ERCP ndi ukadaulo wofunikira kwambiri pozindikira ndi kuchiza matenda a ndulu ndi kapamba. Itangotuluka, yapereka malingaliro ambiri atsopano pochiza matenda a ndulu ndi kapamba. Sikuti imangogwiritsidwa ntchito pa "radiography". Yasintha kuchoka pa ukadaulo woyambirira wozindikira kupita ku mtundu watsopano. Njira zochiritsira zimaphatikizapo sphincterotomy, kuchotsa miyala ya bile duct, kutulutsa madzi m'thupi ndi njira zina zochiritsira matenda a ndulu ndi kapamba.
Kupambana kwa njira yopangira ndulu ya ERCP kumatha kufika pa 90%, koma palinso zochitika zina pomwe zovuta kupeza ndulu zimayambitsa kulephera kwa njira yopangira ndulu ya ndulu. Malinga ndi zomwe agwirizana posachedwapa pankhani yozindikira ndi kuchiza ERCP, njira yovuta yopangira ndulu ya ndulu ingathe kufotokozedwa motere: nthawi yopangira ndulu ya ndulu ya ERCP yachizolowezi ndi mphindi zoposa 10 kapena kuchuluka kwa njira zopangira ndulu ya ndulu ndi nthawi zoposa 5. Pochita ERCP, ngati njira yopangira ndulu ya ndulu ya ndulu nthawi zina imakhala yovuta, njira zogwira mtima ziyenera kusankhidwa panthawi yake kuti ziwongolere kuchuluka kwa njira yopangira ndulu ya ndulu ya ndulu ya ERCP. Nkhaniyi ikuwunikanso njira zingapo zothandizira njira zopangira ndulu ya ndulu ya ndulu ya ndulu ya ERCP, ndi cholinga chopereka maziko a chiphunzitso kwa akatswiri azachipatala kuti asankhe njira yoyankhira akakumana ndi njira yovuta yopangira ndulu ya ERCP.
I. Njira Yothandizira Mawaya Okhaokha, SGT
Njira ya SGT ndikugwiritsa ntchito contrastcatheter kuti mupitirize kuyesa kulowetsa ndulu mu duct pambuyo poti waya wotsogolera walowa mu duct ya pancreatic. M'masiku oyambirira a chitukuko cha ukadaulo wa ERCP, SGT inali njira yodziwika bwino yopezera ndulu zovuta. Ubwino wake ndi wakuti ndi yosavuta kugwiritsa ntchito, imakonza nipple, ndipo imatha kutenga malo otseguka a duct ya pancreatic, zomwe zimapangitsa kuti zikhale zosavuta kupeza malo otseguka a ndulu.
Pali malipoti m'mabuku omwe amati pambuyo poti njira yodziwira matenda yalephera, kusankha njira yodziwira matenda yothandizidwa ndi SGT kumatha kumaliza njira yodziwira matenda ya bile duct pafupifupi 70%-80%. Lipotilo linanenanso kuti pakakhala kulephera kwa SGT, ngakhale kusintha ndi kugwiritsa ntchito njira ziwiri.waya wotsogoleraukadaulo sunathandize kuti njira yotulutsira bile duct igwire bwino ntchito ndipo sunachepetse kuchuluka kwa matenda a post-ERCP pancreatitis (PEP).
Kafukufuku wina wasonyezanso kuti kuchuluka kwa SGT intubation ndi kotsika poyerekeza ndi kawiri.waya wotsogoleraukadaulo ndi ukadaulo wa transpancreatic papillary sphincterotomy. Poyerekeza ndi kuyesera mobwerezabwereza kwa SGT, kukhazikitsa koyambirira kwa opaleshoni ya doublewaya wotsogoleraukadaulo kapena ukadaulo woyambirira kudula ungapangitse zotsatira zabwino.
Kuyambira pomwe ERCP idapangidwa, ukadaulo watsopano wapangidwa kuti ukhale wovuta kulowetsa machubu. Poyerekeza ndi imodzi yokhawaya wotsogoleraukadaulo, ubwino wake ndi woonekeratu ndipo chiŵerengero cha kupambana n'chokwera. Chifukwa chake, munthu mmodziwaya wotsogoleraukadaulowu sugwiritsidwa ntchito kawirikawiri pachipatala.
II.Double-guide waya njira,DGT
DGT ikhoza kutchedwa njira yogwiritsira ntchito waya wotsogolera wa pancreatic duct, yomwe ndi kusiya waya wotsogolera kulowa mu pancreatic duct kuti iwutsatire ndikuugwira, kenako waya wachiwiri wotsogolera ukhoza kuyikidwanso pamwamba pa waya wotsogolera wa pancreatic duct. Kulowetsa kwa ndulu mu duct yosankhidwa.
Ubwino wa njira iyi ndi:
(1) Mothandizidwa ndiwaya wotsogolera, kutsegula kwa duct ya ndulu kumakhala kosavuta kupeza, zomwe zimapangitsa kuti duct ya ndulu ilowe bwino;
(2) Waya wotsogolera ukhoza kukonza nipple;
(3) Motsogozedwa ndi njira yodutsira kapambawaya wotsogolera, kuwona mobwerezabwereza kwa njira yolumikizira kapamba kungapeweke, motero kuchepetsa kukondoweza kwa njira yolumikizira kapamba komwe kumachitika chifukwa cha kulowetsedwa mobwerezabwereza.
Dumonceau ndi ena adawona kuti waya wowongolera ndi catheter yosiyanitsa zitha kuyikidwa mu dzenje la biopsy nthawi yomweyo, kenako adafotokoza za momwe waya wowongolera wa pancreatic duct adagwirira ntchito, ndipo adatsimikiza kutiwaya wotsogoleraKugwiritsa ntchito njira yolumikizira ndulu kumathandizira kuti ndulu ilowe m'magazi. Kuchuluka kwa magazi m'thupi kumabweretsa zotsatira zabwino.
Kafukufuku wa DGT wochitidwa ndi Liu Deren ndi anzake adapeza kuti DGT itachitidwa kwa odwala omwe ali ndi vuto la ERCP bile duct intubation, kuchuluka kwa kupambana kwa intubation kunafika pa 95.65%, komwe kunali kwakukulu kwambiri kuposa kuchuluka kwa kupambana kwa 59.09% kwa intubation yachizolowezi.
Kafukufuku woyembekezeredwa ndi Wang Fuquan et al. adawonetsa kuti pamene DGT idagwiritsidwa ntchito kwa odwala omwe anali ndi vuto la ERCP bile duct intubation m'gulu loyesera, chiŵerengero cha kupambana kwa intubation chinali chokwera kufika pa 96.0%.
Kafukufuku amene ali pamwambawa akusonyeza kuti kugwiritsa ntchito DGT kwa odwala omwe ali ndi vuto la biliary duct intubation pa ERCP kungathandize kwambiri kuti biliary duct intubation ipambane.
Zofooka za DGT zikuphatikizapo mfundo ziwiri izi:
(1) Pancreaswaya wotsogoleramwina kutayika panthawi yolowetsa ndulu m'mimba, kapena chachiwiriwaya wotsogoleraangalowenso mu duct ya pancreatic;
(2) Njira iyi si yoyenera pa milandu monga khansa ya mutu wa kapamba, kutsekeka kwa duct ya kapamba, ndi kusweka kwa kapamba.
Malinga ndi momwe PEP imachitikira, kuchuluka kwa DGT m'magazi a anthu odwala matenda a shuga (PEP) n'kochepa kuposa kuchuluka kwa DGT m'magazi a anthu odwala matenda a shuga (ERCP). Kafukufuku wina anasonyeza kuti kuchuluka kwa DGT m'magazi a anthu odwala matenda a shuga (ERCP) kunali 2.38% yokha mwa odwala omwe ali ndi vuto la biliary duct intubation. Mabuku ena amanena kuti ngakhale DGT ili ndi chiwopsezo chachikulu cha biliary duct intubation, kuchuluka kwa DGT pancreatitis kukadali kwakukulu poyerekeza ndi njira zina zochiritsira, chifukwa opaleshoni ya DGT ingayambitse kuwonongeka kwa pancreatic duct ndi kutsegula kwake. Ngakhale zili choncho, mgwirizano m'dziko muno ndi kunja umanenabe kuti pakakhala vuto la biliary duct intubation, pamene intubation imakhala yovuta ndipo pancreatic duct imasokonezedwa mobwerezabwereza, DGT ndiye chisankho choyamba chifukwa ukadaulo wa DGT uli ndi vuto lochepa pakugwira ntchito, ndipo ndi wosavuta kuulamulira. Umagwiritsidwa ntchito kwambiri posankha njira zovuta zochizira.
III. Chitsogozo cha waya chopangira cannulation-pan-creatic stent, WGC-P5
WGC-PS ingathenso kutchedwa njira yogwiritsira ntchito pancreatic duct stent. Njira iyi ndi yoyika pancreatic duct stent pamodzi ndiwaya wotsogolerayomwe imalowa molakwika mu duct ya pancreatic, kenako n’kutulutsawaya wotsogolerandipo amachita kutsekeka kwa ndulu pamwamba pa stent.
Kafukufuku wochitidwa ndi Hakuta ndi anzake adawonetsa kuti kuwonjezera pa kukweza kupambana kwa njira yonse yopangira ma intubation mwa kutsogolera njira yopangira ma intubation, WGC-PS ingatetezenso kutseguka kwa njira yotulutsira ma pancreatic ndikuchepetsa kwambiri kupezeka kwa PEP.
Kafukufuku wokhudza WGC-PS wochitidwa ndi Zou Chuanxin ndi anzake adawonetsa kuti kuchuluka kwa ma intubation ovuta pogwiritsa ntchito njira ya temporary pancreatic duct stent occupation kunafika pa 97.67%, ndipo kuchuluka kwa PEP kunachepa kwambiri.
Kafukufuku wina adapeza kuti stent ya pancreatic duct ikayikidwa bwino, mwayi wokhala ndi matenda oopsa a pancreatitis pambuyo pa opaleshoni m'mikhalidwe yovuta yolowetsa m'mimba umachepa kwambiri.
Njirayi ikadali ndi zofooka zina. Mwachitsanzo, stent ya pancreatic duct yomwe imayikidwa panthawi ya opaleshoni ya ERCP ikhoza kusunthidwa; ngati stent ikufunika kuyikidwa kwa nthawi yayitali pambuyo pa ERCP, padzakhala mwayi waukulu wotseka stent ndi kutsekeka kwa duct. Kuvulala ndi mavuto ena kumabweretsa kuwonjezeka kwa kuchuluka kwa PEP. Mabungwe ayamba kale kuphunzira za stent yakanthawi ya pancreatic duct yomwe imatha kutuluka mwangozi mu duct ya pancreatic. Cholinga chake ndikugwiritsa ntchito stent ya pancreatic duct kuti apewe PEP. Kuphatikiza pa kuchepetsa kwambiri kuchuluka kwa ngozi za PEP, stent zotere zimathanso kupewa opaleshoni zina kuti zichotse stent ndikuchepetsa nkhawa kwa odwala. Ngakhale kuti kafukufuku wasonyeza kuti stent yakanthawi ya pancreatic duct ili ndi zotsatira zabwino pochepetsa PEP, kugwiritsa ntchito kwawo kuchipatala kumakhalabe ndi zoletsa zazikulu. Mwachitsanzo, kwa odwala omwe ali ndi ducts zoonda za pancreatic ndi nthambi zambiri, zimakhala zovuta kuyika stent ya pancreatic duct. Kuvuta kudzawonjezeka kwambiri, ndipo opaleshoniyi imafuna akatswiri apamwamba a endoscopist. Ndikofunikiranso kudziwa kuti stent ya pancreatic duct yomwe yayikidwa siyenera kukhala yayitali kwambiri mu duodenal lumen. Stent yayitali kwambiri ingayambitse kubowoka kwa duodenal. Chifukwa chake, kusankha njira yogwiritsira ntchito pancreatic duct stent kuyenera kuchitidwa mosamala.
IV. Trans-pancreatocsphincterotomy, TPS
Ukadaulo wa TPS nthawi zambiri umagwiritsidwa ntchito waya wotsogolera akalowa mu duct ya pancreatic mwangozi. Septum yomwe ili pakati pa duct ya pancreatic imadulidwa motsatira njira ya waya wotsogolera wa duct ya pancreatic kuyambira 11 koloko mpaka 12 koloko, kenako chubucho chimayikidwa motsatira njira ya duct ya ndulu mpaka waya wotsogolera akalowa mu duct ya ndulu.
Kafukufuku wopangidwa ndi Dai Xin ndi ena anayerekeza TPS ndi ukadaulo wina wothandiza wolowetsa machubu. Zikuoneka kuti kupambana kwa ukadaulo wa TPS kuli kwakukulu kwambiri, kufika pa 96.74%, koma sikuwonetsa zotsatira zabwino kwambiri poyerekeza ndi ukadaulo wina wothandiza wolowetsa machubu. Ubwino wake.
Zanenedwa kuti makhalidwe a ukadaulo wa TPS akuphatikizapo mfundo zotsatirazi:
(1) Kuduladulako ndi kochepa kwa pancreaticobiliary septum;
(2) Kuchuluka kwa mavuto pambuyo pa opaleshoni n'kochepa;
(3) Kusankha njira yodulira n'kosavuta kulamulira;
(4) Njira iyi ingagwiritsidwe ntchito kwa odwala omwe ali ndi vuto la pancreatic duct intubation kapena nipples mkati mwa diverticulum.
Kafukufuku wambiri wasonyeza kuti TPS sikuti imangothandiza kuti pakhale njira yothandiza yotulutsira bile duct yovuta, komanso sikuwonjezera mavuto pambuyo pa ERCP. Akatswiri ena amati ngati pancreatic duct intubation kapena small duodenal papilla imachitika mobwerezabwereza, TPS iyenera kuganiziridwa kaye. Komabe, mukamagwiritsa ntchito TPS, muyenera kuganizira za kuthekera kwa pancreatic duct stenosis ndi kubwereranso kwa kapamba, zomwe ndi zoopsa za nthawi yayitali za TPS.
V. Precut Sphincterotomy, PST
Njira ya PST imagwiritsa ntchito gulu la papillary arcuate ngati malire apamwamba a pre-incision ndi njira ya 1-2 koloko ngati malire otsegulira duodenal papilla sphincter kuti mupeze potseguka pa bile ndi pancreatic duct. Pano PST ikutanthauza makamaka njira yodziwika bwino ya nipple sphincter pre-incision pogwiritsa ntchito mpeni wozungulira. Monga njira yothetsera vuto la bile duct intubation yovuta ya ERCP, ukadaulo wa PST wawonedwa kwambiri ngati chisankho choyamba cha zovuta za intubation. Endoscopic nipple sphincter pre-incision imatanthauza endoscopic incision ya papilla surface mucosa ndi minofu yochepa ya sphincter kudzera mu mpeni wozungulira kuti mupeze potulukira pa bile duct, kenako gwiritsani ntchitowaya wotsogolerakapena catheter kuti ilowetse ndulu m'magazi.
Kafukufuku wa m'dziko muno wasonyeza kuti chiŵerengero cha PST chopambana ndi chapamwamba kufika pa 89.66%, zomwe sizikusiyana kwambiri ndi DGT ndi TPS. Komabe, kuchuluka kwa PEP mu PST n'kokwera kwambiri kuposa kwa DGT ndi TPS.
Pakadali pano, chisankho chogwiritsa ntchito ukadaulo uwu chimadalira zinthu zosiyanasiyana. Mwachitsanzo, lipoti lina linanena kuti PST imagwiritsidwa ntchito bwino ngati duodenal papilla ili ndi vuto kapena yolakwika, monga duodenal stenosis kapena khansa.
Kuphatikiza apo, poyerekeza ndi njira zina zothanirana ndi vutoli, PST ili ndi zovuta zambiri monga PEP, ndipo zofunikira pa opaleshoniyi ndi zambiri, kotero opaleshoniyi imachitidwa bwino ndi akatswiri odziwa bwino ntchito za endoscopist.
VI. Kuchotsa singano ndi mpeni papillotomy, NKP
NKP ndi njira yopangira machubu pogwiritsa ntchito mpeni. Ngati machubu akuvuta, mpeni wa singano ungagwiritsidwe ntchito kudula gawo la papilla kapena sphincter kuchokera potseguka pa duodenal papilla mozungulira 11-12 koloko, kenako gwiritsani ntchitowaya wotsogolerakapena catheter ku Selective insertion mu common bile duct. Monga njira yothetsera vuto la biliary duct intubation, NKP ikhoza kupititsa patsogolo bwino kuchuluka kwa biliary duct intubation. Kale, anthu ambiri ankakhulupirira kuti NKP ingawonjezere kuchuluka kwa PEP m'zaka zaposachedwa. M'zaka zaposachedwa, malipoti ambiri ofufuza za m'mbuyo adanenanso kuti NKP siwonjezera chiopsezo cha mavuto pambuyo pa opaleshoni. Ndikofunikira kudziwa kuti ngati NKP ichitidwa kumayambiriro kwa biliary tract yovuta, idzakhala yothandiza kwambiri kupititsa patsogolo kupambana kwa biliary tract. Komabe, pakadali pano palibe mgwirizano pa nthawi yogwiritsira ntchito NKP kuti mupeze zotsatira zabwino kwambiri. Kafukufuku wina adanenanso kuti NKP imagwiritsidwa ntchito panthawi yaERCPMphindi zosakwana 20 zinali zokwera kwambiri kuposa za NKP zomwe zinagwiritsidwa ntchito pambuyo pa mphindi zosakwana 20.
Odwala omwe ali ndi vuto la kutsekeka kwa ndulu adzapindula kwambiri ndi njira imeneyi ngati ali ndi ziphuphu za nipple kapena kukulitsa kwambiri kwa ndulu. Kuphatikiza apo, pali malipoti akuti akakumana ndi zovuta zotsekeka, kugwiritsa ntchito pamodzi TPS ndi NKP kumakhala ndi chiwopsezo chachikulu kuposa kugwiritsa ntchito kokha. Choyipa chake ndichakuti njira zingapo zotsekeka zomwe zimagwiritsidwa ntchito pa nipple zidzawonjezera zovuta. Chifukwa chake, kafukufuku wowonjezereka akufunika kuti atsimikizire ngati angasankhe njira yoyambirira yotsekeka kuti achepetse zovuta kapena kuphatikiza njira zingapo zochiritsira kuti apititse patsogolo chiwopsezo cha zovuta zotsekeka.
VII.Mpeni wa singano Fistulotomy,NKE
Njira ya NKF imatanthauza kugwiritsa ntchito mpeni wa singano kuboola mucosa pafupifupi 5mm pamwamba pa nipple, pogwiritsa ntchito mphamvu yosakanikirana kudula gawo ndi gawo mozungulira 11 koloko mpaka kapangidwe kofanana ndi orifice kapena ndulu itasefukira, kenako kugwiritsa ntchito waya wotsogolera kuti adziwe kutuluka kwa ndulu ndi kudula kwa minofu. Kulowetsa ndulu m'mimba mwa njira yosankha kunachitidwa pamalo omwe panali jaundice. Opaleshoni ya NKF imadula pamwamba pa khomo la nipple. Chifukwa cha kukhalapo kwa ndulu m'njira yotupa, imachepetsa kwambiri kuwonongeka kwa kutentha ndi kuwonongeka kwa makina potsegula ndulu m'njira yotupa, zomwe zingachepetse kuchuluka kwa PEP.
Kafukufuku wochitidwa ndi Jin ndi anzake adawonetsa kuti kuchuluka kwa bwino kwa NK tube intubation kumatha kufika 96.3%, ndipo palibe PEP pambuyo pa opaleshoni. Kuphatikiza apo, kuchuluka kwa kupambana kwa NKF pakuchotsa miyala kuli kokwera kufika pa 92.7%. Chifukwa chake, kafukufukuyu akulimbikitsa NKF ngati chisankho choyamba chochotsera miyala ya ndulu. Poyerekeza ndi papillomyotomy yachikhalidwe, zoopsa za opaleshoni ya NKF ndizokwerabe, ndipo zimakhala ndi zovuta monga kubowoka ndi kutuluka magazi, ndipo zimafuna akatswiri odziwa bwino ntchito. Malo otsegulira zenera oyenera, kuya koyenera, ndi njira yolondola zonse ziyenera kuphunziridwa pang'onopang'ono.
Poyerekeza ndi njira zina zodulira zisanadulidwe, NKF ndi njira yosavuta kwambiri yokhala ndi chiwopsezo chachikulu. Komabe, njira iyi imafuna kuchitapo kanthu kwa nthawi yayitali komanso kusonkhanitsa kosalekeza kwa wogwiritsa ntchito kuti akhale waluso, kotero njira iyi si yoyenera kwa oyamba kumene.
VIII.Repeat-ERCP
Monga tafotokozera pamwambapa, pali njira zambiri zothetsera vuto la kulowetsa m'mimba movutikira. Komabe, palibe chitsimikizo chakuti zinthu ziyenda bwino 100%. Mabuku ofunikira asonyeza kuti nthawi zina kulowetsa m'mimba movutikira kumakhala kovuta, kulowetsa m'mimba movutikira kwa nthawi yayitali komanso mowirikiza kapena kutentha komwe kumalowa m'mimba movutikira kungayambitse kutupa kwa duodenal papilla. Ngati opaleshoniyo ipitirira, sikuti kulowetsa m'mimba movutikira kokha sikungapambane, komanso mwayi wa zovuta udzawonjezeka. Ngati vutoli litachitika, mutha kuganizira zothetsa vuto la m'mimba.ERCPChoyamba, chita opaleshoni yachiwiri ya ERCP nthawi ina iliyonse. Pambuyo poti edema ya papilloedema yatha, opaleshoni ya ERCP idzakhala yosavuta kuti ipangitse kuti ilowetsedwe bwino.
Donnnellan ndi anzake adachita sekondi yachiwiriERCPOpaleshoni ya odwala 51 omwe ERCP yawo inalephera atadulidwa ndi mpeni, ndipo milandu 35 inayenda bwino, ndipo kuchuluka kwa mavuto sikunachuluke.
Kim ndi anzake adachita opaleshoni yachiwiri ya ERCP pa odwala 69 omwe adalepheraERCPPambuyo podula singano ndi mpeni, ndipo milandu 53 inapambana, ndi chiŵerengero cha kupambana cha 76.8%. Milandu ina yotsalayo yosapambana inachitidwanso opaleshoni yachitatu ya ERCP, ndi chiŵerengero cha kupambana cha 79.7%., ndipo opaleshoni zingapo sizinawonjezere kubuka kwa zovuta.
Yu Li ndi anzake adachita secondary yosankhidwaERCPpa odwala 70 omwe adalephera kuchita ERCP atangodulidwa ndi mpeni, ndipo milandu 50 idapambana. Chiwerengero chonse cha kupambana (ERCP yoyamba + ERCP yachiwiri) chinakwera kufika pa 90.6%, ndipo kuchuluka kwa zovuta sikunakwere kwambiri. . Ngakhale malipoti atsimikizira kuti ERCP yachiwiri imagwira ntchito bwino, nthawi pakati pa ntchito ziwiri za ERCP siyenera kukhala yayitali kwambiri, ndipo nthawi zina zapadera, kutuluka kwa ndulu mochedwa kungapangitse vutoli kukhala lalikulu kwambiri.
IX. Kutuluka kwa ndulu motsogozedwa ndi Endoscopicultrasound, EUS-BD
EUS-BD ndi njira yolowerera yomwe imagwiritsa ntchito singano yoboola ndulu kuti iboole ndulu kuchokera m'mimba kapena duodenum lumen motsogozedwa ndi ultrasound, kulowa mu duodenum kudzera mu duodenal papilla, kenako nkuika ndulu m'mimba. Njira imeneyi imaphatikizapo njira zamkati mwa chiwindi ndi zina.
Kafukufuku wobwerezabwereza adanenanso kuti kuchuluka kwa EUS-BD komwe kunapambana kunafika pa 82%, ndipo kuchuluka kwa mavuto omwe amabwera pambuyo pa opaleshoni kunali 13% yokha. Mu kafukufuku woyerekeza, EUS-BD poyerekeza ndi ukadaulo wa pre-incision, kuchuluka kwa kupambana kwake kwa intubation kunali kwakukulu, kufika pa 98.3%, komwe kunali kwakukulu kwambiri kuposa 90.3% ya pre-incision. Komabe, pakadali pano, poyerekeza ndi ukadaulo wina, pakadalibe kafukufuku wokhudza kugwiritsa ntchito EUS pazovuta.ERCPKulowetsa m'chubu. Palibe deta yokwanira yotsimikizira kugwira ntchito kwa ukadaulo woboola ndulu wotsogozedwa ndi EUS pazovutaERCPKuika m'chubu. Kafukufuku wina wasonyeza kuti kwachepetsa. Ntchito ya PEP pambuyo pa opaleshoni si yokhutiritsa.
X. Kutuluka kwa madzi m'chiwindi kudzera m'chiwindi, PTCD
PTCD ndi njira ina yowunikira yomwe ingagwiritsidwe ntchito limodzi ndiERCPPa vuto la kutsekeka kwa ndulu, makamaka ngati ndulu yatsekeka. Njira imeneyi imagwiritsa ntchito singano yoboola kuti ilowe m'njira ya ndulu, kuboola ndulu kudzera papilla, kenako kulowetsa ndulu m'njira yobwerera m'mbuyo kudzera mu njira yosungidwa.waya wotsogoleraKafukufuku wina adafufuza odwala 47 omwe anali ndi vuto la biliary duct intubation omwe adagwiritsa ntchito njira ya PTCD, ndipo chiwopsezo cha kupambana chidafika 94%.
Kafukufuku wochitidwa ndi Yang ndi anzake adawonetsa kuti kugwiritsa ntchito EUS-BD n'kochepa pankhani ya hilar stenosis komanso kufunika koboola duct yoyenera ya bile intrahepatic, pomwe PTCD ili ndi ubwino wotsatira mzere wa duct ya bile komanso kukhala wosinthasintha kwambiri pazida zowongolera. Kulowetsa duct ya bile kuyenera kugwiritsidwa ntchito mwa odwala otere.
PTCD ndi ntchito yovuta yomwe imafuna maphunziro a nthawi yayitali komanso kumaliza milandu yokwanira. N'zovuta kwa oyamba kumene kumaliza ntchito imeneyi. PTCD si yovuta kuigwiritsa ntchito kokha, komansowaya wotsogolerazingawonongenso njira ya ndulu panthawi yopititsa patsogolo.
Ngakhale njira zomwe zili pamwambazi zitha kupititsa patsogolo kwambiri kuchuluka kwa kupambana kwa njira yovuta yotulutsira bile duct, chisankhocho chiyenera kuganiziridwa bwino.ERCP, SGT, DGT, WGC-PS ndi njira zina zitha kuganiziridwa; ngati njira zomwe zili pamwambapa zalephera, akatswiri a endoscopist odziwa bwino ntchito komanso odziwa bwino ntchito amatha kuchita njira zoyambira kudula, monga TPS, NKP, NKF, ndi zina zotero; ngati akadalibe Ngati njira yosankha ya bile duct intubation singathe kumalizidwa, njira yachiwiri yosankhaERCPakhoza kusankhidwa; ngati palibe njira iliyonse yomwe ili pamwambapa yomwe ingathetse vuto la kutsekeka kwa machubu ovuta, opaleshoni yolowerera monga EUS-BD ndi PTCD ikhoza kuyesedwa kuti ithetse vutoli, ndipo chithandizo cha opaleshoni chingasankhidwe ngati pakufunika kutero.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China omwe amagwira ntchito kwambiri pazinthu zogwiritsidwa ntchito m'ma endoscopic, monga biopsy forceps, hemoclip, polyp snare, sclerotherapy needle, spray catheter, cytology brushes,waya wotsogolera, dengu lotengera miyala, katheta yotulutsira madzi m'mphunondi zina zotero zomwe zimagwiritsidwa ntchito kwambiri mu EMR, ESD,ERCPZogulitsa zathu zili ndi satifiketi ya CE, ndipo mafakitale athu ali ndi satifiketi ya ISO. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi mbali ina ya Asia, ndipo makasitomala ambiri amalandira ulemu ndi kutamandidwa!
Nthawi yotumizira: Januwale-31-2024