknoloji ayizange iphucule izinga lokuphumelela kwe-bile duct intubation kwaye ayizange inciphise iziganeko ze-post-ERCP pancreatitis (PEP).
Olunye uphononongo lukwabonise ukuba izinga lempumelelo ye-SGT intubation lingaphantsi kunelo eliphindwe kabiniguidewireitekhnoloji kunye neteknoloji ye-transpancreatic papillary sphincterotomy.Xa kuthelekiswa neenzame eziphindaphindiweyo zeSGT, ukuphunyezwa kwangaphambili kokuphindwe kabiniguidewireitekhnoloji okanye itekhnoloji ye-pre-incision inokufezekisa iziphumo ezingcono.
Ukusukela ekuphuhlisweni kwe-ERCP, iintlobo zetekhnoloji ezintsha ziye zaphuhliswa ukwenzela ukuba kube nzima ukungena.Xa kuthelekiswa nomntu ongatshatangaguidewireiteknoloji, iinzuzo zicace ngakumbi kwaye izinga lempumelelo liphezulu.Ngoko ke, ungatshatangaguidewireitekhnoloji okwangoku ayifane isetyenziswe eklinikhi.
II.Ubuchule bocingo lwesikhokelo esiphindwe kabini,DGT
I-DGT ingabizwa ngokuba yi-pancreatic duct guide wire occupation method, leyo kukushiya i-guide yesikhokelo ingena kwi-pancreatic duct ukuze ilandele kwaye ihlale kuyo, kwaye isikhokelo sesibini socingo sinokuphinda sisetyenziswe ngaphezu kwe-pancreatic duct guide wire.Intubation yenyongo ekhethiweyo.
Iinzuzo zale ndlela yile:
(1) Ngoncedo aguidewire, ukuvulwa kwe-bile duct kulula ukuyifumana, okwenza i-bile duct intubation ibe lula;
(2) Ucingo lwesikhokelo luyakwazi ukulungisa ingono;
(3) Ngaphantsi kwesikhokelo se-pancreatic ductguidewire, ukubonwa ngokuphindaphindiweyo kwe-pancreatic duct kunokugwenywa, ngaloo ndlela kuncitshiswe ukukhuthazwa kwe-pancreatic duct ebangelwa ukuphindaphinda ngokuphindaphindiweyo.
Dumonceau et al.waqaphela ukuba i-guidewire kunye necatheter yokuchasana inokufakwa kumngxunya we-biopsy ngaxeshanye, kwaye emva koko wachaza imeko eyimpumelelo ye-pancreatic duct guidewire occupying method, kwaye wagqiba kwelokubaguidewireukuhlala kwindlela ye-pancreatic duct kuyimpumelelo kwi-bile duct intubation.izinga linempembelelo entle.
Uphononongo kwi-DGT nguLiu Deren et al.yafumanisa ukuba emva kokuba i-DGT yenziwe kwizigulane ezinobunzima be-ERCP bile duct intubation, izinga lokuphumelela kwe-intubation lifikelele kwi-95.65%, eyayiphezulu kakhulu kune-59.09% yezinga lempumelelo ye-intubation eqhelekileyo.
Uphononongo olulindelekileyo nguWang Fuquan et al.yabonisa ukuba xa i-DGT isetyenziswa kwizigulana ezinobunzima be-ERCP bile duct intubation kwiqela lovavanyo, izinga lokuphumelela le-intubation laliphezulu njenge-96.0%.
Ezi zifundo zingasentla zibonisa ukuba ukusetyenziswa kwe-DGT kwizigulana ezinobunzima be-bile duct intubation ye-ERCP kunokuphucula ngokufanelekileyo izinga lempumelelo ye-bile duct intubation.
Ukusilela kwe-DGT ikakhulu kubandakanya la manqaku mabini alandelayo:
(1) Indlalaguidewiremhlawumbi ilahleke ngexesha le-bile duct intubation, okanye okwesibiniguidewireinokungena kwi-pancreatic duct kwakhona;
(2) Le ndlela ayifanelekanga kwiimeko ezifana nomhlaza wentloko ye-pancreatic, i-pancreatic duct tortuosity, kunye ne-pancreatic fission.
Ngokwembono yezehlo ze-PEP, izehlo ze-PEP ze-DGT zisezantsi kunezo zesiqhelo ze-bile duct intubation.Uphononongo olulindelekileyo lubonise ukuba izehlo ze-PEP emva kwe-DGT zaziyi-2.38% kuphela kwizigulane ze-ERCP ezinobunzima be-bile duct intubation.Olunye uncwadi lubonisa ukuba nangona i-DGT inezinga eliphezulu lempumelelo ye-bile duct intubation, izehlo ze-post-DGT pancreatitis zisephezulu xa kuthelekiswa namanye amanyathelo okulungisa, kuba ukusebenza kwe-DGT kunokubangela umonakalo kwi-pancreatic duct kunye nokuvulwa kwayo.Ngaphandle koku, imvumelwano ekhaya nakwamanye amazwe isabonisa ukuba kwiimeko ezinzima ze-bile duct intubation, xa intubation inzima kwaye i-pancreatic duct iphinda idutyulwe ngokuphindaphindiweyo, i-DGT lukhetho lokuqala kuba iteknoloji ye-DGT inobunzima obungaphantsi ekusebenzeni, kwaye kulula. ukulawula.Isetyenziswa ngokubanzi ekukhetheni intubation enzima.
III.Isikhokelo ngocingo cannulation-pan-creatic stent,WGC-P5
I-WGC-PS inokubizwa ngokuba yi-pancreatic duct stent occupation method.Le ndlela kukubeka i-pancreatic duct stent kunye neguidewireleyo ngempazamo ingena kwi-pancreatic duct, emva koko uyikhupheguidewirekwaye wenze i-bile duct cannulation ngaphezu kwe-stent.
Uphononongo olwenziwe nguHakuta et al.ibonise ukuba ngaphezu kokuphucula ukuphumelela kwe-intubation jikelele ngokukhokela i-intubation, i-WGC-PS inokukhusela nokuvulwa kwe-pancreatic duct kunye nokunciphisa kakhulu ukwenzeka kwe-PEP.
Uphononongo kwi-WGC-PS nguZou Chuanxin et al.ibonise ukuba izinga lokuphumelela kwe-intubation enzima usebenzisa indlela yesikhashana ye-pancreatic duct stent occupation yafikelela kwi-97.67%, kwaye iziganeko ze-PEP zancitshiswa kakhulu.
Olunye uphononongo lwafumanisa ukuba xa i-pancreatic duct stent ibekwe ngokuchanekileyo, amathuba okuba i-postoperative pancreatitis enzima kwiimeko ezinzima ze-intubation iyancipha kakhulu.
Le ndlela iseneentsilelo ezithile.Ngokomzekelo, i-pancreatic duct stent efakwe ngexesha lokusebenza kwe-ERCP ingasuswa;ukuba i-stent idinga ukubekwa ixesha elide emva kwe-ERCP, kuya kuba nethuba eliphezulu lokuvaleka kwe-stent kunye nokuphazamiseka kombhobho.Ukwenzakala kunye nezinye iingxaki zikhokelela ekwandeni kweziganeko ze-PEP.Ngoku, amaziko sele eqalisile ukufunda i-pancreas duct stents enokuthi iphume ngokuzenzekelayo kwi-pancreatic duct.Injongo kukusebenzisa i-pancreatic duct stents ukuthintela i-PEP.Ukongeza ekunciphiseni kakhulu izehlo zeengozi ze-PEP, ezo stents zinokuphepha ezinye iinkqubo zokususa i-stent kunye nokunciphisa umthwalo kwizigulana.Nangona uphononongo lubonise ukuba i-pancreatic duct stents inesiphumo esihle ekunciphiseni i-PEP, ukusetyenziswa kwabo kwezonyango kusenemida emikhulu.Ngokomzekelo, kwizigulana ezinemibhobho ye-pancreatic ebhityileyo kunye namasebe amaninzi, kunzima ukufaka i-pancreatic duct stent.Ubunzima buya kwandiswa kakhulu, kwaye lo msebenzi ufuna umgangatho ophezulu weengcali ze-endoscopists.Kuyafaneleka ukuba uqaphele ukuba i-pancreatic duct stent ebekwe akufanele ibe yinde kakhulu kwi-duodenal lumen.I-stent emide kakhulu inokubangela ukugqojozwa kwe-duodenal.Ke ngoko, ukhetho lwendlela yokusebenza kwe-pancreatic duct stent kusafuneka luphathwe ngononophelo.
IV.Trans-pancreatocsphincterotomy,TPS
I-teknoloji ye-TPS isetyenziswa ngokubanzi emva kokuba ucingo lwesikhokelo lungene kwi-pancreatic duct ngempazamo.I-septum embindini we-pancreatic duct ihlanjululwa ecaleni kwendlela yocingo lwesikhokelo se-pancreatic duct ukusuka kwintsimbi ye-11 ukuya kwintsimbi ye-12, kwaye ityhubhu ifakwe kwicala le-bile duct de ucingo lwesikhokelo lungene kwi-bile. umbhobho.
Uphononongo olwenziwe nguDai Xin et al.kuthelekisa i-TPS kunye nezinye iitekhnoloji ezimbini ezincedisayo ze-intubation.Ingabonwa ukuba izinga lempumelelo yetekhnoloji ye-TPS iphezulu kakhulu, ifikelela kwi-96.74%, kodwa ayibonisi iziphumo ezibalaseleyo xa kuthelekiswa nobunye ubuchwephesha be-intubation ezimbini.Iingenelo.
Kuye kwaxelwa ukuba iimpawu zobuchwepheshe be-TPS ziquka ezi ngongoma zilandelayo:
(1) Ukusika kuncinci kwi-pancreantobiliary septum;
(2) Iziganeko zeengxaki emva kokuhlinzwa ziphantsi;
(3) Ukukhethwa kwesikhokelo sokusika kulula ukulawula;
(4) Le ndlela ingasetyenziselwa izigulane ezine-pancreatic duct intubation okanye iingono ngaphakathi kwe-diverticulum.
Uphononongo oluninzi luye lwabonisa ukuba i-TPS ayinakukwazi ukuphucula ngokufanelekileyo izinga lokuphumelela kwe-bile duct intubation enzima, kodwa kwakhona ayinyusi iziganeko zeengxaki emva kwe-ERCP.Abanye abaphengululi bacebisa ukuba ukuba i-pancreatic duct intubation okanye i-duodenal papilla encinci iyenzeka ngokuphindaphindiweyo, i-TPS kufuneka iqwalaselwe kuqala.Nangona kunjalo, xa usebenzisa i-TPS, ingqalelo kufuneka ihlawulwe kwi-pancreatic duct stenosis kunye nokuphindaphinda kwe-pancreatitis, enokuthi ibe yingozi yexesha elide le-TPS.
V.Precut Sphincterotomy,PST
Ubuchule be-PST busebenzisa ibhendi ye-papillary arcuate njengomda ophezulu we-pre-incision kunye ne-1-2 ye-o'clock yesikhokelo njengomda wokuvula i-duodenal papilla sphincter ukufumana ukuvulwa kwe-bile kunye ne-pancreatic duct.Apha i-PST ibhekisa ngokukodwa kubuchule obuqhelekileyo be-nipple sphincter yangaphambi kokusika kusetyenziswa imela yearcuate.Njengesicwangciso sokujongana ne-bile duct intubation enzima ye-ERCP, iteknoloji ye-PST ithathwa ngokubanzi njengento yokuqala yokukhetha intubation enzima.I-Endoscopic nipple sphincter pre-incision ibhekiselele kwi-endoscopic yokusikwa kwe-papilla surface mucosa kunye nentwana encinci ye-sphincter muscle ngokusebenzisa imela yokusika ukufumana ukuvuleka kombhobho wenyongo, kwaye emva koko usebenzise i-sphincter.guidewireokanye i-catheter yokufaka i-bile duct.
Uphononongo lwasekhaya lubonise ukuba izinga lokuphumelela kwe-PST liphezulu njenge-89.66%, eyahluke kakhulu kwi-DGT kunye ne-TPS.Nangona kunjalo, izehlo ze-PEP kwi-PST ziphezulu kakhulu kunezo ze-DGT kunye ne-TPS.
Okwangoku, isigqibo sokusebenzisa le teknoloji sixhomekeke kwizinto ezahlukeneyo.Ngokomzekelo, enye ingxelo yathi iPST isetyenziswa kakuhle kwiimeko apho iduodenal papilla ingaqhelekanga okanye igqwethekile, njengeduodenal stenosis okanye i-malignancy.
Ukongezelela, xa kuthelekiswa nezinye izicwangciso zokuhlangabezana, i-PST ineziganeko eziphezulu zeengxaki ezifana ne-PEP, kwaye iimfuno zokusebenza ziphezulu, ngoko ke lo msebenzi wenziwa kakuhle ngabachwephesha abanamava.
VI.Inaliti-imela Papillotomy,NKP
I-NKP yindlela yokufaka i-intubation encediswa ngenaliti.Xa intubation inzima, imela yenaliti ingasetyenziselwa ukuhlaba inxalenye yepapilla okanye i-sphincter ukusuka ekuvulekeni kwe-duodenal papilla ukuya kwicala le-11-12 intsimbi, kwaye emva koko usebenziseguidewireokanye catheter ukuya Ufakelo olukhethiweyo kumbhobho wenyongo eqhelekileyo.Njengesicwangciso sokumelana ne-bile duct intubation enzima, i-NKP inokuphucula ngokufanelekileyo izinga lempumelelo ye-bile duct intubation enzima.Ngaphambili, bekukholelwa ngokubanzi ukuba i-NKP iyakwandisa izehlo ze-PEP kwiminyaka yakutshanje.Kwiminyaka yakutshanje, iingxelo ezininzi zokuhlalutya okuphindaphindiweyo zibonise ukuba i-NKP ayinyusi umngcipheko weengxaki ze-postoperative.Kuyafaneleka ukuba uqaphele ukuba ukuba i-NKP yenziwa kwinqanaba lokuqala le-intubation enzima, kuya kuba luncedo olukhulu ekuphuculeni izinga lokuphumelela kwe-intubation.Nangona kunjalo, okwangoku akukho mvumelwano malunga nokuba ungafaka nini isicelo se-NKP ukufezekisa iziphumo ezingcono.Olunye uphononongo luchaze ukuba izinga lokungeniswa kwe-NKP lisetyenziswe ngexeshaI-ERCPngaphantsi kwemizuzu ye-20 yayiphezulu kakhulu kune-NKP esetyenziswe emva kwemizuzu ye-20 kamva.
Izigulana ezinobunzima be-bile duct cannulation ziyakuxhamla kakhulu kolu buchule ukuba banamaqhuqhuva engono okanye i-bile duct dilation ebalulekileyo.Ukongezelela, kukho iingxelo ezithi xa uhlangabezana neemeko ezinzima ze-intubation, ukusetyenziswa okudibeneyo kwe-TPS kunye ne-NKP kunezinga eliphezulu lokuphumelela kunokusebenzisa yedwa.Ububi kukuba iindlela ezininzi zokusika ezifakwe kwingono ziyakwandisa ukwenzeka kweengxaki.Ngoko ke, uphando olongezelelweyo luyafuneka ukubonisa ukuba ngaba ukhetha ukucolwa kwangaphambili ukunciphisa ukuvela kweengxaki okanye ukudibanisa amanyathelo amaninzi okuphucula ukuphucula izinga lokuphumelela kwe-intubation enzima.
VII.Inaliti-imela Fistulotomy,NKE
Ubuchule be-NKF bubhekiselele ekusebenziseni imela yenaliti ukugqobhoza i-mucosa malunga ne-5mm ngaphezulu kwengono, usebenzisa ingxubevange yangoku ukusika umaleko kwicala le-11 de i-orifice-efana nesakhiwo okanye ukuphuphuma kwenyongo kufunyenwe, kwaye emva koko usebenzisa. ucingo lwesikhokelo ukubona ukuphuma kwenyongo kunye nokusikwa kwethishu.I-intubation ekhethiweyo ye-bile duct yenziwa kwindawo ye-jaundice.Utyando lwe-NKF lusika ngaphaya kokuvuleka kwengono.Ngenxa yobukho be-bile duct sinus, kunciphisa kakhulu umonakalo wokushisa kunye nomonakalo womatshini wokuvulwa kwe-pancreatic duct, enokunciphisa iziganeko ze-PEP.
Uphononongo olwenziwe nguJin et al.ibonise ukuba izinga lokuphumelela kwe-tube intubation ye-NK linokufikelela kwi-96.3%, kwaye akukho PEP ye-postoperative.Ukongezelela, izinga lokuphumelela kwe-NKF ekususweni kwamatye liphezulu njenge-92.7%.Ke ngoko, olu phononongo lucebisa i-NKF njengokhetho lokuqala lokususwa kwelitye lenyongo eqhelekileyo..Xa kuthelekiswa ne-papillomyotomy eqhelekileyo, iingozi zokusebenza kwe-NKF zisephezulu, kwaye zivame ukuba neengxaki ezifana nokubhoboza kunye nokopha, kwaye kufuna inqanaba eliphezulu lokusebenza kwee-endoscopists.Indawo echanekileyo yokuvula ifestile, ubunzulu obufanelekileyo, kunye nobuchule obuchanekileyo zonke kufuneka zifundwe ngokuthe ngcembe.inkosi.
Xa kuthelekiswa nezinye iindlela zokusikwa kwangaphambili, i-NKF yindlela efanelekileyo kakhulu enezinga eliphezulu lempumelelo.Nangona kunjalo, le ndlela idinga ukusetyenziswa kwexesha elide kunye nokuqokelela okuqhubekayo ngumqhubi ukuba abe nobuchule, ngoko le ndlela ayifanelekanga kwabaqalayo.
VIII.Phinda-ERCP
Njengoko kukhankanyiwe ngasentla, kukho iindlela ezininzi zokujongana ne-intubation enzima.Nangona kunjalo, akukho siqinisekiso sokuphumelela kwe-100%.Uncwadi olufanelekileyo luye lwabonisa ukuba xa i-bile duct intubation inzima kwezinye iimeko, ixesha elide kunye ne-multiple intubation okanye umphumo wokungena kwe-thermal yokunqunyulwa kwangaphambili kunokukhokelela kwi-duodenal papilla edema.Ukuba utyando luyaqhubeka, akuyi kuphumelela kuphela i-bile duct intubation, kodwa ithuba leengxaki liya kwanda.Ukuba le meko ingentla iyenzeka, unokuqwalasela ukuphelisa umsingaI-ERCPukusebenza kuqala kwaye wenze i-ERCP yesibini ngexesha elikhethiweyo.Emva kokuba i-papilloedema ilahleka, ukusebenza kwe-ERCP kuya kuba lula ukufezekisa intubation ephumelelayo.
UDonnelan et al.wenze okwesibiniI-ERCPutyando kwizigulane ezingama-51 i-ERCP yazo iye yasilela emva kokuchongwa kwenaliti yemela, kwaye iimeko ezingama-35 ziye zaphumelela, kwaye izehlo zeengxaki azizange zinyuke.
UKim et al.yenza utyando lwesibini lwe-ERCP kwizigulane ezingama-69 ezingaphumelelangaI-ERCPemva kokusikwa kwangaphambili kwenaliti, kunye namatyala angama-53 aphumelele, kunye nezinga lempumelelo lama-76.8%.Amatyala aseleyo angaphumelelanga nawo aye aqhuba umsebenzi wesithathu we-ERCP, ngezinga lempumelelo lama-79.7%., kwaye imisebenzi emininzi ayizange ikhulise ukuvela kweengxaki.
U-Yu Li et al.yenze ukhetho lwesibiniI-ERCPkwizigulane ezingama-70 eziye zasilela i-ERCP emva kokusikwa kwangaphambili, kwaye iimeko ezingama-50 ziye zaphumelela.Izinga lempumelelo lilonke (i-ERCP yokuqala + i-ERCP yesibini) yanda ukuya kwi-90.6%, kwaye iziganeko zeengxaki azizange zinyuke kakhulu..Nangona iingxelo zibonise ukusebenza kwe-ERCP yesibini, ikhefu phakathi kwemisebenzi emibini ye-ERCP akufanele ibe yinde kakhulu, kwaye kwezinye iimeko ezikhethekileyo, ukulibaziseka kwe-biliary drainage kunokuyenza ibe mandundu imeko.
IX.Endoscopicultrasound-guide biliary drainage,EUS-BD
I-EUS-BD yinkqubo ehlaselayo esebenzisa inaliti yokuhlatywa ukugqobhoza i-gallbladder ukusuka esiswini okanye kwi-duodenum lumen phantsi kwesikhokelo se-ultrasound, ingene kwi-duodenum nge-duodenal papilla, kwaye emva koko yenza i-biliary intubation.Olu buchule lubandakanya zombini iindlela ze-intrahepatic kunye ne-extrahepatic.
Uphononongo oluhlaziyiweyo luchaze ukuba izinga lokuphumelela kwe-EUS-BD lifikelele kwi-82%, kwaye iziganeko zeengxaki ze-postoperative zaziyi-13 kuphela.Kuphononongo oluthelekisayo, i-EUS-BD xa kuthelekiswa nobuchwepheshe be-pre-incision, izinga layo lokuphumelela le-intubation laliphezulu, lifikelela kwi-98.3%, eyayiphezulu kakhulu kune-90.3% ye-pre-incision.Nangona kunjalo, ukuza kuthi ga ngoku, xa kuthelekiswa nezinye itekhnoloji, kusekho ukusilela kophando malunga nokusetyenziswa kwe-EUS yobunzima.I-ERCPIntubation.Kukho idatha eyaneleyo yokubonisa ukusebenza kwe-EUS-guided bile duct puncture technology kunzimaI-ERCPIntubation.Olunye uphononongo lubonise ukuba lwehlile Indima ye-PEP yasemva kotyando ayikholisi.
X.Percutaneous transhepatic cholangial drainage,PTCD
I-PTCD yenye indlela yoviwo ehlaselayo enokusetyenziswa ngokudibeneyoI-ERCPkwi-bile duct intubation enzima, ngakumbi kwiimeko ze-biliary obstruction.Obu buchule busebenzisa inaliti yokugqobhoza ukungena ngombhobho wenyongo, ukugqobhoza umbhobho wenyongo kwipapilla, emva koko kuhlawulwe umbhobho wenyongo ukubuyisela umva ngokugcinwaguidewire.Olunye uphononongo luhlalutye izigulana ezingama-47 ezinobunzima be-bile duct intubation abaye benza ubuchule be-PTCD, kwaye izinga lempumelelo lifike kwi-94%.
Uphononongo olwenziwe nguYang et al.yabonisa ukuba ukusetyenziswa kwe-EUS-BD kulinganiselwe ngokucacileyo xa kuziwa kwi-hilar stenosis kunye nesidingo sokuhlatywa kwe-intrahepatic intrahepatic bile duct, ngelixa i-PTCD ineenzuzo zokuhambelana ne-bile duct axis kunye nokuguquguquka ngakumbi kwizixhobo ezikhokelayo.I-bile duct intubation kufuneka isetyenziswe kwizigulana ezinjalo.
I-PTCD ngumsebenzi onzima ofuna uqeqesho olucwangcisiweyo lwexesha elide kunye nokugqitywa kwenani elaneleyo lamatyala.Kunzima kwabaqalayo ukugqiba lo msebenzi.I-PTCD ayinzima nje ukusebenza, kodwa iguidewireinokonakalisa umbhobho wenyongo ngexesha lokuhambela phambili.
Nangona ezi ndlela zingasentla zinokuphucula kakhulu izinga lempumelelo ye-bile duct intubation enzima, ukhetho kufuneka luqwalaselwe ngokubanzi.Xa kusenziwaI-ERCP, SGT, DGT, WGC-PS kunye nobunye ubuchule bunokuqwalaselwa;ukuba ezi ndlela zingasentla ziyasilela, ii-endoscopists eziphezulu kunye nabanamava bangenza ubuchule bokusika kwangaphambili, njenge-TPS, NKP, NKF, njl.;Ukuba kunjalo Ukuba i-bile duct intubation ekhethiweyo ayinakugqitywa, ukhetho lwesibiniI-ERCPinokukhethwa;ukuba akukho nanye yeendlela ezingasentla ezinokusombulula ingxaki ye-intubation enzima, imisebenzi ehlaselayo efana ne-EUS-BD kunye ne-PTCD inokuzama ukuxazulula ingxaki, kwaye unyango lotyando lunokukhethwa ukuba luyimfuneko.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ngumenzi e-China okhethekileyo kwizinto ezisetyenziswa kwi-endoscopic, ezifana ne-biopsy forceps, i-hemoclip, i-polyp snare, inaliti ye-sclerotherapy, i-catheter yokutshiza, iibrashi ze-cytology,guidewire, ibhasikithi yokubuyiswa kwamatye, i-catheter ye-biliary drainage yeempumlonjl. ezisetyenziswa ngokubanzi kwi-EMR, ESD,I-ERCP.Iimveliso zethu ziqinisekisiwe nge-CE, kwaye izityalo zethu ziqinisekisiwe nge-ISO.Impahla yethu ithunyelwe eYurophu, kuMntla Melika, kuMbindi Mpuma kunye nenxalenye yeAsia, kwaye ifumana ngokubanzi umthengi wokuqatshelwa kunye nendumiso!
Ixesha lokuposa: Jan-31-2024