Cov pob zeb hauv cov kav dej kua tsib muab faib ua cov pob zeb ib txwm thiab cov pob zeb nyuaj. Niaj hnub no peb yuav kawm paub yuav ua li cas tshem tawm cov pob zeb hauv cov kav dej kua tsib uas nyuaj ua.ERCP.
Qhov "nyuaj" ntawm cov pob zeb nyuaj yog vim muaj cov duab nyuaj, qhov chaw tsis zoo, nyuaj thiab kev pheej hmoo ntawm kev tshem tawm. Piv nrogERCPrau cov qog nqaij hlav ntawm cov kua tsib, qhov kev pheej hmoo yog sib npaug lossis siab dua. Thaum ntsib teeb meem hauv txhua hnubERCPua haujlwm, peb yuav tsum npaj peb lub siab nrog kev paub thiab cia peb txoj kev xav hloov peb cov txuj ci kom daws tau cov teeb meem.
01 Kev faib tawm ntawm "pob zeb nyuaj"
Cov pob zeb nyuaj muaj peev xwm muab faib ua pawg pob zeb, pawg teeb meem ntawm lub cev, pawg kab mob tshwj xeeb thiab lwm yam raws li lawv cov ua rau.
① Pawg pob zeb
Cov pob zeb tseem ceeb suav nrog cov pob zeb loj loj hauv cov kua tsib, cov pob zeb ntau dhau (cov pob zeb tawg), cov pob zeb hauv siab, thiab cov pob zeb cuam tshuam (uas nyuaj los ntawm AOSC). Cov no yog cov xwm txheej uas nyuaj rau tshem tawm cov pob zeb thiab xav tau kev ceeb toom ua ntej.
· Lub pob zeb loj heev (txoj kab uas hla >1.5 cm). Qhov nyuaj thawj zaug hauv kev tshem tawm lub pob zeb yog tias lub pob zeb tsis tuaj yeem tshem tawm lossis tawg los ntawm cov khoom siv. Qhov nyuaj thib ob yog tias lub pob zeb tsis tuaj yeem tshem tawm lossis tawg tom qab raug tshem tawm. Xav tau cov xuab zeb thaum muaj xwm txheej ceev tam sim no.
· Cov pob zeb me me heev yuav tsum tsis txhob saib tsis taus. Cov pob zeb me me tshwj xeeb tuaj yeem txav mus los yog khiav mus rau hauv lub siab tau yooj yim, thiab cov pob zeb me me nyuaj nrhiav thiab npog, ua rau lawv nyuaj kho nrog kev kho mob endoscopic.
· Rau cov pob zeb uas muaj cov kua tsib hauv cov kua tsib,ERCPKev tshem tawm pob zeb siv sijhawm ntev dhau thiab yooj yim ua rau raug kaw. Feem ntau yuav tsum tau phais kom tshem tawm cov pob zeb.
② Kev txawv txav ntawm lub cev
Cov teeb meem ntawm lub cev muaj xws li cov hlab ntsha hauv cov zis tsis zoo, Mirrizi syndrome, thiab cov teeb meem ntawm cov qauv hauv qab thiab qhov tawm ntawm cov hlab ntsha hauv cov zis. Peripapillary diverticula kuj yog ib qho teeb meem ntawm lub cev uas feem ntau tshwm sim.
Tom qab phais LC, cov qauv ntawm cov kua tsib tsis zoo li qub thiab cov kua tsib ntswj. Thaum lub sijhawm phaisERCPkev ua haujlwm, cov hlau qhia yog "yooj yim rau kev muab tso rau hauv qab tab sis tsis yooj yim rau kev muab tso rau" (nws poob tawm tsis tau xav tom qab thaum kawg nce mus), yog li thaum cov hlau qhia raug muab tso rau saum toj, nws yuav tsum tau khaws cia kom tiv thaiv cov hlau qhia tawm thiab poob sab nraum cov kav dej kua tsib.
·Mirizz syndrome yog ib qho teeb meem ntawm lub cev uas yooj yim pom thiab tsis quav ntsej. Kev kawm txog rooj plaub: Tom qab phais LC, tus neeg mob uas muaj pob zeb hauv cov hlab ntsha cystic tau nias cov hlab ntsha hauv cov hlab ntsha, ua rau muaj Mirrizz syndrome. Cov pob zeb tsis tuaj yeem raug tshem tawm hauv kev soj ntsuam X-ray. Thaum kawg, qhov teeb meem tau daws tom qab kuaj pom thiab tshem tawm hauv kev pom ncaj qha nrog eyeMAX.
·RauERCPKev tshem tawm cov pob zeb hauv cov kav dej ntawm cov neeg mob plab tom qab phais Bi II, qhov tseem ceeb yog kom ncav cuag lub txiv mis los ntawm lub scope. Qee zaum nws siv sijhawm ntev (uas yuav tsum muaj lub siab xav zoo) kom ncav cuag lub txiv mis, thiab yog tias txoj hlua qhia tsis tau saib xyuas zoo, nws tuaj yeem tawm tau yooj yim.
③Lwm yam xwm txheej
Peripapillary diverticulum ua ke nrog cov pob zeb hauv cov kav dej kua tsib yog qhov tshwm sim ntau heev. Qhov nyuaj ntawm kev phais lub sijhawm no yog qhov kev pheej hmoo ntawm kev phais lub txiv mis thiab nthuav dav. Qhov kev pheej hmoo no yog qhov loj tshaj plaws rau cov txiv mis hauv diverticulum, thiab qhov kev pheej hmoo rau cov txiv mis ze ntawm diverticulum yog me dua.
Lub sijhawm no, nws tseem yog qhov tsim nyog los nkag siab txog qib ntawm kev nthuav dav. Lub hauv paus ntsiab lus dav dav ntawm kev nthuav dav yog kom txo qhov kev puas tsuaj uas yuav tsum tau tshem tawm cov pob zeb. Kev puas tsuaj me dua txhais tau tias muaj kev pheej hmoo me dua. Niaj hnub no, kev nthuav dav ntawm lub pob zeb (CRE) ntawm lub txiv mis nyob ib puag ncig diverticula feem ntau yog siv los zam EST.
Cov neeg mob uas muaj kab mob hematological, cardiopulmonary function uas tsis tuaj yeem ua siab ntevERCP, lossis cov kab mob ntawm cov pob qij txha uas tsis tuaj yeem ua siab ntev rau kev tso sab laug pw tsaug zog yuav tsum tau them sai sai thiab soj ntsuam thaum ntsib cov pob zeb nyuaj.m
02 Lub siab xav ntawm kev ntsib "pob zeb nyuaj"
Lub siab tsis ncaj ncees thaum ntsib "pob zeb nyuaj": kev ntshaw thiab kev vam meej, kev tsis quav ntsej, kev saib tsis taus ua ntej kev phais, thiab lwm yam.
· Kev ntshaw thiab kev hlub rau cov haujlwm zoo
Thaum ntsib cov pob zeb hauv cov kua tsib, tshwj xeeb tshaj yog cov uas muaj ntau lub pob zeb, peb yeej ib txwm xav tshem tawm tag nrho cov pob zeb. Qhov no yog ib hom "kev ntshaw" thiab ua tiav zoo heev.
Qhov tseeb, nws yog qhov yog los noj tag nrho thiab cov ntshiab, tab sis kev noj cov ntshiab txawm tias tus nqi yog "zoo tagnrho", uas tsis muaj kev nyab xeeb thiab yuav coj ntau yam teeb meem thiab kev nyuaj siab. Ntau lub pob zeb hauv cov kua tsib yuav tsum tau txiav txim siab raws li tus neeg mob qhov xwm txheej. Hauv cov xwm txheej tshwj xeeb, lub raj tsuas yog yuav tsum muab tso lossis tshem tawm ua pawg.
Thaum cov pob zeb loj loj hauv cov kav dej zis nyuaj rau tshem tawm ib ntus, yuav xav txog "kev yaj ntawm cov stent". Tsis txhob yuam kom tshem cov pob zeb loj, thiab tsis txhob muab koj tus kheej tso rau hauv qhov xwm txheej txaus ntshai heev.
·tsis saib xyuas
Uas yog, kev phais qhov muag tsis pom kev yam tsis muaj kev tshuaj xyuas thiab kev tshawb fawb ntau zaus ua rau kev tshem tawm pob zeb tsis ua haujlwm. Yog li ntawd, cov neeg mob uas muaj pob zeb hauv cov kav dej yuav tsum tau kuaj xyuas tag nrho ua ntej phais, soj ntsuam qhov tseeb (xav tau lub peev xwm ntawmERCPcov kws kho mob nyeem cov duab), kev txiav txim siab zoo thiab kev npaj thaum muaj xwm txheej ceev yuav tsum tau ua kom tiv thaiv kev tshem tawm pob zeb tsis tau xav txog.
LubERCPTxoj kev npaj rho pob zeb yuav tsum yog kev tshawb fawb, muaj lub hom phiaj, ua tiav, thiab muaj peev xwm tiv taus kev tshuaj xyuas thiab kev xav. Peb yuav tsum ua raws li lub hauv paus ntsiab lus ntawm kev ua kom tus neeg mob tau txiaj ntsig ntau tshaj plaws thiab tsis txhob ua raws li qhov xav tau.
kev saib tsis taus
Cov pob zeb me me nyob rau hauv qab ntawm cov kav dej kua tsib yooj yim tsis quav ntsej. Yog tias cov pob zeb me me ntsib teeb meem ntawm cov qauv hauv qab ntawm cov kav dej kua tsib thiab nws qhov tawm, nws yuav nyuaj heev rau 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 nyuaj thiab muaj kev pheej hmoo ib yam li lossis siab dua liERCPkev kho mob rau cov qog nqaij hlav ntawm cov kua tsib. Yog li ntawd, yog tias koj tsis ua siab mos siab muag, koj yuav tso koj tus kheej txoj kev khiav tawm uas tsim nyog.
03Yuav ua li cas nrog "pob zeb nyuaj"
Thaum ntsib cov pob zeb nyuaj, yuav tsum tau ua kev ntsuam xyuas tus neeg mob kom meej, yuav tsum tau nthuav dav txaus, thiabpob zeb rub tawm pob zebyuav tsum tau xaiv thiab npaj lub lithotripter, thiab yuav tsum tau tsim ib daim phiaj xwm ua ntej thiab txoj kev npaj kho mob.
Ua lwm txoj kev xaiv, qhov zoo thiab qhov tsis zoo yuav tsum tau soj ntsuam raws li tus neeg mob tus mob ua ntej txuas ntxiv mus.
· Kev ua tiav qhib
Qhov loj ntawm qhov qhib yog raws li qhov xwm txheej ntawm lub pob zeb thiab cov kav dej kua tsib. Feem ntau, kev phais me me + kev nthuav dav loj (nruab nrab) yog siv los nthuav qhov qhib. Thaum lub sijhawm EST, nws yog qhov tsim nyog kom tsis txhob loj sab nraud thiab me sab hauv.
Thaum koj tsis muaj kev paub dhau los, nws yooj yim ua qhov phais uas "loj sab nraud tab sis me sab hauv", uas yog, lub txiv mis zoo li loj sab nraud, tab sis tsis muaj qhov phais sab hauv. Qhov no yuav ua rau kev tshem tawm pob zeb tsis ua tiav.
Thaum ua qhov phais EST, yuav tsum siv "qhov nkhaus qis thiab qhov phais qeeb" los tiv thaiv kev phais zipper. Qhov phais yuav tsum nrawm npaum li txhua qhov phais. Riam yuav tsum tsis txhob "nyob twj ywm" thaum lub sijhawm phais kom tiv thaiv kev cuam tshuam ntawm lub txiv mis thiab ua rau mob pancreatitis.
· Kev ntsuam xyuas cov txheej txheem ntawm seem qis dua thiab kev xa tawm
Cov pob zeb hauv cov kav dej kua tsib feem ntau yuav tsum tau soj ntsuam qhov seem qis thiab qhov tawm ntawm cov kav dej kua tsib. Yuav tsum tau soj ntsuam ob qho chaw. Kev sib xyaw ua ke ntawm ob qho tib si txiav txim siab qhov kev pheej hmoo thiab qhov nyuaj ntawm cov txheej txheem phais lub txiv mis.
Kev phais mob thaum muaj xwm txheej ceev
Cov pob zeb loj thiab tawv dhau thiab cov pob zeb uas tsis tuaj yeem tshem tawm hauv hnab looj tes yuav tsum tau kho nrog lub tshuab lithotripter thaum muaj xwm txheej ceev (emergency lithotripter).
Cov pob zeb xim ntawm cov kua tsib feem ntau tuaj yeem raug rhuav ua tej daim me me, thiab feem ntau ntawm cov pob zeb roj cholesterol uas tawv dua kuj tuaj yeem daws tau li no. Yog tias lub cuab yeej tsis tuaj yeem tso tawm tom qab rub tawm, thiab lub lithotripter tsis tuaj yeem tsoo cov pob zeb, nws yog qhov "nyuaj" tiag tiag. Lub sijhawm no, tej zaum yuav xav tau eyeMAX los kuaj mob thiab kho cov pob zeb ncaj qha.
Lus Cim: Tsis txhob siv lithotripsy rau hauv qab thiab tawm ntawm cov kav dej kua tsib. Tsis txhob siv lithotripsy tag nrho thaum lub sijhawm lithotripsy, tab sis tseg chaw rau nws. Lithotripsy thaum muaj xwm txheej ceev muaj kev pheej hmoo. Thaum lub sijhawm lithotripsy thaum muaj xwm txheej ceev, qhov kawg ntawm cov kav dej kua tsib yuav tsis sib xws nrog cov kav dej kua tsib, thiab qhov kev nruj yuav loj dhau los ua rau muaj kev tawg.
· Pob zeb yaj stent
Yog tias lub pob zeb loj dhau thiab nyuaj rau tshem tawm, koj tuaj yeem xav txog kev yaj stent - uas yog, muab cov yas stent tso rau. Tos kom txog thaum lub pob zeb ntsws ua ntej tshem lub pob zeb, ces qhov muaj feem yuav ua tiav yuav siab heev.
· Cov pob zeb hauv lub siab
Cov kws kho mob hluas uas tsis muaj kev paub ntau yog qhov zoo tshaj plaws kom tsis txhob ua kev kho mob endoscopic ntawm cov pob zeb hauv cov hlab ntsha hauv lub siab. Vim tias cov pob zeb hauv thaj chaw no yuav tsis tuaj yeem raug ntes lossis yuav khiav tob dua thiab tiv thaiv kev phais ntxiv, txoj kev no muaj kev phom sij heev thiab nqaim.
Cov pob zeb hauv cov kav dej kua tsib ua ke nrog cov peripapillary diverticulum
Nws yog ib qho tsim nyog los soj ntsuam qhov kev pheej hmoo thiab kev cia siab ntawm kev nthuav dav. Qhov kev pheej hmoo ntawm EST perforation yog qhov siab heev, yog li tam sim no txoj kev ntawm kev nthuav dav ntawm lub npas yog qhov xaiv tau. Qhov loj me ntawm kev nthuav dav yuav tsum txaus kom tshem tawm lub pob zeb. Cov txheej txheem nthuav dav yuav tsum qeeb thiab ib kauj ruam zuj zus, thiab tsis pub muaj kev nthuav dav lossis kev nthuav dav hnyav. Koob txhaj tshuaj nthuav dav raws li qhov xav tau. Yog tias muaj kev los ntshav tom qab nthuav dav, yuav tsum tau kho kom zoo.
Peb, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., yog lub chaw tsim khoom hauv Suav teb tshwj xeeb hauv cov khoom siv endoscopic, xws licov forceps biopsy,hemoclip,polyp snare,koob txhaj tshuaj sclerotherapy,tshuaj tsuag catheter,cov txhuam cytology,txoj hlua qhia,pob zeb rov qab tau pob zeb,lub qhov ntswg biliary kua catheter thiab lwm yam. uas siv dav hauvEMR,ESD,ERCPPeb cov khoom muaj daim ntawv pov thawj CE, thiab peb cov nroj tsuag muaj daim 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 kev lees paub thiab qhuas los ntawm cov neeg siv khoom!
Lub sijhawm tshaj tawm: Lub Xya Hli-26-2024