ERCP ndiukadaulo wofunikira pakuzindikiritsa ndi kuchiza matenda a biliary ndi kapamba.Ikatuluka, yapereka malingaliro ambiri atsopano ochizira matenda a biliary ndi kapamba.Sizimangotengera "radiography".Zasintha kuchokera ku teknoloji yoyambirira yodziwira matenda kukhala mtundu watsopano.Njira zothandizira zimaphatikizapo sphincterotomy, kuchotsa miyala ya bile duct, bile drainage ndi njira zina zochizira matenda a bile ndi kapamba.
Kupambana kwa kusankha kwa bile duct intubation kwa ERCP kumatha kupitilira 90%, komabe pali nthawi zina pomwe kuvutikira kwa biliary kumapangitsa kusankha kwa bile duct intubation kulephera.Malinga ndi kuvomerezana kwaposachedwa pa matenda ndi chithandizo cha ERCP, intubation yovuta ingatanthauzidwe kuti: nthawi yosankha njira yopangira ndulu ya ERCP yodziwika bwino ndi yopitilira mphindi 10 kapena kuchuluka kwa kuyeserera kopitilira 5 nthawi.Pamene mukuchita ERCP, ngati bile duct intubation imakhala yovuta nthawi zina, njira zogwira mtima ziyenera kusankhidwa panthawi yake kuti ziwongolere bwino.Nkhaniyi ikuwunikiranso mwadongosolo njira zingapo zothandizira zopangira zomwe zimagwiritsidwa ntchito pothana ndi zovuta za bile duct intubation, ndi cholinga chopereka maziko ongoyerekeza kwa akatswiri azachipatala kuti asankhe njira yoyankhira akakumana ndi zovuta za bile duct intubation ya ERCP.
I.Singleguidewire Technique,SGT
Njira ya SGT ndikugwiritsa ntchito chosiyanitsa kuti mupitirize kuyesa kulowetsa duct ya bile pambuyo waya wowongolera kulowa mu pancreatic duct.M'masiku oyambilira aukadaulo wa ERCP, SGT inali njira yodziwika bwino yopangira biliary intubation.Ubwino wake ndikuti ndiyosavuta kugwiritsa ntchito, imakonza nsonga ya nsonga, ndipo imatha kukhala ndikutsegula kwa pancreatic duct, zomwe zimapangitsa kuti zikhale zosavuta kupeza kutsegula kwa bile.
Pali malipoti m'mabuku oti pambuyo pakulephereka kwanthawi zonse, kusankha intubation yothandizidwa ndi SGT kumatha kumaliza bwino njira yolumikizira ma ducts pafupifupi 70% -80% yamilandu.Lipotilo linanenanso kuti milandu ya SGT yolephera, ngakhale kusintha ndi kugwiritsa ntchito kawiriguidewireluso laukadaulo silinasinthe kuchuluka kwabwino kwa bile duct intubation ndipo silinachepetse kuchuluka kwa post-ERCP pancreatitis (PEP).
Kafukufuku wina wawonetsanso kuti kupambana kwa SGT intubation ndikotsika kuposa kuwirikiza kawiriguidewireteknoloji ndi ukadaulo wa transpancreatic papillary sphincterotomy.Poyerekeza ndi kuyesa mobwerezabwereza kwa SGT, kukhazikitsa koyambirira kawiriguidewireumisiri kapena ukadaulo wa pre-incision ukhoza kupeza zotsatira zabwino.
Chiyambireni chitukuko cha ERCP, mitundu yosiyanasiyana ya matekinoloje atsopano yapangidwa kuti ikhale yovuta.Poyerekeza ndi singleguidewireluso, ubwino ndi zoonekeratu kwambiri ndi mlingo bwino ndi apamwamba.Choncho, singleguidewireumisiri panopa kawirikawiri ntchito zachipatala.
II.Double-guide waya njira,DGT
DGT imatha kutchedwa njira ya pancreatic duct guide wire occupation njira, yomwe imasiya waya wowongolera womwe umalowa mu pancreatic duct kuti uutsate ndikukhalamo, kenako waya wowongolera wachiwiri ungagwiritsidwenso ntchito pamwamba pa waya wowongolera pancreatic duct.Kusankha bile duct intubation.
Ubwino wa njirayi ndi:
(1) Mothandizidwa ndi aguidewire, kutsegula kwa ndulu ndikosavuta kupeza, kupangitsa kuti intubation ya ndulu ikhale yosalala;
(2) Waya wowongolera amatha kukonza nsonga;
(3) Motsogozedwa ndi pancreatic ductguidewire, kuyang'ana mobwerezabwereza kwa pancreatic duct kungapewedwe, motero kuchepetsa kukopa kwa pancreatic duct chifukwa cha kubwereza mobwerezabwereza.
Dumonceau et al.adawona kuti katheta wowongolera komanso wosiyanitsa amatha kulowetsedwa mu dzenje la biopsy nthawi imodzi, ndiyeno adanenanso za njira yopambana ya pancreatic duct guidewire occupying njira, ndipo adatsimikiza kuti.guidewirekugwiritsa ntchito njira ya pancreatic duct ndikopambana kwa bile duct intubation.mtengo uli ndi zotsatira zabwino.
Kafukufuku pa DGT wopangidwa ndi Liu Deren et al.adapeza kuti DGT itachitidwa pa odwala omwe ali ndi vuto la ERCP bile duct intubation, chiwopsezo cha intubation chidafika 95.65%, chomwe chinali chokwera kwambiri kuposa 59.09% yakuchita bwino kwa intubation wamba.
Kafukufuku woyembekezeredwa ndi Wang Fuquan et al.adawonetsa kuti DGT ikagwiritsidwa ntchito kwa odwala omwe ali ndi zovuta za ERCP bile duct intubation mu gulu loyesera, chiwopsezo cha intubation chinali chokwera mpaka 96.0%.
Maphunziro omwe ali pamwambapa akuwonetsa kuti kugwiritsa ntchito DGT kwa odwala omwe ali ndi vuto la bile duct intubation ya ERCP kumatha kupititsa patsogolo kuchuluka kwa bile duct intubation.
Zofooka za DGT makamaka zimaphatikizapo mfundo ziwiri izi:
(1) Pancreatoguidewiremwina kutayika panthawi yopangira bile, kapena yachiwiriguidewireatha kulowanso pancreatic duct;
(2) Njira imeneyi si yoyenera pa milandu monga khansa ya mutu wa pancreatic, pancreatic duct tortuosity, ndi pancreatic fission.
Malinga ndi zochitika za PEP, zochitika za PEP za DGT ndizotsika kuposa zomwe zimachitika wamba duct intubation.Kafukufuku woyembekezeredwa adawonetsa kuti kuchuluka kwa PEP pambuyo pa DGT kunali 2.38% yokha mwa odwala a ERCP omwe ali ndi vuto la bile duct intubation.Mabuku ena akuwonetsa kuti ngakhale DGT ili ndi chiwopsezo chokwera kwambiri cha bile duct intubation, kuchuluka kwa post-DGT pancreatitis akadali ochulukirapo poyerekeza ndi njira zina zochizira, chifukwa ntchito ya DGT imatha kuwononga pancreatic duct ndikutsegula kwake.Ngakhale izi, kuvomerezana kunyumba ndi kunja kumawonetsabe kuti pakagwa zovuta za bile duct intubation, pamene intubation imakhala yovuta ndipo pancreatic duct imasokonekera mobwerezabwereza, DGT ndiye chisankho choyamba chifukwa ukadaulo wa DGT umakhala ndi zovuta zochepa kugwira ntchito, komanso zosavuta. to control.Imagwiritsidwa ntchito kwambiri posankha zovuta.
III.Waya kalozera cannulation-pan-creatic stent,WGC-P5
WGC-PS imathanso kutchedwa njira ya pancreatic duct stent occupation.Njira iyi ndikuyika pancreatic duct stent ndiguidewireyomwe imalowa molakwika mu pancreatic duct, kenako ndikutulutsaguidewirendikuchita kutsekemera kwa bile pamwamba pa stent.
Kafukufuku wopangidwa ndi Hakuta et al.adawonetsa kuti kuwonjezera pakuwongolera kuchuluka kwabwino kwa intubation powongolera intubation, WGC-PS imathanso kuteteza kutseguka kwa pancreatic duct ndikuchepetsa kwambiri kupezeka kwa PEP.
Kafukufuku pa WGC-PS wolembedwa ndi Zou Chuanxin et al.adawonetsa kuti chiwongolero chazovuta za intubation pogwiritsa ntchito njira yanthawi yochepa ya pancreatic duct stent occupation idafika 97.67%, ndipo kuchuluka kwa PEP kudachepa kwambiri.
Kafukufuku wina adapeza kuti pancreatic duct stent ikayikidwa molondola, mwayi wa pancreatitis yoopsa kwambiri muzochitika zovuta za intubation imachepetsedwa kwambiri.
Njira imeneyi ikadali ndi zofooka zina.Mwachitsanzo, pancreatic duct stent yomwe imayikidwa panthawi ya ERCP ikhoza kuchotsedwa;ngati stent iyenera kuikidwa kwa nthawi yayitali pambuyo pa ERCP, padzakhala mwayi waukulu wa kutsekeka kwa stent ndi kutsekeka kwa njira.Kuvulala ndi mavuto ena kumabweretsa kuwonjezeka kwa chiwerengero cha PEP.Mabungwe ayamba kale kuphunzira ma stents akanthawi a pancreatic duct omwe amatha kutuluka mwangozi mu pancreatic duct.Cholinga chake ndikugwiritsa ntchito pancreatic duct stents kuteteza PEP.Kuphatikiza pa kuchepetsa kwambiri zochitika za ngozi za PEP, ma stents oterewa amathanso kupewa maopaleshoni ena kuti achotse stent ndikuchepetsa kulemetsa kwa odwala.Ngakhale kafukufuku wasonyeza kuti ma pancreatic duct stents akanthawi amakhala ndi zotsatira zabwino pakuchepetsa PEP, kugwiritsa ntchito kwawo kuchipatala kumakhalabe ndi malire akulu.Mwachitsanzo, kwa odwala omwe ali ndi ma pancreatic ducts ndi nthambi zambiri, zimakhala zovuta kuyika pancreatic duct stent.Vutoli lidzawonjezeka kwambiri, ndipo opaleshoniyi imafuna akatswiri apamwamba a endoscopists.Ndikoyeneranso kudziwa kuti pancreatic duct stent yoyikidwa siyenera kukhala yayitali kwambiri mu duodenal lumen.Kutupa kwanthawi yayitali kungayambitse kuphulika kwa duodenum.Chifukwa chake, kusankha njira ya pancreatic duct stent kuyenera kuchitidwabe mosamala.
IV.Trans-pancreatocsphincterotomy,TPS
Ukadaulo wa TPS umagwiritsidwa ntchito nthawi zambiri waya wowongolera atalowa munjira ya pancreatic molakwika.Septum yomwe ili pakati pa pancreatic duct imayikidwa motsatira njira ya waya wotsogolera pancreatic duct kuyambira 11 koloko mpaka 12 koloko, kenako chubucho chimalowetsedwa molunjika ku njira ya bile mpaka waya wowongolera alowa mu bile. njira.
Kafukufuku wopangidwa ndi Dai Xin et al.poyerekeza TPS ndi maukadaulo ena awiri othandizira intubation.Zitha kuwoneka kuti kupambana kwaukadaulo wa TPS ndikokwera kwambiri, kufika 96.74%, koma sikuwonetsa zotsatira zabwino poyerekeza ndi matekinoloje ena awiri othandizira intubation.Ubwino wake.
Zanenedwa kuti mawonekedwe aukadaulo wa TPS akuphatikiza mfundo zotsatirazi:
(1) Chochekacho ndi chaching'ono kwa pancreaticobiliary septum;
(2) Zomwe zimachitika pambuyo pa opaleshoni zimakhala zochepa;
(3) Kusankhidwa kwa njira yodulira ndikosavuta kuwongolera;
(4) Njirayi ingagwiritsidwe ntchito kwa odwala omwe ali ndi mobwerezabwereza pancreatic duct intubation kapena nipples mkati mwa diverticulum.
Kafukufuku wambiri wasonyeza kuti TPS sikungangowonjezera bwino kuchuluka kwa zovuta za bile duct intubation, komanso sizimawonjezera mavuto pambuyo pa ERCP.Akatswiri ena amati ngati pancreatic duct intubation kapena papilla yaying'ono ya duodenal imachitika mobwerezabwereza, TPS iyenera kuganiziridwa kaye.Komabe, mukamagwiritsa ntchito TPS, chidwi chiyenera kuperekedwa ku kuthekera kwa pancreatic duct stenosis ndi kuyambiranso kwa kapamba, zomwe zitha kukhala zoopsa za nthawi yayitali za TPS.
V.Precut Sphincterotomy,PST
Njira ya PST imagwiritsa ntchito gulu la papillary arcuate monga malire apamwamba a pre-incision ndi njira ya 1-2 koloko ngati malire otsegula duodenal papilla sphincter kuti apeze kutsegula kwa bile ndi pancreatic duct.Apa PST imatanthawuza njira yokhazikika ya nipple sphincter pre-incision pogwiritsa ntchito mpeni wa arcuate.Monga njira yothanirana ndi zovuta za bile duct intubation ya ERCP, ukadaulo wa PST wawonedwa mofala kuti ndiye chisankho choyamba pakupanga zovuta.Endoscopic nipple sphincter pre-incision imatanthawuza kudulidwa kwa endoscopic kwa papilla surface mucosa ndi minofu yaing'ono ya sphincter kupyolera mu mpeni kuti mupeze kutsegula kwa ndulu, ndiyeno gwiritsani ntchitoguidewirekapena catheter kuti mulowetse njira ya bile.
Kafukufuku wapakhomo adawonetsa kuti kupambana kwa PST ndikwambiri kuposa 89.66%, zomwe sizosiyana kwambiri ndi DGT ndi TPS.Komabe, zochitika za PEP mu PST ndizokwera kwambiri kuposa za DGT ndi TPS.
Pakalipano, chisankho chogwiritsa ntchito teknolojiyi chimadalira zinthu zosiyanasiyana.Mwachitsanzo, lipoti lina linanena kuti PST imagwiritsiridwa ntchito bwino kwambiri pamene papilla ya m’mimba mwa duodenal ili yachilendo kapena yopotoka, monga ngati duodenal stenosis kapena zilonda.
Kuonjezera apo, poyerekeza ndi njira zina zothandizira kuthana ndi vutoli, PST imakhala ndi zovuta zambiri monga PEP, ndipo zofunikira zogwirira ntchito zimakhala zapamwamba, choncho opaleshoniyi imachitidwa bwino ndi akatswiri odziwa bwino za endoscopists.
VI. Singano-mpeni Papillotomy,NKP
NKP ndi singano-mpeni-assisted intubation njira.Pamene intubation ili yovuta, mpeni wa singano ukhoza kugwiritsidwa ntchito kupaka gawo la papilla kapena sphincter kuchokera pakatikati pa duodenal papilla molunjika 11-12 koloko, ndiyeno gwiritsani ntchitoguidewirekapena catheter kupita Kusankha kuika mu wamba ndulu duct.Monga njira yothanirana ndi zovuta za bile duct intubation, NKP imatha kusintha bwino kuchuluka kwa zovuta za bile duct intubation.M'mbuyomu, anthu ankakhulupirira kuti NKP idzawonjezera chiwerengero cha PEP m'zaka zaposachedwa.M'zaka zaposachedwa, malipoti ambiri owonetsera zakale awonetsa kuti NKP sichikuwonjezera chiopsezo cha zovuta zapambuyo.Ndikoyenera kudziwa kuti ngati NKP ikuchitika kumayambiriro kwa zovuta za intubation, zidzakhala zothandiza kwambiri kuti zitheke bwino.Komabe, pakadali pano palibe mgwirizano pa nthawi yoti mugwiritse ntchito NKP kuti mupeze zotsatira zabwino.Kafukufuku wina adanenanso kuti intubation rate ya NKP idagwiritsidwa ntchito panthawiyiERCPzosakwana mphindi 20 zinali zapamwamba kwambiri kuposa zomwe NKP idagwiritsidwa ntchito mochedwa kuposa mphindi 20 pambuyo pake.
Odwala omwe ali ndi vuto la kutsekeka kwa ndulu amapindula kwambiri ndi njirayi ngati ali ndi zotupa za nsonga kapena dilation yayikulu.Kuonjezera apo, pali malipoti oti mukakumana ndi zovuta zowonongeka, kugwiritsidwa ntchito pamodzi kwa TPS ndi NKP kumakhala ndi kupambana kwakukulu kuposa kugwiritsa ntchito nokha.Choyipa chake ndichakuti njira zingapo zodulira nsonga zamabele zimawonjezera zovuta.Choncho, kafukufuku wochuluka akufunika kuti atsimikizire ngati angasankhiretu kudulidwa koyambirira kuti achepetse kuyambika kwa zovuta kapena kuphatikiza njira zingapo zothanirana ndi vuto la intubation yovuta.
VII.Mpeni wa singano Fistulotomy,NKE
Njira ya NKF imatanthawuza kugwiritsa ntchito mpeni wa singano kuboola mucosa pafupifupi 5mm pamwamba pa nipple, pogwiritsa ntchito makina osakanikirana kuti alowetse wosanjikiza ndi wosanjikiza molunjika 11 koloko mpaka mawonekedwe a orifice kapena bile kusefukira kwapezeka, ndiyeno kugwiritsa ntchito. waya wowongolera kuti azindikire kutuluka kwa ndulu ndi kung'ambika kwa minofu.Kusankha kwa bile duct intubation kunachitika pamalo a jaundice.Opaleshoni ya NKF imadula pamwamba pa kutsegula kwa nipple.Chifukwa cha kukhalapo kwa bile duct sinus, imachepetsa kwambiri kuwonongeka kwamafuta komanso kuwonongeka kwamakina pakutsegula kwa pancreatic duct, zomwe zimatha kuchepetsa kuchuluka kwa PEP.
Kafukufuku wopangidwa ndi Jin et al.adawonetsa kuti kupambana kwa NK chubu intubation kumatha kufika 96.3%, ndipo palibe PEP ya postoperative.Kuphatikiza apo, kupambana kwa NKF pakuchotsa miyala ndikukwera mpaka 92.7%.Chifukwa chake, kafukufukuyu amalimbikitsa NKF ngati chisankho choyamba chochotsa miyala ya ndulu..Poyerekeza ndi ochiritsira papillomyotomy, NKF ntchito zoopsa akadali apamwamba, ndipo sachedwa mavuto monga perforation ndi magazi, ndipo pamafunika mkulu opaleshoni mlingo wa endoscopists.Malo oyenera otsegulira zenera, kuya koyenera, ndi njira zolondola zonse ziyenera kuphunziridwa pang'onopang'ono.mbuye.
Poyerekeza ndi njira zina zocheka zisanadze, NKF ndi njira yosavuta komanso yopambana kwambiri.Komabe, njirayi imafuna chizolowezi cha nthawi yayitali komanso kudzikundikira kosalekeza ndi wogwira ntchitoyo kuti akhale oyenerera, kotero njira iyi si yoyenera kwa oyamba kumene.
VIII.Repeat-ERCP
Monga tafotokozera pamwambapa, pali njira zambiri zothanirana ndi zovuta za intubation.Komabe, palibe chitsimikizo cha kupambana kwa 100%.Zolemba zofunikira zasonyeza kuti pamene bile duct intubation imakhala yovuta nthawi zina, kulowetsa kwa nthawi yaitali ndi kangapo kapena kulowetsedwa kwa kutentha kwa pre-cut kungayambitse duodenal papilla edema.Opaleshoniyo ikapitilira, sikuti kulowetsa bile duct intubation sikungapambane, koma mwayi wamavuto udzawonjezekanso.Ngati zomwe zili pamwambapa zichitika, mutha kuganizira zothetsa vutoliERCPopareshoni kaye ndikuchita ERCP yachiwiri panthawi yomwe mukufuna.Papilloedema ikatha, ntchito ya ERCP idzakhala yosavuta kukwaniritsa intubation yopambana.
Donnelan et al.anachita sekondiERCPopaleshoni pa 51 odwala amene ERCP analephera pambuyo singano mpeni preincision, ndipo 35 milandu anapambana, ndipo zochitika za mavuto sanachuluke.
Kim ndi al.adachita opareshoni yachiwiri ya ERCP kwa odwala 69 omwe adalepheraERCPpambuyo pocheka mpeni wa singano, ndipo milandu 53 idapambana, ndi chipambano cha 76.8%.Milandu yotsala yomwe sinapambane idachitanso ntchito yachitatu ya ERCP, ndikuchita bwino kwa 79.7%., ndipo ntchito zambiri sizinawonjezere zochitika za zovuta.
Yu Li et al.anachita elective secondaryERCPpa odwala 70 omwe analephera ERCP pambuyo podulidwa ndi singano, ndipo milandu 50 idapambana.Chiwopsezo chonse (choyamba ERCP + ERCP yachiwiri) chinawonjezeka kufika ku 90.6%, ndipo chiwerengero cha zovuta sichinachuluke kwambiri..Ngakhale malipoti atsimikizira kugwira ntchito kwa ERCP yachiwiri, nthawi pakati pa maopaleshoni awiri a ERCP siyenera kukhala yayitali kwambiri, ndipo nthawi zina zapadera, kuchedwa kwa biliary ngalande kungapangitse vutoli.
IX.Endoscopicultrasound-guided biliary drainage,EUS-BD
EUS-BD ndi njira yowonongeka yomwe imagwiritsa ntchito singano yoboola ndulu kuchokera m'mimba kapena duodenum lumen motsogozedwa ndi ultrasound, kulowa mu duodenum kudzera mu duodenal papilla, ndiyeno biliary intubation.Njirayi imaphatikizapo njira za intrahepatic ndi extrahepatic.
Kafukufuku wobwereza adanenanso kuti kupambana kwa EUS-BD kunafika 82%, ndipo zochitika zapambuyo pa opaleshoni zinali 13 peresenti yokha.Pakafukufuku woyerekeza, EUS-BD poyerekeza ndi ukadaulo wa pre-incision, chiwopsezo chake cha intubation chinali chokwera, kufika pa 98.3%, chomwe chinali chokwera kwambiri kuposa 90.3% ya pre-incision.Komabe, mpaka pano, poyerekeza ndi matekinoloje ena, padakali kusowa kwa kafukufuku wokhudzana ndi kugwiritsa ntchito EUS kwa zovuta.ERCPintubation.Palibe deta yokwanira yotsimikizira kugwira ntchito kwaukadaulo wotsogozedwa ndi EUS wotsogola ndi zovutaERCPintubation.Kafukufuku wina wasonyeza kuti wachepetsa Udindo wa PEP pambuyo pa opaleshoni siwokhutiritsa.
X.Percutaneous transhepatic cholangial drainage,PTCD
PTCD ndi njira ina yowunikira yomwe ingagwiritsidwe ntchito kuphatikizaERCPkwa zovuta za bile duct intubation, makamaka ngati zilonda zam'mimba zatsekeka.Njira imeneyi imagwiritsa ntchito singano yoboola kuti ilowe munjira ya ndulu, kuboola njira ya ndulu kudzera pa papilla, kenako ndikulowetsanso njira ya ndulu kudzera munjira yosungidwa.guidewire.Kafukufuku wina adasanthula odwala 47 omwe anali ndi vuto la bile duct intubation omwe adadutsa njira ya PTCD, ndipo kupambana kudafika 94%.
Kafukufuku wopangidwa ndi Yang et al.adanenanso kuti kugwiritsa ntchito EUS-BD mwachiwonekere kumakhala kochepa pankhani ya hilar stenosis komanso kufunika koboola njira yoyenera ya intrahepatic bile, pamene PTCD ili ndi ubwino wogwirizana ndi axis ya bile ndikukhala osinthasintha pazida zowongolera.Odwala oterowo ayenera kugwiritsidwa ntchito potengera njira ya bile.
PTCD ndi ntchito yovuta yomwe imafuna kuphunzitsidwa mwadongosolo kwa nthawi yayitali komanso kumaliza milandu yambiri.Ndizovuta kwa novice kumaliza ntchitoyi.PTCD sizovuta kugwira ntchito, komaguidewireZitha kuwononganso njira ya bile pakupita patsogolo.
Ngakhale njira zomwe zili pamwambazi zitha kupititsa patsogolo kuchuluka kwa zovuta za bile duct intubation, chisankhocho chiyenera kuganiziridwa mozama.Pamene akuchitaERCP, SGT, DGT, WGC-PS ndi njira zina zitha kuganiziridwa;ngati njira zomwe zili pamwambazi zikulephera, akatswiri a endoscopist akuluakulu komanso odziwa zambiri amatha kupanga njira zopangiratu, monga TPS, NKP, NKF, ndi zina zotero;ngati akadali Ngati kusankha bile duct intubation sangathe kumaliza, elective secondaryERCPakhoza kusankhidwa;ngati palibe njira zomwe zili pamwambazi zomwe zingathetse vuto la intubation yovuta, ntchito zowonongeka monga EUS-BD ndi PTCD zikhoza kuyesedwa kuthetsa vutoli, ndipo chithandizo cha opaleshoni chingasankhidwe ngati kuli kofunikira.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China okhazikika pazakudya zam'mimba, monga biopsy forceps, hemoclip, polyp msampha, singano ya sclerotherapy, catheter yopopera, maburashi a cytology,guidewire, dengu lochotsa miyala, catheter ya nasal biliary drainagendi zina zomwe zimagwiritsidwa ntchito kwambiri mu EMR, ESD,ERCP.Zogulitsa zathu ndi zovomerezeka za CE, ndipo mbewu zathu ndi zovomerezeka za ISO.Katundu wathu watumizidwa ku Europe, North America, Middle East ndi gawo la Asia, ndipo amapeza makasitomala ambiri kuzindikira ndi kutamandidwa!
Nthawi yotumiza: Jan-31-2024