Cov pob zeb ntawm cov kua tsib tau muab faib ua cov pob zeb zoo tib yam thiab cov pob zeb nyuaj. Niaj hnub no peb yuav kawm txog yuav ua li cas tshem tawm cov kua tsib lub pob zeb uas nyuaj rau kev uaERCP.
Qhov "nyuaj" ntawm cov pob zeb nyuaj yog feem ntau yog vim qhov nyuaj ntawm cov duab, qhov chaw txawv txav, qhov nyuaj thiab kev pheej hmoo ntawm kev tshem tawm. Piv nrogERCPrau cov qog nqaij hlav hauv lub cev, qhov kev pheej hmoo yog sib npaug lossis ntau dua. Thaum ntsib teeb meem txhua hnubERCPkev ua haujlwm, peb yuav tsum tau muab peb lub siab nrog kev paub thiab cia peb lub siab xav hloov peb cov kev txawj los daws cov teeb meem.
01 Etiological kev faib tawm ntawm "cov pob zeb nyuaj"
Cov pob zeb nyuaj tuaj yeem muab faib ua pawg pob zeb, pawg anatomical abnormality, pawg kab mob tshwj xeeb thiab lwm yam raws li lawv qhov ua rau.
① Pob zeb pawg
Cov ntsiab lus tseem ceeb suav nrog cov pob zeb loj hauv cov kav dej, cov pob zeb ntau dhau (slam pob zeb), pob zeb intrahepatic, thiab pob zeb cuam tshuam ( nyuaj los ntawm AOSC). Cov no yog txhua lub sijhawm uas nws nyuaj rau tshem cov pob zeb thiab yuav tsum tau ceeb toom ntxov.
· Lub pob zeb loj tshwj xeeb (inch> 1.5 cm). Thawj qhov nyuaj ntawm kev tshem lub pob zeb yog tias lub pob zeb tsis tuaj yeem raug tshem tawm lossis tawg los ntawm cov khoom siv. Qhov nyuaj thib ob yog tias lub pob zeb tsis tuaj yeem raug tshem tawm lossis tawg tom qab raug tshem tawm. Lub sijhawm no yuav tsum muaj gravel thaum muaj xwm ceev.
· Cov pob zeb me me tshwj xeeb yuav tsum tsis txhob maj maj. Cov pob zeb me me tuaj yeem hloov pauv tau yooj yim lossis khiav mus rau hauv daim siab, thiab cov pob zeb me me nyuaj nrhiav thiab npog, ua rau lawv nyuaj rau kev kho mob nrog kev kho mob endoscopic.
· Rau cov pob zeb uas muaj cov kab mob uas muaj cov kua tsib,ERCPpob zeb tshem tawm yuav siv sij hawm ntev heev thiab yooj yim rau raug kaw. Kev phais feem ntau yuav tsum tau tshem tawm cov pob zeb.
②Anatomical abnormalities
Anatomical abnormalities muaj xws li bile duct distortion, Mirrizi syndrome, thiab structural abnormalities nyob rau hauv lub qis ntu thiab qhov hluav taws xob ntawm cov kua tsib duct. Peripapillary diverticula kuj yog ib qho kev txawv txav ntawm lub cev.
· Tom qab kev phais LC, cov qauv ntawm cov kab mob ntawm cov kua tsib yog qhov txawv txav thiab cov kab mob bile yog twisted. ThaumERCPkev khiav hauj lwm, cov kev taw qhia hlau yog "yooj yim tso rau hauv tab sis tsis yooj yim rau muab tso rau" (nws ntog tawm los ntawm thaum kawg mus txog), yog li thaum cov lus qhia hlau raug muab tso, nws yuav tsum tau muab khaws cia kom tiv thaiv cov kev taw qhia hlau prolapse thiab poob. sab nraum cov kua tsib.
· Mirizz Syndrome yog ib qho kev txawv txav ntawm lub cev uas yooj yim plam thiab tsis quav ntsej. Cov ntaub ntawv kawm: Tom qab LC phais, tus neeg mob uas muaj pob zeb cystic ducts compressed cov kua tsib, ua rau Mirrizz syndrome. Cov pob zeb tsis tuaj yeem raug tshem tawm raws li kev soj ntsuam X-ray. Thaum kawg, qhov teeb meem tau daws tau tom qab kuaj xyuas thiab tshem tawm raws li kev pom ncaj qha nrog eyeMAX.
· RauERCPCov pob zeb tshem tawm cov kua tsib nyob rau hauv cov neeg mob plab tom qab phais Bi II, qhov tseem ceeb yog kom ncav cuag lub txiv mis los ntawm qhov chaw. Qee lub sij hawm nws yuav siv sij hawm ntev (uas yuav tsum muaj lub siab xav kom muaj zog) kom ncav cuag lub txiv mis, thiab yog tias cov ntawv qhia tsis tau khaws cia zoo, nws tuaj yeem tawm tau yooj yim.
③ Lwm yam xwm txheej
Peripapillary diverticulum ua ke nrog cov pob zeb hauv cov ducts yog feem ntau. Qhov nyuaj ntawm kev ua haujlwm ntawm lub sijhawm no yog qhov kev pheej hmoo ntawm lub txiv mis incision thiab nthuav dav. Qhov kev pheej hmoo no loj tshaj plaws rau cov txiv mis hauv diverticulum, thiab qhov kev pheej hmoo rau cov txiv mis ze ntawm diverticulum yog me dua.
Nyob rau lub sij hawm no, nws tseem yuav tsum tau tuav lub degree ntawm expansion. Lub hauv paus ntsiab lus ntawm kev nthuav dav yog kom txo qis qhov kev puas tsuaj uas yuav tsum tau tshem tawm pob zeb. Kev puas tsuaj me me txhais tau tias muaj kev pheej hmoo me me. Niaj hnub no, balloon expansion (CRE) ntawm lub txiv mis nyob ib ncig ntawm diverticula feem ntau yog siv kom tsis txhob EST.
Cov neeg mob uas muaj kab mob hematological, cardiopulmonary muaj nuj nqi uas tsis tuaj yeem zamERCP, los yog cov kab mob txha caj qaum uas tsis tuaj yeem zam lub sij hawm ntev sab laug txoj hauj lwm yuav tsum tau them sai sai rau thiab tshuaj xyuas thaum ntsib cov pob zeb nyuaj.m
02 Psychology ntawm ntsib "pob zeb nyuaj"
Kev xav tsis zoo thaum ntsib "pob zeb nyuaj": kev ntshaw thiab kev vam meej, kev ua tsis zoo, kev thuam ua ntej, thiab lwm yam.
· Kev ntshaw thiab kev hlub rau kev ua tau zoo
Thaum ntsib cov pob zeb hauv cov hlab ntsha, tshwj xeeb tshaj yog cov uas muaj ntau lub pob zeb, peb ib txwm xav kom tshem tawm tag nrho cov pob zeb. Qhov no yog hom "kev ntshaw" thiab kev vam meej.
Qhov tseeb, nws yog qhov tseeb los coj tag nrho thiab cov ntshiab, tab sis kev noj cov ntshiab ntawm txhua tus nqi yog "zoo tagnrho", uas tsis muaj kev nyab xeeb thiab yuav ua rau muaj kev nyuaj siab ntau heev. Ntau lub pob zeb ntawm cov kua tsib yuav tsum tau txiav txim siab raws li tus neeg mob qhov xwm txheej. Nyob rau hauv tshwj xeeb, lub raj yuav tsum tsuas yog muab tso rau los yog tshem tawm nyob rau hauv batch.
Thaum cov pob zeb loj loj hauv cov kav dej yog qhov nyuaj rau tshem tawm ib ntus, "stent dissolution" tuaj yeem xav txog. Tsis txhob yuam kom tshem tawm cov pob zeb loj, thiab tsis txhob muab koj tus kheej tso rau hauv qhov xwm txheej txaus ntshai heev.
· tsis ua txhaum
Ntawd yog, qhov muag tsis pom kev ua haujlwm yam tsis muaj kev tshuaj ntsuam xyuas thiab kev tshawb fawb feem ntau ua rau pob zeb tshem tawm tsis ua haujlwm. Yog li ntawd, cov kab mob ntawm cov pob zeb hauv cov kua tsib yuav tsum tau soj ntsuam tag nrho ua ntej kev phais, kev soj ntsuam lub hom phiaj (yuav tsum muaj peev xwm ntawmERCPcov kws kho mob kom nyeem cov duab), ua tib zoo txiav txim siab thiab cov phiaj xwm xwm txheej ceev yuav tsum tau ua kom tsis txhob muaj pob zeb tshem tawm.
CovERCPpob zeb extraction txoj kev npaj yuav tsum yog scientific, lub hom phiaj, ua tiav, thiab muaj peev xwm tiv thaiv kev tsom xam thiab kev txiav txim siab. Peb yuav tsum ua raws li lub hauv paus ntsiab lus ntawm kev ua kom cov neeg mob tau txais txiaj ntsig ntau tshaj plaws thiab tsis yog kev txiav txim siab.
· saib tsis taus
Cov pob zeb me me nyob rau sab qis ntawm cov kua tsib yooj yim tsis quav ntsej. Yog tias cov pob zeb me me ntsib teeb meem ntawm cov txheej txheem nyob rau hauv qis qis ntawm cov kua tsib thiab nws lub qhov hluav taws xob, nws yuav nyuaj heev kom tshem tawm cov pob zeb.
ERCPkev kho mob rau cov pob zeb hauv cov kua tsib muaj ntau yam sib txawv thiab muaj kev pheej hmoo siab. Nws yog qhov nyuaj thiab pheej hmoo npaum li lossis txawm siab duaERCPkev kho rau cov kab mob bile duct. Yog li ntawd, yog tias koj tsis coj nws maj mam, koj yuav tso koj tus kheej ib txoj kev khiav uas tsim nyog.
03 Yuav ua li cas nrog "pob zeb nyuaj"
Thaum ntsib cov pob zeb nyuaj, kev ntsuam xyuas dav dav ntawm tus neeg mob yuav tsum tau ua, kev nthuav dav txaus yuav tsum tau ua,pob zeb retrieal pob tawbyuav tsum tau xaiv thiab ib lub lithotripter npaj, thiab prefabricated txoj kev npaj thiab kev kho mob yuav tsum tau tsim.
Raws li lwm txoj hauv kev, qhov zoo thiab qhov tsis zoo yuav tsum raug soj ntsuam raws li tus neeg mob tus mob ua ntej yuav mus.
· Qhib kev ua haujlwm
Qhov luaj li cas ntawm qhov qhib yog nyob ntawm qhov xwm txheej ntawm lub hom phiaj pob zeb thiab cov kua tsib duct. Feem ntau, me me incision + loj (nruab nrab) dilation yog siv los nthuav qhov qhib. Thaum lub sij hawm EST, nws yog ib qho tsim nyog kom tsis txhob loj sab nraud thiab sab hauv me me.
Thaum koj tsis muaj kev paub dhau los, nws yog qhov yooj yim los ua ib qho kev phais uas "loj rau sab nraud tab sis me me ntawm sab hauv", uas yog, lub txiv mis zoo li loj rau sab nraud, tab sis tsis muaj qhov incision ntawm sab hauv. Qhov no yuav ua rau lub pob zeb tshem tawm tsis tiav.
Thaum ua EST incision, "dawb hneev nti thiab qeeb incision" yuav tsum tau siv los tiv thaiv zipper incision. Lub incision yuav tsum ceev li txhua qhov incision. Cov riam yuav tsum tsis txhob "nyob twj ywm" thaum lub sij hawm txiav los tiv thaiv lub txiv mis cuam tshuam thiab ua rau mob pancreatitis. .
· Kev ntsuam xyuas ntawm ntu qis thiab xa tawm
Cov pob zeb uas muaj cov kua tsib feem ntau xav tau kev soj ntsuam ntawm ntu ntu thiab qhov hluav taws xob ntawm cov kab dej sib xyaw. Ob qhov chaw yuav tsum tau soj ntsuam. Kev sib xyaw ua ke ntawm ob qho tib si txiav txim siab qhov kev pheej hmoo thiab qhov nyuaj ntawm cov txheej txheem ntawm lub txiv mis.
· Emergency lithotripsy
Cov pob zeb loj heev thiab tawv thiab pob zeb uas tsis tuaj yeem degloved yuav tsum tau kho nrog lub lithotripter thaum muaj xwm ceev (emergency lithotripter).
Bile pigment pob zeb tuaj yeem pib tawg mus rau hauv daim, thiab feem ntau ntawm cov pob zeb uas muaj roj cholesterol kuj tuaj yeem daws tau los ntawm txoj kev no. Yog tias lub cuab yeej tsis tuaj yeem raug tso tawm tom qab rov qab, thiab lub lithotripter tsis tuaj yeem tawg pob zeb, nws yog qhov "qhov nyuaj". Lub sijhawm no, eyeMAX tej zaum yuav xav tau los kuaj xyuas thiab kho pob zeb.
Lus Cim: Tsis txhob siv lithotripsy nyob rau hauv qis qis thiab tawm ntawm cov kab mob sib kis. Tsis txhob siv lithotripsy tag nrho thaum lub lithotripsy, tab sis tawm hauv chav rau nws. Emergency lithotripsy yog qhov txaus ntshai. Thaum muaj xwm txheej ceev lithotripsy, qhov kawg axis yuav tsis sib haum nrog cov kua tsib axis, thiab qhov nro tuaj yeem loj dhau los ua rau perforation.
· Stent dissolving pob zeb
Yog tias lub pob zeb loj dhau thiab nyuaj rau tshem tawm, koj tuaj yeem xav txog kev tshem tawm stent - uas yog, muab cov yas stent. Tos kom txog thaum lub pob zeb shrinks ua ntej tshem lub pob zeb, ces txoj kev vam meej yuav siab heev.
· Intrahepatic pob zeb
Cov kws kho mob hluas uas muaj kev paub me ntsis yog qhov zoo tshaj plaws tsis ua kev kho mob endoscopic ntawm intrahepatic bile duct pob zeb. Vim tias cov pob zeb nyob hauv thaj chaw no yuav tsis tuaj yeem raug daig lossis tuaj yeem khiav tob dua thiab tiv thaiv kev ua haujlwm ntxiv, txoj kev yog qhov txaus ntshai heev thiab nqaim.
· Cov pob zeb hauv cov hlab ntsha ua ke nrog peripapillary diverticulum
Nws yog ib qho tsim nyog los ntsuas qhov kev pheej hmoo thiab kev cia siab ntawm kev nthuav dav. Qhov kev pheej hmoo ntawm EST perforation yog qhov siab, yog li tam sim no txoj kev nthuav dav ntawm lub zais pa yog qhov pib xaiv. Qhov loj me me yuav tsum txaus kom tshem tawm pob zeb. Cov txheej txheem nthuav dav yuav tsum qeeb thiab ib kauj ruam zuj zus, thiab tsis muaj kev nthuav dav lossis kev nthuav dav raug tso cai. Syringe nthuav dav ntawm qhov xav tau. Yog tias muaj los ntshav tom qab dilation, yuav tsum tau kho kom 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 libiopsy forceps,hemoclip,polyp nuv,koob sclerotherapy,tshuaj tsuag catheter,cytology txhuam,phau ntawv qhia,pob zeb retrieval pob tawb,qhov ntswg biliary kua catheter thiab lwm yam. uas yog dav siv nyob rau hauvEMR,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: Lub Xya hli ntuj-26-2024