ERCP yog ib qho cuab yeej tseem ceeb rau kev kuaj mob thiab kho cov kab mob biliary thiab pancreatic.Thaum nws tawm los, nws tau muab ntau lub tswv yim tshiab rau kev kho mob ntawm biliary thiab pancreatic kab mob.Nws tsis txwv rau "radiography".Nws tau hloov los ntawm thawj cov cuab yeej kuaj mob mus rau hom tshiab.Cov txheej txheem kev kho mob suav nrog sphincterotomy, tshem tawm cov pob zeb ntawm cov kua tsib, cov kua tsib thiab lwm txoj hauv kev los kho cov kab mob hauv cov kua tsib thiab cov kab mob pancreatic.
Qhov kev vam meej ntawm kev xaiv cov ducts intubation rau ERCP tuaj yeem ncav cuag ntau dua 90%, tab sis tseem muaj qee qhov xwm txheej uas nyuaj rau kev nkag mus rau biliary ua rau xaiv cov kab mob hauv lub cev tsis ua haujlwm.Raws li qhov kev pom zoo zaum kawg ntawm kev kuaj mob thiab kev kho mob ntawm ERCP, qhov nyuaj intubation tuaj yeem txhais tau tias: lub sijhawm rau kev xaiv cov kab mob hauv lub cev ntawm lub txiv mis ntawm cov pa ERCP yog ntau tshaj 10 feeb lossis tus naj npawb ntawm intubation sim ntau dua 5 zaug.Thaum ua haujlwm ERCP, yog tias cov kab mob hauv cov hlab ntsha yog qhov nyuaj hauv qee qhov, cov tswv yim zoo yuav tsum raug xaiv rau lub sijhawm txhawm rau txhim kho qhov ua tiav ntawm cov kab mob hauv lub cev.Tsab ntawv xov xwm no ua rau kev tshuaj xyuas ntau yam kev pab cuam intubation siv los daws cov kab mob hauv lub cev nyuaj, nrog rau kev pom los muab lub hauv paus theoretical rau cov kws kho mob endoscopists xaiv cov tswv yim teb thaum ntsib teeb meem bile duct intubation rau ERCP.
I.Singleguidewire Technique, SGT
Cov txheej txheem SGT yog siv lub contrastcatheter los txuas ntxiv sim ua rau cov kab mob hauv cov kua tsib tom qab cov ntawv qhia xaim nkag mus rau hauv cov kab mob pancreatic.Nyob rau hauv thaum ntxov hnub ntawm txoj kev loj hlob ntawm ERCP technology, SGT yog ib tug ntau txoj kev rau nyuaj biliary intubation.Nws qhov zoo dua yog tias nws yooj yim rau kev khiav lag luam, kho lub txiv mis, thiab tuaj yeem tuav qhov qhib ntawm lub txiav, ua kom yooj yim rau kev nrhiav qhov qhib ntawm cov kua tsib.
Muaj cov lus ceeb toom hauv cov ntaub ntawv hais tias tom qab ib qho kev ua tsis tiav, xaiv SGT-pab intubation tuaj yeem ua tiav cov kab mob hauv cov kab mob hauv lub cev hauv li 70% -80% ntawm cov neeg mob.Daim ntawv tshaj tawm kuj tau taw qhia tias nyob rau hauv rooj plaub ntawm SGT tsis ua haujlwm, txawm tias kev hloov kho thiab kev siv ob npaugphau ntawv qhiathev naus laus zis tsis tau txhim kho qhov ua tau zoo ntawm cov kab mob hauv cov hlab ntsha thiab tsis txo qhov tshwm sim ntawm post-ERCP pancreatitis (PEP).
Qee qhov kev tshawb fawb kuj tau pom tias qhov kev ua tiav ntawm SGT intubation qis dua ob npaugphau ntawv qhiatechnology thiab transpancreatic papillary sphincterotomy technology.Piv nrog rau kev sim rov ua dua ntawm SGT, kev siv thaum ntxov ntawm obphau ntawv qhiatechnology lossis pre-incision technology tuaj yeem ua tiav cov txiaj ntsig zoo dua.
Txij li thaum txoj kev loj hlob ntawm ERCP, ntau yam tshiab technologies tau raug tsim rau intubation nyuaj.Piv nrog ib leegphau ntawv qhiathev naus laus zis, qhov zoo yog qhov pom tseeb dua thiab qhov kev vam meej yog siab dua.Yog li ntawd, ib leegphau ntawv qhiatechnology tam sim no tsis tshua muaj siv kho mob.
II.Double-guid wire technique, DGT
DGT tuaj yeem raug hu ua kab mob pancreatic duct qhia txoj haujlwm xaim, uas yog tawm ntawm cov kab qhia kev nkag mus rau hauv cov kab mob pancreatic kom taug qab thiab tuav nws, thiab tom qab ntawd cov lus qhia thib ob tuaj yeem siv rov qab siv dua li ntawm cov kab mob pancreatic.Selective bile duct intubation.
Qhov zoo ntawm txoj kev no yog:
(1) Nrog kev pab los ntawm aphau ntawv qhia, cov kua tsib lub qhov qhib yog yooj yim dua mus nrhiav, ua rau cov kua tsib duct intubation smoother;
(2) Cov ntawv qhia hlau tuaj yeem kho lub txiv mis;
(3) Raws li kev taw qhia ntawm tus kab mob pancreaticphau ntawv qhia, rov ua dua qhov pom ntawm cov kab mob pancreatic tuaj yeem zam tau, yog li txo qis qhov stimulation ntawm pancreatic duct tshwm sim los ntawm kev rov ua dua.
Dumonceau et al.pom tau hais tias ib tug guidewire anda contrast catheter yuav muab tso rau hauv lub biopsy qhov tib lub sij hawm, thiab ces qhia ib tug ua tiav cov ntaub ntawv ntawm lub pancreatic duct guidewire occupying txoj kev, thiab xaus lus tias covphau ntawv qhiaKev ua haujlwm ntawm cov kab mob pancreatic duct yog ua tiav rau cov kab mob hauv lub cev.tus nqi muaj qhov cuam tshuam zoo.
Kev kawm ntawm DGT los ntawm Liu Deren et al.pom tias tom qab DGT tau ua rau cov neeg mob uas nyuaj rau ERCP cov kab mob hauv cov hlab ntsha, qhov kev ua tiav ntawm intubation nce mus txog 95.65%, uas yog siab dua li ntawm 59.09% kev vam meej ntawm cov pa intubation.
Kev kawm yav tom ntej los ntawm Wang Fuquan et al.taw qhia tias thaum DGT tau siv rau cov neeg mob uas nyuaj ERCP cov kab mob hauv cov hlab ntsha hauv cov pab pawg sim, qhov kev ua tiav ntawm intubation yog siab li 96.0%.
Cov kev tshawb fawb saum toj no qhia tau hais tias daim ntawv thov ntawm DGT rau cov neeg mob uas muaj cov kab mob hauv lub cev nyuaj rau ERCP tuaj yeem txhim kho qhov ua tau zoo ntawm cov kab mob hauv cov hlab ntsha.
Qhov tsis txaus ntawm DGT feem ntau suav nrog ob lub ntsiab lus hauv qab no:
(1) Cov kab mob pancreaticphau ntawv qhiatej zaum poob thaum lub sij hawm cov kua tsib intubation, los yog thib obphau ntawv qhiatuaj yeem nkag mus rau hauv cov kab mob pancreatic dua;
(2) Txoj kev no tsis haum rau cov mob xws li mob qog noj ntshav pancreatic, pancreatic duct tortuosity, thiab pancreatic fission.
Los ntawm qhov kev xav ntawm PEP tshwm sim, PEP qhov tshwm sim ntawm DGT yog qis dua li cov kab mob hauv cov kab mob hauv lub cev.Ib txoj kev tshawb fawb yav tom ntej tau taw qhia tias qhov tshwm sim ntawm PEP tom qab DGT tsuas yog 2.38% hauv ERCP cov neeg mob uas muaj cov kab mob hauv lub cev nyuaj.Qee cov ntaub ntawv qhia tau hais tias txawm hais tias DGT muaj qhov ua tau zoo dua ntawm cov kab mob hauv cov hlab ntsha, qhov tshwm sim ntawm tus mob pancreatitis tom qab DGT tseem tseem siab dua piv rau lwm cov kev kho mob, vim tias kev ua haujlwm DGT tuaj yeem ua rau muaj kev puas tsuaj rau cov kab mob pancreatic thiab nws qhov qhib.Txawm li cas los xij, kev pom zoo nyob hauv tsev thiab txawv teb chaws tseem qhia tau hais tias nyob rau hauv cov ntaub ntawv ntawm cov kab mob hauv lub cev nyuaj, thaum intubation yog qhov nyuaj thiab cov kab mob pancreatic tau rov ua tsis zoo, DGT yog thawj qhov kev xaiv vim tias DGT thev naus laus zis muaj qhov nyuaj hauv kev ua haujlwm, thiab kuj yooj yim. los tswj.Nws yog dav siv nyob rau hauv xaiv nyuaj intubation.
III.Wire guide cannulation-yias-creatic stent, WGC-P5
WGC-PS tseem tuaj yeem hu ua thepancreatic duct stent txoj haujlwm.Txoj kev no yog muab cov kab mob pancreatic stent nrog rauphau ntawv qhiauas yuam kev nkag mus rau hauv cov kab mob pancreatic, ces rub tawmphau ntawv qhiathiab ua cov kua tsib cannulation saum lub stent.
Kev tshawb fawb los ntawm Hakuta et al.qhia tau hais tias ntxiv rau kev txhim kho tag nrho cov intubation ua tau zoo npaum li cas los ntawm kev taw qhia intubation, WGC-PS kuj tseem tuaj yeem tiv thaiv qhov qhib ntawm cov kab mob pancreatic thiab txo qhov tshwm sim ntawm PEP.
Kev kawm ntawm WGC-PS los ntawm Zou Chuanxin et al.tau taw qhia tias qhov kev vam meej ntawm qhov nyuaj intubation siv txoj kev ua haujlwm ntawm tus txiav pancreatic duct stent mus txog 97.67%, thiab qhov tshwm sim ntawm PEP tau txo qis.
Ib txoj kev tshawb fawb pom tau hais tias thaum cov kab mob pancreatic duct stent tau raug muab tso rau, qhov kev pheej hmoo ntawm mob pancreatitis tom qab mob hnyav hauv cov kab mob intubation nyuaj tau txo qis.
Txoj kev no tseem muaj qee qhov tsis txaus.Piv txwv li, lub pancreatic duct stent tso rau lub sijhawm ua haujlwm ERCP tuaj yeem raug tshem tawm;yog tias lub stent yuav tsum tau muab tso rau ntev ntev tom qab ERCP, yuav muaj feem ntau ntawm stent blockage thiab duct obstruction.Kev raug mob thiab lwm yam teeb meem ua rau muaj kev nce ntxiv ntawm PEP.Twb tau, cov tsev kawm tau pib kawm txog cov kab mob pancreatic ib ntus stents uas tuaj yeem txav mus los ntawm cov kab mob pancreatic.Lub hom phiaj yog siv pancreatic duct stents los tiv thaiv PEP.Ntxiv rau qhov txo qis qhov tshwm sim ntawm PEP cov xwm txheej, cov stents kuj tseem tuaj yeem zam lwm yam kev ua haujlwm kom tshem tawm cov stent thiab txo lub nra ntawm cov neeg mob.Txawm hais tias cov kev tshawb fawb tau pom tias cov kab mob pancreatic ib ntus stents muaj txiaj ntsig zoo hauv kev txo PEP, lawv daim ntawv thov kev kho mob tseem muaj cov kev txwv loj.Piv txwv li, nyob rau hauv cov neeg mob uas nyias nyias ducts thiab ntau ceg, nws yog ib qho nyuaj rau ntxig ib tug pancreatic duct stent.Qhov nyuaj yuav nce siab heev, thiab qhov kev ua haujlwm no yuav tsum muaj qib siab ntawm endoscopists.Nws tseem tsim nyog sau cia tias cov kab mob pancreatic duct stent yuav tsum tsis txhob ntev dhau ntawm duodenal lumen.Ib qho stent ntev ntev yuav ua rau duodenal perforation.Yog li ntawd, kev xaiv ntawm pancreatic duct stent txoj haujlwm tseem yuav tsum tau kho nrog ceev faj.
IV.Trans-pancreatocsphincterotomy, TPS
TPS thev naus laus zis feem ntau yog siv tom qab cov lus qhia xaim nkag mus rau hauv cov kab mob pancreatic los ntawm kev yuam kev.Lub septum nyob rau hauv nruab nrab ntawm lub pancreatic duct yog incised raws li cov kev taw qhia ntawm lub pancreatic duct qhia hlau los ntawm 11 teev mus rau 12 teev, thiab ces lub raj yog muab tso rau hauv cov kev taw qhia ntawm cov kua tsib duct mus txog rau thaum cov kev taw qhia hlau nkag mus rau hauv cov kua tsib. cev.
Kev kawm los ntawm Dai Xin et al.piv TPS thiab ob lwm yam kev pabcuam intubation technologies.Nws tuaj yeem pom tau tias qhov kev vam meej ntawm TPS thev naus laus zis yog qhov siab heev, ncav cuag 96.74%, tab sis nws tsis pom cov txiaj ntsig zoo piv nrog rau lwm qhov kev pab cuam intubation technologies.Qhov zoo.
Nws tau raug tshaj tawm tias cov yam ntxwv ntawm TPS thev naus laus zis suav nrog cov ntsiab lus hauv qab no:
(1) Qhov kev txiav me me rau pancreaticobiliary septum;
(2) Qhov tshwm sim ntawm cov teeb meem tom qab phais yog tsawg;
(3) Kev xaiv ntawm kev txiav txiav yog yooj yim los tswj;
(4) Txoj kev no tuaj yeem siv tau rau cov neeg mob uas rov ua rau lub plab zom mov lossis lub txiv mis hauv lub diverticulum.
Ntau cov kev tshawb fawb tau taw qhia tias TPS tsis tuaj yeem txhim kho qhov ua tau zoo ntawm cov kab mob hauv lub cev nyuaj, tab sis kuj tsis ua rau muaj qhov teeb meem tshwm sim tom qab ERCP.Qee cov kws tshawb fawb qhia tias yog cov kab mob pancreatic intubation lossis me me duodenal papilla tshwm sim dua, TPS yuav tsum tau txiav txim siab ua ntej.Txawm li cas los xij, thaum thov TPS, kev saib xyuas yuav tsum tau them rau qhov muaj peev xwm ntawm cov kab mob pancreatic stenosis thiab rov tshwm sim ntawm tus mob pancreatitis, uas tuaj yeem ua rau muaj kev pheej hmoo ntev ntawm TPS.
V.Precut Sphincterotomy, PST
Cov txheej txheem PST siv cov papillary arcuate band raws li qhov txwv sab sauv ntawm qhov kev txiav ua ntej thiab 1-2 teev kev taw qhia raws li tus ciam teb qhib lub duodenal papilla sphincter kom pom qhov qhib ntawm cov kua tsib thiab cov kab mob pancreatic.Ntawm no PST tshwj xeeb yog hais txog tus qauv txiv mis sphincter pre-incision cov txheej txheem siv riam arcuate.Raws li lub tswv yim los daws cov kab mob nyuaj rau cov kab mob hauv lub cev rau ERCP, PST thev naus laus zis tau suav hais tias yog thawj qhov kev xaiv rau qhov nyuaj intubation.Endoscopic txiv mis sphincter pre-incision yog hais txog qhov endoscopic incision ntawm papilla deg mucosa thiab ib tug me me ntawm cov leeg nqaij sphincter los ntawm ib tug incision riam mus nrhiav qhov qhib ntawm cov kua tsib, thiab ces siv ib tug me me ntawm cov nqaij mos sphincter.phau ntawv qhialos yog catheter rau intubate cov kua tsib.
Ib txoj kev tshawb fawb hauv tsev tau pom tias qhov kev ua tiav ntawm PST yog siab li 89.66%, uas tsis txawv ntawm DGT thiab TPS.Txawm li cas los xij, qhov tshwm sim ntawm PEP hauv PST yog qhov siab dua li ntawm DGT thiab TPS.
Tam sim no, kev txiav txim siab los siv cov cuab yeej no yog nyob ntawm ntau yam.Piv txwv li, ib daim ntawv qhia tau hais tias PST yog qhov zoo tshaj plaws siv nyob rau hauv cov ntaub ntawv uas duodenal papilla yog txawv txav los yog distorted, xws li duodenal stenosis los yog malignancy.
Tsis tas li ntawd, piv nrog lwm cov tswv yim daws teeb meem, PST muaj qhov tshwm sim ntau dua ntawm cov teeb meem xws li PEP, thiab cov kev xav tau ntawm kev ua haujlwm siab, yog li qhov kev ua haujlwm no tau ua tau zoo tshaj plaws los ntawm cov kws paub txog endoscopists.
VI.Needle-riam Papillotomy, NKP
NKP yog ib rab riam-pab intubation txheej txheem.Thaum intubation yog ib qho nyuaj, rab koob yuav siv tau rau incise ib feem ntawm papilla los yog sphincter los ntawm qhib lub duodenal papilla nyob rau hauv cov kev taw qhia ntawm 11-12 teev, thiab ces siv ib tug.phau ntawv qhialos yog catheter rau Selective insertion rau hauv cov kab mob uas muaj cov kab mob.Raws li lub tswv yim daws teeb meem rau cov kab mob hauv cov kab mob nyuaj, NKP tuaj yeem txhim kho qhov kev vam meej ntawm cov kab mob nyuaj rau cov kab mob hauv lub cev.Yav dhau los, feem ntau ntseeg tau tias NKP yuav nce qhov xwm txheej ntawm PEP hauv xyoo tas los no.Nyob rau hauv xyoo tas los no, ntau cov ntaub ntawv tshawb xyuas rov qab tau taw qhia tias NKP tsis ua rau muaj kev pheej hmoo ntawm kev mob tom qab phais.Nws yog ib nqi sau cia hais tias yog hais tias NKP tau ua nyob rau hauv thaum ntxov theem ntawm intubation nyuaj, nws yuav yog ib tug zoo kev pab los txhim kho qhov kev vam meej ntawm intubation.Txawm li cas los xij, tam sim no tsis muaj kev pom zoo thaum twg los thov NKP kom ua tiav cov txiaj ntsig zoo tshaj plaws.Ib txoj kev tshawb fawb qhia tias qhov intubation tus nqi ntawm NKP siv thaum lub sij hawmERCPtsawg dua 20 feeb tau nce siab dua li ntawm NKP thov tom qab 20 feeb tom qab.
Cov neeg mob uas muaj cov kua tsib nyuaj cannulation yuav tau txais txiaj ntsig zoo tshaj plaws los ntawm cov txheej txheem no yog tias lawv muaj lub txiv mis bulges lossis tseem ceeb cov kua tsib dilation.Tsis tas li ntawd, muaj cov lus ceeb toom hais tias thaum ntsib teeb meem intubation nyuaj, kev siv ua ke ntawm TPS thiab NKP muaj qhov ua tau zoo dua li kev thov ib leeg.Qhov tsis zoo yog tias ntau cov txheej txheem incision siv rau lub txiv mis yuav ua rau muaj teeb meem tshwm sim.Yog li ntawd, kev tshawb fawb ntxiv yog xav tau los ua pov thawj seb puas yuav xaiv qhov kev txiav ua ntej ua ntej kom txo tau qhov tshwm sim ntawm cov teeb meem los yog muab ntau yam kev kho mob los txhim kho qhov ua tiav ntawm qhov nyuaj intubation.
VII.Needle-riam Fistulotomy, NKE
Cov txheej txheem NKF hais txog kev siv rab koob txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txog 5 hli saum lub txiv mis, siv cov tam sim no sib xyaw rau txheej txheej los ntawm txheej txheej nyob rau hauv cov kev taw qhia ntawm 11 teev kom txog rau thaum lub orifice zoo li qauv los yog cov kua tsib overflow, thiab ces siv. ib daim ntawv qhia xaim txhawm rau txheeb xyuas qhov tawm ntawm cov kua tsib thiab incision ntawm cov ntaub so ntswg.Selective bile duct intubation tau ua rau ntawm qhov chaw jaundice.NKF phais txiav saum lub txiv mis qhib.Vim tias muaj cov kab mob ntawm cov kab mob hauv lub cev, nws txo qis thermal puas thiab kev puas tsuaj rau lub qhov txhab qhib, uas tuaj yeem txo qhov tshwm sim ntawm PEP.
Kev kawm los ntawm Jin et al.taw qhia tias qhov kev vam meej ntawm NK tube intubation tuaj yeem ncav cuag 96.3%, thiab tsis muaj PEP tom qab phais.Tsis tas li ntawd, qhov ua tiav ntawm NKF hauv kev tshem tawm pob zeb yog siab li 92.7%.Yog li, txoj kev tshawb no pom zoo NKF ua thawj qhov kev xaiv rau kev tshem tawm cov pob zeb hauv cov kua tsib..Piv nrog rau cov papillomyotomy cov pa, NKF kev ua haujlwm txaus ntshai tseem muaj siab dua, thiab nws muaj feem cuam tshuam rau cov teeb meem xws li perforation thiab los ntshav, thiab nws yuav tsum tau ua haujlwm siab ntawm endoscopists.Qhov qhib qhov rais qhov tseeb, qhov tob tsim nyog, thiab cov txheej txheem meej txhua tus yuav tsum tau kawm maj mam.tus tswv.
Piv nrog rau lwm txoj hauv kev ua ntej, NKF yog ib txoj hauv kev yooj yim dua nrog kev ua tiav ntau dua.Txawm li cas los xij, txoj kev no yuav tsum muaj kev xyaum mus sij hawm ntev thiab txuas ntxiv txuas ntxiv los ntawm tus neeg teb xov tooj kom muaj peev xwm, yog li txoj kev no tsis haum rau cov pib tshiab.
VIII.Repeat-ERCP
Raws li tau hais los saum no, muaj ntau txoj hauv kev los daws qhov nyuaj intubation.Txawm li cas los xij, tsis muaj kev lav 100% kev ua tiav.Cov ntaub ntawv tseem ceeb tau taw qhia tias thaum cov kab mob hauv cov hlab ntsha yog qhov nyuaj nyob rau qee kis, lub sijhawm ntev thiab ntau qhov intubation los yog cov thermal nkag mus rau hauv kev txiav ua ntej tuaj yeem ua rau duodenal papilla edema.Yog tias kev ua haujlwm txuas ntxiv mus, tsis yog tsuas yog cov kua tsib lub plab intubation yuav ua tsis tiav, tab sis txoj kev pheej hmoo ntawm cov teeb meem tseem yuav nce ntxiv.Yog tias qhov xwm txheej saum toj no tshwm sim, koj tuaj yeem txiav txim siab txiav tam sim noERCPua ntej thiab ua ERCP thib ob ntawm lub sijhawm xaiv.Tom qab cov papilloedema ploj lawm, ERCP kev ua haujlwm yuav yooj yim dua kom ua tiav qhov ua tiav intubation.
Donnellan et al.ua ib tug thib obERCPkev ua haujlwm ntawm 51 tus neeg mob uas nws ERCP ua tsis tiav tom qab koob-hniav preincision, thiab 35 kis tau ua tiav, thiab qhov tshwm sim ntawm cov teeb meem tsis tau nce ntxiv.
Kim et al.ua haujlwm ERCP thib ob ntawm 69 tus neeg mob uas ua tsis tiavERCPtom qab koob-rhais pre-incision, thiab 53 kis tau zoo, nrog rau kev ua tiav ntawm 76.8%.Cov xwm txheej tseem tsis tau ua tiav tseem tau ua haujlwm thib peb ERCP, nrog rau kev ua tiav ntawm 79.7%., thiab ntau yam kev khiav hauj lwm tsis ua rau muaj teeb meem tshwm sim.
Yu Li et al.ua elective secondaryERCPntawm 70 tus neeg mob uas ua tsis tau ERCP tom qab koob-rhiab pre-incision, thiab 50 kis tau ua tiav.Qhov kev vam meej tag nrho (thawj ERCP + theem nrab ERCP) tau nce mus rau 90.6%, thiab qhov xwm txheej ntawm cov teeb meem tsis tau nce ntau..Txawm hais tias cov ntawv ceeb toom tau ua pov thawj qhov ua tau zoo ntawm ERCP theem nrab, lub sijhawm nruab nrab ntawm ob txoj haujlwm ERCP yuav tsum tsis txhob ntev dhau, thiab qee qhov tshwj xeeb, kev tso dej tawm qeeb yuav ua rau mob hnyav dua.
IX.Endoscopicultrasound-guided biliary drainage,EUS-BD
EUS-BD yog tus txheej txheem invasive uas siv rab koob txhawm rau txhawm rau lub gallbladder los ntawm lub plab los yog duodenum lumen nyob rau hauv kev taw qhia ultrasound, nkag mus rau hauv duodenum los ntawm duodenal papilla, thiab tom qab ntawd ua cov kab mob hauv plab.Cov txheej txheem no suav nrog ob qho tib si intrahepatic thiab extrahepatic mus kom ze.
Ib txoj kev tshawb nrhiav rov qab tau tshaj tawm tias qhov ua tiav ntawm EUS-BD mus txog 82%, thiab qhov tshwm sim ntawm cov teeb meem tom qab tsuas yog 13%.Hauv kev tshawb fawb sib piv, EUS-BD piv nrog cov tshuab ua ntej incision, nws qhov kev ua tiav ntawm intubation tau siab dua, nce mus txog 98.3%, uas yog qhov siab dua li ntawm 90.3% ntawm kev txiav ua ntej.Txawm li cas los xij, txog tam sim no, piv nrog lwm cov thev naus laus zis, tseem tsis muaj kev tshawb fawb txog kev siv EUS rau kev nyuaj.ERCPintubation.Muaj cov ntaub ntawv tsis txaus los ua pov thawj qhov ua tau zoo ntawm EUS-guided bile duct puncture technology rau qhov nyuajERCPintubation.Qee qhov kev tshawb fawb tau pom tias nws tau txo qis Lub luag haujlwm ntawm PEP tom qab kev ua haujlwm tsis zoo.
X.Percutaneous transhepatic cholangial kua, PTCD
PTCD yog lwm txoj kev kuaj mob uas tuaj yeem siv ua ke nrogERCPrau kev nyuaj siab duct intubation, tshwj xeeb tshaj yog nyob rau hauv malignant biliary obstruction.Cov txheej txheem no siv rab koob txhawm rau percutaneously nkag mus rau hauv cov kua tsib duct, puncture cov kua tsib los ntawm papilla, thiab ces intubate cov kua tsib retrogradely los ntawm ib tug reserved.phau ntawv qhia.Ib txoj kev tshawb fawb tau soj ntsuam 47 cov neeg mob uas muaj cov kab mob hauv cov hlab ntsha nyuaj uas tau txais cov txheej txheem PTCD, thiab qhov ua tiav tau mus txog 94%.
Kev kawm los ntawm Yang et al.taw qhia tias daim ntawv thov ntawm EUS-BD yog pom tseeb txwv thaum nws los txog rau hilar stenosis thiab yuav tsum tau puncture txoj cai intrahepatic bile duct, thaum PTCD muaj qhov zoo ntawm kev ua raws li cov kua tsib duct axis thiab ua tau yooj yim dua nyob rau hauv kev taw qhia cov khoom.Cov kab mob hauv lub cev yuav tsum tau siv rau cov neeg mob zoo li no.
PTCD yog ib qho kev ua haujlwm nyuaj uas yuav tsum tau muaj kev cob qhia mus sij hawm ntev thiab ua tiav cov neeg mob txaus.Nws yog ib qho nyuaj rau cov novices kom ua tiav qhov haujlwm no.PTCD tsis yog tsuas yog nyuaj rau kev khiav lag luam, tab sis covphau ntawv qhiakuj tseem tuaj yeem ua rau cov kua tsib puas thaum lub sij hawm nce qib.
Txawm hais tias cov txheej txheem saum toj no tuaj yeem txhim kho qhov ua tau zoo ntawm cov kab mob hauv cov hlab ntsha nyuaj, qhov kev xaiv yuav tsum tau txiav txim siab.Thaum uaERCP, SGT, DGT, WGC-PS thiab lwm yam txheej txheem tuaj yeem txiav txim siab;Yog tias cov txheej txheem saum toj no ua tsis tiav, cov neeg laus thiab cov kws paub txog endoscopists tuaj yeem ua cov txheej txheem ua ntej, xws li TPS, NKP, NKF, thiab lwm yam;yog tseem Yog hais tias xaiv cov kab mob hauv lub cev tsis tuaj yeem ua kom tiav, xaiv theem nrabERCPtuaj yeem xaiv tau;yog tias tsis muaj cov txheej txheem saum toj no tuaj yeem daws qhov teeb meem ntawm qhov nyuaj intubation, kev ua haujlwm tsis zoo xws li EUS-BD thiab PTCD tuaj yeem sim daws qhov teeb meem, thiab kev kho phais tuaj yeem xaiv yog tias tsim nyog.
Peb, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., yog cov chaw tsim khoom hauv Suav teb tshwj xeeb hauv cov khoom siv endoscopic, xws li biopsy forceps, hemoclip, polyp snare, sclerotherapy koob, tshuaj tsuag catheter, cytology txhuam,phau ntawv qhia, pob zeb retrieval pob tawb, qhov ntswg biliary kua catheterthiab lwm yam uas tau siv dav hauv EMR, ESD,ERCP.Peb cov khoom muaj ntawv pov thawj CE, thiab peb cov nroj tsuag tau ntawv pov thawj ISO.Peb cov khoom tau raug xa tawm mus rau Tebchaws Europe, North America, Middle East thiab ib feem ntawm Asia, thiab tau txais cov neeg siv khoom ntawm kev lees paub thiab qhuas!
Post lub sij hawm: Jan-31-2024