Ercp ndiukadaulo wofunikira pakupezeka ndi matenda a biliary komanso pancreatic. Itatuluka, yapereka malingaliro ambiri othandizira matenda a biliary ndi pancreatic. Sizingokhala "radiciography". Icho chasintha kuchokera ku ukadaulo woyambirira wazindikiritso ku mtundu watsopano. Njira zochizira zimaphatikizanso sphictemyy, bile duct mwala kuchotsa, madzi ena amadzimadzi ndi njira zina zochitira Bile komanso pancreatic dongosolo.
Kupambana kwa njira yosanja ya bile ductition ya Ercp imatha kufika pa 90%, koma pali milandu yomwe imachitika yovuta yovuta ya Bile Duartion Intubotion. Malinga ndi mgwirizano waposachedwa wopezeka ndi matenda a Ercp, zovuta zitha kufotokozedwa monga: Nthawi Yosankha Yosankha Bile Draction Yachikulu ya Ercp yopitilira 3 kapena nambala yopitilira kasanu. Mukamachita Kulephera, ngati hule ductotion yovuta nthawi zina, njira zothandiza ziyenera kusankhidwa munthawi kuti zitheke bwino kwambiri. Nkhaniyi imawonetsa kuwunika mwatsatanetsatane njira zothandizirana ndi zothandizira zovuta zomwe zimagwiritsidwa ntchito kuthana ndi vuto lalikulu la bile dutication, ndikuwona kuti ndikupereka njira yothandizirana ndi ma endoscopists mukakumana ndi ndulu ya bile.
I.Singlebiideiirwire
Njira ya SGT ndikugwiritsa ntchito chosiyanitsa kuti apitilize kuyesera kuti muchepetse bile duct pambuyo pa waya wowongolera M'masiku oyambilira a ukadaulo wa Ercp, SGT inali njira yofala yothandizira intubation yovuta. Ubwino wake ndikuti ndikosavuta kugwira ntchito, kukonza chivundikiro, ndipo kumatha kukhala kosatseguka ka pancreatic, kumapangitsa kukhala kosavuta kupeza kutseguka kwa bile.
Pali malipoti mu mawu achinsinsi omwe pambuyo pa intubation amalephera, kusankha kuthandizidwa ndi SGT kungakwaniritse bwino ma bile dubiction mu 70% -80% ya milandu. Lipotilo linanenanso kuti ngati vuto la SGT, ngakhale kusintha ndi kugwiritsa ntchito kawirigongoTekinoloje sizinathandize bwino kuchuluka kwa bile dubition isbitition ndipo sanachepetse matenda a post-ercp pancreatis (PEP).
Maphunziro ena awonetsanso kuti kupambana kwa SGT intubation ndi yotsika kuposa iwirigongoTekinoloje ndi transpancuntchec papillary sphillary ukadaulo. Poyerekeza ndi zoyeserera mobwerezabwereza, kukhazikitsa koyambirira kwa kawirigongoTekinoloje kapena technology yolowera isanathe kukwaniritsa zotsatira zabwino.
Popeza kukula kwa Ercp, matekinoloje osiyanasiyana a New Technologies apangidwa kuti azikhala ovuta. Poyerekeza ndi imodzigongoTekinoloje, Ubwino ndi woonekeratu ndipo kupambana kwachuma ndikwapamwamba. Chifukwa chake, osakwatiwagongoTekinoloje yakadali pano sigwiritsidwa ntchito pakachipatala.
Njira ya II.Subled-waya, DGT
DGT imatha kutchedwa Pancreatic Dract Duct Duct Njira ya waya, yomwe ndikusiya waya wa pancreatic Dractic Dract Dract Dract Dract Dract Duct Duct waya wa waya wa Pancreact. Kusankha bile ductibution.
Ubwino wa njirayi ndi:
(1) mothandizidwa ndi agongo, kutseguka kwa bile kuli kosavuta kupeza, kupanga bile ductition yabwino;
(2) Waya wotsogolera akhoza fixehe.
(3) motsogozedwa ndi kapa ka pancreatic Ductgongo, zobwerezabwereza za Duct Duct imatha kupewedwa, potengera kukondoweza kwa ductic Dract yoyambitsidwa ndi intubation.
Dummoncau et al. adazindikira kuti chiwongolero cha catheter chimatha kuyikidwa mu dzenje la biopsy nthawi yomweyo, kenako adanenanso bwino za pancreatic DutwalagongoKupeza njira ya Pancreatic Dractic Duct imachita bwino ku bii ductition intubition. Mulingo wabwino.
Kafukufuku pa DGT ndi Liu Deren et al. anapeza kuti DGT adachitidwa kwa odwala omwe ali ndi vuto la Ercp Ble Coubakition, yopambana ya intubation idafika 95.65%, yomwe inali yokwezeka kwambiri kuposa 59.5% yopambana ya intubation.
Phunziro loyembekezera ndi lang Fuquan et al. Adanenanso kuti DGT idagwiritsidwa ntchito kwa odwala omwe ali ndi vuto lovuta la Ercp Rule Dulection mu Gulu Loyesera, opambana a 96.0%.
Kafukufuku yemwe ali pamwambawa akuwonetsa kuti kugwiritsa ntchito kwa odwala omwe ali ndi vuto la bile dubition ya Ercp kumatha kusintha bwino kuchuluka kwa bile ductition.
Zolakwika za DGT makamaka zimaphatikizapo mfundo ziwiri zotsatirazi:
(1) ka pancreaticgongoMwinanso kutayika nthawi ya bile ductition, kapena yachiwirigongoMulole ikani chiwonetsero cha pancreatic kachiwiri;
.
Kuchokera pakuwona kwa zigawo za Pep, zomwe zimachitika pa DGT ndizotsika kuposa za bile zomwe zimakupangitsani. Phunziro loyembekezera linati kuchitika kwa Pep pambuyo pa DGT kunali kokha 2.38% kokha kwa odwala olakwika ndi zovuta za bile dubiction. Mabuku ena amalongosola kuti ngakhale DGT ili ndi vuto lalikulu la bile ductitis, chifukwa ntchito ya DGT imatha kuwonongeka kwa kapa ka pancreatic dract ndi kutsegula kwake. Ngakhale izi, mgwirizano kunyumba ndi kumayiko ena akunena kuti nthawi yovuta kwambiri ya bile dubition, pomwe ukadaulo wa DGT umakhala wovuta kwambiri chifukwa chowongolera.
III.Wire malangizo owongolera - Pan-creatic stent, wgc-p5
WGC-PS amathanso kutchedwa Thepareatatic Duct Stent Yogwira Ntchito. Njirayi ndikuyika pancreatic duct stent ndigongomolakwika zomwe zimalowa pampando wa pancreatic, kenako kwezanigongondi kuchita bile duct pamwamba pamwamba pa trant.
Kafukufuku wokhudza Hakuta et al. Anawonetsa kuti kuwonjezera pa kusintha kwa intramu yopambana potsogolera intubition, WGC-PS imatha kuteteza kutseguka kwa kapa ka pancreatic.
Phunziro pa WGC-PS ndi Zou Chuanxin et al. Adanenanso kuti kuchita bwino kwa zovuta kugwiritsa ntchito kanthawi kochepa kanthawi kochepa komwe kumafika 97.67%, ndipo matendawa adatsitsidwa kwambiri.
Kafukufuku wina adapeza kuti pali chifuwa cha pancreatic dunt chimayikidwa bwino, mwayi woopsa kapamba kakang'ono mu milandu yovuta ya intubating umachepetsedwa kwambiri.
Njira iyi ilibe ndi zophophonya. Mwachitsanzo, pancreatic duct stent stent stent yolumikizidwa panthawi ya Ercp ikhoza kusanja; Ngati tsinde liyenera kuyikidwa kwa nthawi yayitali pambuyo pa Sercp, padzakhala mwayi wapamwamba wa stent block ndi duct kutsekeka. Kuvulala ndi zovuta zina kuti zikuwonjezereka mu matenda a PEP. Poyamba, mabungwe ayamba kuphunzira ma comcreetic osakhalitsa amatulutsa zigawo zomwe zingatuluke mu kapa ka pancreatic. Cholinga chake ndikugwiritsa ntchito kapa ka pancreatic Dract kuti aletse Pep. Kuphatikiza pa zovuta kuchepetsa kuchuluka kwa ngozi za ngozi za Pep, zimapewanso ntchito zina kuti zichotse tsinde ndikuchepetsa cholemetsa pa odwala. Ngakhale maphunziro awonetsa kuti ma dractiasic osakhalitsa osakhalitsa amakhala ndi zotsatira zabwino pochepetsa pep, ntchito yawo yamankhwala ili ndi zolephera zazikulu. Mwachitsanzo, odwala omwe ali ndi ma ductratic drakiti ndi nthambi zambiri, zimakhala zovuta kuyika kapa ka pancreatic drint. Zovuta ziwonjezeredwe kwakukulu, ndipo opaleshoniyi imafunikira gawo laling'ono la endoscopists. Ndikofunikanso kudziwa kuti pali stent stent stent stent yoyikidwa sikuyenera kukhala lalitali kwambiri mu duodenal luoden. Mbasi yayitali kwambiri imatha kuyambitsa matendawa. Chifukwa chake, kusankha kwa kapamba kantchito kagwiritsidwe kake kamene amafunika kuthandizidwa mosamala.
IV.Trans-Pancreatocsphinfinmy, TPS
Tekinoloje ya TPS imagwiritsidwa ntchito ngati waya wotsogolera atalowa pa kapaka ka pancreatic molakwitsa. Septum pakati pa kapa ka pancreatic duct yolumikizidwa ndikuwongolera kapa kaya ndi 2 koloko mpaka 12 koloko, kenako yaya waogawika amalowa muubowo.
Kuphunzira ndi dai Xin et al. kuyerekeza TPS ndi ziphunzitso zina ziwiri zaukadaulo. Zitha kuwona kuti kupambana kwa ukadaulo wa TPS kuli kokwera kwambiri, kufikira 96.70%, koma sikuwonetsa zotsatira zapamwamba poyerekeza ndi matekinolojewirira awiri a Arexikulu. Ubwino.
Zanenedwa kuti mapangidwe a TPS Technology amaphatikizapo mfundo zotsatirazi:
.
(2) Kuchuluka kwa zovuta za postoperative zovuta ndizochepa;
(3) Kusankhidwa kwa njira yodulira ndikosavuta kuwongolera;
.
Kafukufuku ambiri adanenanso kuti TPS siingathe kusintha bwino kuchuluka kwa bile dubition intubition, komanso sikuwonjezera zovuta zomwe zimachitika pambuyo pa zoletseka. Akatswiri ena amati ngati intuctic ductic ductication kapena papilla wawung'ono wa Duodenal amapezeka mobwerezabwereza, TPS iyenera kuwerengedwa koyamba. Komabe, mukamagwiritsa ntchito TPP, chidwi chiyenera kulipidwa kwa kapamba ductic Duct Snoction ndi kubwezeretsanso kwa kapamba, yomwe ndi yotheka nthawi yayitali ya TPS.
V.precut spanctetencey, pst
Njira ya PSS imagwiritsa ntchito gulu la papillary monga malire a chisanachitike ndi malire a 1-2 koloko pomwe malire kuti atsegule papilla wa Duodenal kuti apeze kutseguka kwa bile ndi kapa kapamba. Apa Ps makamaka amatanthauza njira yokhazikika ya nippnncy isanayambe yogwiritsa ntchito mpeni wakugwa. Monga njira yothanirana ndi maudindo ovuta a bicp, a ukadaulo wa pst waganiziridwa kwambiri kuti ndi chisankho choyambirira cha intubation. Endoscopic nippncter pre-inffiers amatanthauza kuyika kwa endoscopic kwa mucosa ndi minofu yochepa kwambiri kuti muchepetse kutseguka kwa bile, kenako ndikugwiritsa ntchito agongokapena catheter kuti musangalatse bile duct.
Phunziro lanyumba linawonetsa kuti kupambana kwa PSS ikhale yokwera kwambiri 89.66%, yomwe siyisiyana kwambiri ndi DGT ndi TPS. Komabe, matenda a PRT mu PST ali okwera kwambiri kuposa a DGT ndi TPS.
Pakadali pano, kusankha kugwiritsa ntchito ukadaulo uwu kumatengera zinthu zosiyanasiyana. Mwachitsanzo, lipoti lina linanena kuti PSS imagwiritsidwa ntchito bwino nthawi yomwe duodenal Papilla ndi zachilendo kapena zosokoneza, monga duodenal steosis kapena ziphuphu.
Kuphatikiza apo, poyerekeza ndi njira zina zokopera, pst ili ndi zovuta zambiri monga pep, ndipo zofunikira za opaleshoni ndizokwera, motero opaleshoni iyi imachitidwa bwino ndi endoscopiscists.
Vi.needle-mpeni papilillotomy, nkp
NKP ndi njira yothandizirana ndi istle. Pamene ulesi ndi wovuta, mpeni wa singano ungagwiritsidwe ntchito kutsegulidwa kwa papilla kapena sphinrter kuchokera kutsegulidwa kwa papilla wa Duodenal Papillan wa 11-12 koloko, kenako ndikugwiritsa ntchito agongokapena catheter kuti musinthe kulowetsa mu buct wamba. Monga njira yothanirana ndi ndulu ya bile dubition, nngp imatha kusintha bwino kuchuluka kwa bile dubition intubition. M'mbuyomu, nthawi zambiri zimakhulupirira kuti NKP imawonjezera kuchuluka kwa tizilombo m'zaka zaposachedwa. M'zaka zaposachedwa, malipoti ambiri osankhidwa adawonetsa kuti NBP siyikuwonjezera chiopsezo cha zovuta za postoperative. Ndikofunika kudziwa kuti ngati NGP imachitika kumayambiriro kwa intubation, ikhale yothandiza kwambiri kukonza bwinobwino. Komabe, palibe mgwirizano womwe ukugwirizana nawo mukamagwiritsa ntchito NKP kuti mukwaniritse zabwino. Kafukufuku wina adanena kuti kuchuluka kwa NDP kugwiritsidwa ntchitoErcpMphindi zosakwana 20 zinali zazikulu kwambiri kuposa NBP yogwiritsidwa ntchito mtsogolo mphindi 20 pambuyo pake.
Odwala omwe ali ndi vuto lalikulu la bile amapindula kwambiri ndi njirayi ngati ali ndi zipolopolo za buluzi kapena bile duct digiction dile. Kuphatikiza apo, pali malipoti akuti mukakumana ndi milandu yovuta, kuphatikiza kwa TPS ndi NKP imakhala yopambana kuposa kugwiritsa ntchito yokha. Zovuta ndichakuti njira zingapo zowoneka bwino kwa nipple zimawonjezera zovuta. Chifukwa chake, kafukufuku wochulukirapo ndikofunikira kuti atsimikizire ngati mungasankhe kukonzekera kuchitika kapena kuphatikiza njira zingapo zothanirana ndi zovuta zopambana.
VII.NEEE-Knife Fistulotomy, Nke
Njira ya NKF imatanthawuza kugwiritsa ntchito mpeni wa singano kuti mubowole mucosa pafupifupi 5mm kapena kugwiritsa ntchito waya wa olojekiti kuti adziwe kutuluka kwa bile komanso kusakhazikika minofu. Zosankha za Bile Bolection zidachitidwa pa tsamba la jaundice. Opaleshoni ya NKF imadula pamwamba pa kutsegula kwa utoto. Chifukwa cha kukhalapo kwa bile duct sinus, kumachepetsa kuwonongeka kwa mafuta komanso kuwonongeka kwamakina kutsegulidwa kwa kapacreetic Duct, yomwe imatha kuchepetsa matenda a PER.
Kuphunzira ndi jin et al. Adanenanso kuti chopambana cha NK chubu TuBE chitha kufikira 96.3%, ndipo palibe postream. Kuphatikiza apo, kupambana kwa NKF mu kuchotsa miyala kuli kokwera ngati 92.7%. Chifukwa chake, phunziroli limalimbikitsa Nkf ngati chisankho choyambirira cha miyala yamiyala yoyendetsedwa. . Poyerekeza ndi papillomyyotomymyy, zoopsa za Nkf zikukwerabe, ndipo zimakonda kuvuta monga zotupa ndi magazi, ndipo zimafunikira kuchuluka kwa endoscopists. Panja lotsegulira zenera lotseguka, mozama, testiquey yense yonse yofunikira ophunzira pang'onopang'ono. mbuye.
Poyerekeza ndi njira zina zopindika, Nkf ndi njira yabwino kwambiri yopambana kwambiri. Komabe, njirayi imafunikira chizolowezi cha nthawi yayitali komanso kudzipatula kopitilira wogwiritsa ntchito kuti akhale waluso, ndiye kuti njirayi sioyenera kwa oyamba kumene.
VIII.EPAT-ERCP
Monga tafotokozera pamwambapa, pali njira zothanirana ndi zovuta. Komabe, palibe chitsimikizo cha kupambana kwa 100%. Mabuku oyenera anena kuti pamene Bile Duckion ndi yovuta nthawi zina, int-inter-interbider kapena angapo Ngati opaleshoniyo ikupitilira, sikuti kachilombo ka bile pokhapokha ngati intubotion siyikulephera, koma mwayi wovuta udzachulukanso. Ngati momwe zilili pamwambapa zimachitika, mutha kuganizira kuthetsa zomwe zilipoErcpKuchita Choyamba ndikuchita Chinsinsi Chachiwiri Panthawi Yosankha. Papilloedemmaeedeedeedeer, kugwirira ntchito kwa Ercp kudzakhala kosavuta kukwaniritsa zoyenda bwino.
Donelllan et al. anachita sekondiErcpKuchitapo kanthu pa odwala 51 omwe Ercp adalephera pambuyo pa mawonekedwe a singano-mpeni, ndipo milandu 35 idachita bwino, ndipo zovuta sizinachuluke.
Kim et al. anachitapo kanthu wachiwiri kwa odwala 69 odwala omwe alepheraErcpPambuyo pa singano - mpeni woyamba, ndipo milandu 53 idachita bwino, yopambana ya 76.8%. Milandu yomwe yalephera idagwirira ntchito ntchito yachitatu yachitatu, yopambana ya 79.7%. , ndipo maopaleshoni ambiri sanawonjezere zovuta.
Yu li et al. Katundu Wosankha WosankhaErcpOdwala 70 omwe adalephera Ercp pambuyo pa singano pambuyo pa chisanachitike, ndipo milandu 50 idachita bwino. Kuchita bwino kwambiri (woyamba ercp + sercp) Kuchuluka kwa 90.6%, komanso zovuta zina sizinakule kwambiri. . Ngakhale malipoti atsimikizira kupambana kwa Ercp, nthawi yomwe ili pakati pa ntchito ziwiri siziyenera kukhala zazitali, ndipo m'milandu yapadera, kuchedwa kwa bilia wochedwa kumatha kukulitsa vutoli.
IX.endoScopichiltrasound-yotsogozedwa ndi mitundu yotsogozedwa, Eus-BD
Eus-BD ndi njira yoyipa yomwe imagwiritsa ntchito singano yopumira kuti ipume ya ndulu kuchokera ku chitsogozo cha ultrasound pansi pa chitsogozo cha ultransaal. Njirayi imaphatikizapo zonse zovuta komanso zowonjezera.
Kafukufuku wodziwikiratu anati kuchuluka kwa Eus-BD kunafika 82%, ndipo matendawa ndi omwe ali ndi zaka 13% okha. Mu kafukufuku wofananira, EUS-Bad poyerekeza ndi ukadaulo wokhazikika, wochita bwino kwambiri, mpaka 98.3%, yomwe inali yokwezeka kwambiri kuposa 90.3% yoyambira. Komabe, pakadali pano, poyerekeza ndi matekinoloji ena, komabe alibe kafukufuku wogwiritsa ntchito Eus chifukwa chovutaErcpintubatition. Palibe zambiri zokwanira kutsimikizira kugwira bwino kwaukadaulo wotsogozedwa ndi bileErcpintubatition. Kafukufuku wina wawonetsa kuti wachepetsa gawo la postoperative Pup silitsimikizika.
X.perctioneous trashepapatic cholangial ngalande, PTCD
PTCD ndi njira ina yoyeserera yomwe ingagwiritsidwe ntchito limodziErcpKwa ndutsi yovuta ya bile ductition, makamaka ngati mitengo yovuta kubisala. Njirayi imagwiritsa ntchito singano yopumira yoti zitheke pompopompo bilegongo. Phunziro limodzi losanthula odwala 47 omwe ali ndi vuto la bile dubition lomwe limayambitsa njira ya PTCD, ndipo opambanawo adafika 94%.
Kuphunzira ndi Yang et al. Adanenanso kuti kugwiritsa ntchito Eus-BD kumangokhala ochepa pomwe kumangofunika kusinthika kwa bile pomwepo, pomwe PTCD ili ndi maubwino ogwiritsira ntchito bile duct axis ndikusinthanso pazida zotsogolera. Mitundu ya bile ducti iyenera kugwiritsidwa ntchito mwa odwala.
PTCD ndi chovuta chovuta chomwe chimafuna maphunziro autali komanso kumaliza kwa milandu yokwanira. Zimakhala zovuta kuti novelic kuti akwaniritse izi. Ptcd sikovuta kugwira ntchito, komagongoatha kuwononganso bile duct pa kupita patsogolo.
Ngakhale njira zomwe zili pamwambazi zitha kusintha kwambiri momwe zingatheke kuti zingatheke kukhala zovuta, chisankhochi chiyenera kuganiziridwa bwino. MukamachitaErcp, SGT, DGC-WGC-PS ndi njira zina zomwe zingaganizidwe; Ngati luso lapamwambalo likulephera, wokalamba komanso wodziwa matenda a Endoscopists amatha kuchita njira zolowera kale, monga TPS, NKF, Nkf, etc.; Ngati akadali kusankha ma bile dubiction sangathe, sekondale yachiwiriErcpzitha kusankhidwa; Ngati palibe njira zomwe zili pamwambazi zomwe zingathetse vuto la intubation, maofesi osokoneza bongo monga Eus-Bd ndi PTCD akhoza kuyesedwa kuthetsa vutoli, ndipo opaleshoni ingasankhidwe ngati pakufunika.
Iiangxi zhuoruiacachirical chida co., ltd.gongo, Mtanga Wobwezeretsa Mlandu, Minda ya NASAAL BRARARDetc. zomwe zimagwiritsidwa ntchito kwambiri ku Emr, ESD,Ercp. Zogulitsa zathu ndi CE kutsimikizika, ndipo mbewu zathu ndiotsimikizika. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi gawo la Asia, ndipo amapeza kasitomala wodziwika kuti avomereze ndi matamando!
Post Nthawi: Jan-31-2024