ErCP ni tekoloji ikomeye yo gusuzuma no kuvura indwara z'ibisirikare n'inyamanswa. Iyo bimaze gusohoka, byatanze ibitekerezo byinshi byo kuvura indwara zibiriba n'inyamanswa. Ntabwo bigarukira kuri "radiyo". Yahinduye muburyo bwa tekinoroji ya mbere yo gusuzuma muburyo bushya. Ubuhanga bwo kuvura burimo sphincterotomy, umuyoboro wa bile twicyuma, imiyoboro ya bile nubundi buryo bwo kuvura indwara za sisitemu zipiganwa na pancreatic.
Igipimo cyo gutsinda cyo guhitamo uruziga rw'ibisimba kuri ercp birashobora kugera kuri 90%, ariko haracyariho imanza zimwe na zimwe aho ifatanyabikorwa bigoye bitera kunanirwa kw'ibirenge byatoranijwe. Ukurikije ubwumvikane bugezweho kubijyanye no kwisuzumisha no kuvura ercp, intoki zitoroshye zirashobora gusobanurwa nka: igihe cyo guhitamo urubingo rwibihe byingenzi ni iminota isanzwe Iyo ukora ercp, niba intoki ya kera yuzuye mubihe bimwe, ingamba zifatika zigomba gutorwa mugihe cyo kunoza igipimo cyo gutsinda cyimiyoboro yigituba. Iyi ngingo ikora isubiramo ritunganijwe ryubuhanga bukoreshwa muburyo bwo gukemura uruziga rwa rundile buto, hagamijwe gutanga urufatiro rwa Clinique EndoscoPopiste mugihe uhuye ningamba zo gusubiza mugihe gihuye na ercp.
I.Gukoresha Tekinike, Sgt
Tekinike ya SGT ni ugukoresha itandukaniro kugirango ukomeze kugerageza kwikuramo imiyoboro ya bile nyuma yisi yose insinga yinjira muri pancreatic. Mu minsi ya mbere yiterambere ryikoranabuhanga rya ErCP, Sgt yari uburyo busanzwe bwo kwikuramo ibinyabiziga bigoye. Inyungu zayo ni uko byoroshye gukora, gukosora ishoka, kandi zirashobora gufungura umuyoboro wa paccreatic, byoroshye kubona gufungura umuyoboro wa bile.
Hariho amakuru muri ubushyuhe busanzwe ko imitekerereze isanzwe yananiwe, ihitamo ibitekerezo bya SGT irashobora kumarana neza ibitekerezo byigicucu cyigituba muri 70% -80% byimanza. Raporo yagaragaje kandi ko mu bihe byatsinzwe na SGT, ndetse no guhindura no gushyira mu bikorwa kabirikuyoboraIkoranabuhanga ntiryogeze ritezimbere igipimo cyimiterere yigilinga cyigituba kandi nticyagabanije kwangirika kwa nyuma ya Passecreatite (Pep).
Ubushakashatsi bumwe bwerekanye kandi ko igipimo cyo gutsinda cya SGT kiri munsi kurenza icya kabirikuyoboraIkoranabuhanga hamwe na transpancreatic papillary sphincterotomy tekinoroji. Ugereranije no kugerageza SGT, gushyira mu bikorwa hakiri kare kabirikuyoboraIkoranabuhanga cyangwa Ikoranabuhanga mbere ryikoranabuhanga rirashobora kugera kubisubizo byiza.
Kuva iterambere rya ercp, tekinoroji itandukanye yatejwe imbere kugirango hakusane. Ugereranije na kimwekuyoboraIkoranabuhanga, ibyiza biragaragara kandi igipimo cyo gutsinda kiri hejuru. Rero, ingaragukuyoboraIkoranabuhanga ridakunze gukoreshwa.
II.Donable-ongera uyobora tekinike, DGT
Dgt irashobora kwitwa umukunzi wa Pancreatic Table uburyo bwo gutwara insinga, igomba kuva mu mutwe uyobora pancreatic yinjira kandi ikayifata, hanyuma insinga ya kabiri iyobora irashobora kongera gukoreshwa hejuru ya pancreatique iyobora insinga. Guhitamo Igicucu Uruziga.
Ibyiza byo ubu buryo ni:
(1) hamwe nubufasha bwa akuyobora, gufungura bile duct biromo biroroshye kubona, gukora uruziga rwibisimba cyoroshye;
(2) insinga irashobora gukosora nipple;
(3) bayobowe n'umuyoboro wa pancreatickuyobora, inshuro nyinshi kwiyumvisha umuyoboro wa paccreatike, birashobora kwirindwa, bityo bigabanya imbaraga za pancreatike zatewe no kwikuramo inshuro nyinshi.
Dumoncentau et al. yabonye ko kwita ku itandukaniro ry'agatsiko kayobora rishobora kwinjizwa mu mwobo wa biopsy icyarimwe, hanyuma ruvuga ko ari ikibazo cyiza cya Paccreatic Thuctwing Freew uburyo, maze yemeza ko UwitekakuyoboraKwigarurira uburyo bwa pancreatiyabu bwatsinze ibitekerezo byibibyimba. igipimo gifite ingaruka nziza.
Kwiga kuri DGT by Liu Deren et al. Saba iyo DGT imaze gukorwa ku barwayi bafite imitsi ya Ercp igoye, intsinzi y'urukundo yageze kuri 95,65%, irenze urugero kuruta amanota ya 59.09%.
Kwiga Kwiga by Wang Fuquan et al. yerekanye ko igihe Dgt yakoreshwaga ku barwayi bafite imitsi ya ErCP igoye mu itsinda ry'ibigeragezo, igipimo cyo gutsinda cyatsindiye, igipimo cy'imitsi yari hejuru ya 96.0%.
Inyigisho zavuzwe haruguru zerekana ko gusaba Dgt kubarwayi bafite uruziga rugoye kubyimba kuri ercp birashobora kunoza neza igipimo cyatsinzwe cyimiyoboro ya gile.
Amakosa ya DGT ahanini akubiyemo ingingo ebyiri zikurikira:
(1) pancreatickuyoborabirashoboka ko wabuze mugihe cyimisoro yigicucu, cyangwa icya kabirikuyoboraUrashobora kongera kwinjira muri pancreatic thoct;
.
Dukurikije uko urunukaga rwa Pep, urunuka rwinshi rwa DGT ruri munsi yurwo rurimi rusanzwe. Ubushakashatsi bwerekanye ko ari ikibazo cya Pep nyuma ya DGT yari 2.38% gusa mubarwayi ba Ercp bafite uruziga rugoye. Ibitabo bimwe byerekana ko nubwo DGT ifite umubare munini watsinze umuvuduko wigituba wigicucu, hakiri ibyuma bya DGT biracyari byinshi ugereranije nindi ngamba zo gukosora, kuko ibikorwa bya DGT bishobora kwangiza umuyoboro wa pancreatic no gufungura. Nubwo bimeze bityo ariko, ubwumvikane murugo kandi mumahanga biracyagaragaza ko mugihe cyambere cyimiterere igoye, mugihe ikoranabuhanga ritoroshye kandi rifite ikibazo cya pant rigoye cyane kubikorwa, kandi bisa nkibisanzwe kandi byoroshye kugenzura.
III .Wire Ubuyobozi bwa Cannulation-Pan-Stent Ikiruhuko, WGC-P5
WGC-PS irashobora kandi kwitwa uburyo bwo gutera imiyoboro. Ubu buryo ni ugushyira pacnt ya pancreatic hamwe nakuyoboraIbyo byibasiye imyenda ya pancreatic, hanyuma ukurehokuyoboraKandi kora umuyoboro wigituba hejuru yigiti.
Ubushakashatsi bwa Hakuta et al. yerekanye ko usibye kunoza intsinzi rusange mu ntsinzi mu nyungu, wgc-PS irashobora kurengera umuyoboro wa paccreatic kandi igabanya cyane ko ibintu bya Pep.
Kwiga kuri WGC-Zab by Zou Chuanxin et al. Yerekanye ko igipimo cyo gutsinda kitoroshye gikoresha uburyo bwa pacteratike yigihe gito paccreative aho yageze kuri 97,67%, kandi indwara ya Pep yagabanutse cyane.
Ubushakashatsi bumwe bwasanze iyo pancreatic yihuta cyane, amahirwe yo guparwa gukomeye nyuma yo guhagarika imanza zikomeye.
Ubu buryo buracyafite amakosa. Kurugero, intambwe ya pancreatic yinjijwe mugihe cyo gukora Ercp irashobora kwimurwa; Niba stent igomba gushyirwa igihe kinini nyuma ya ercp, hazabaho amahirwe menshi yo guhagarika no guhagarika umutima. Gukomeretsa hamwe nibindi bibazo byo kwiyongera kwa pep. Bimaze, ibigo byatangiye kwiga umuyoboro wigihe gito wa Paccreatic Cyimico ishobora kuva mumutwe wa pancreatic. Intego ni ugukoresha pancreatic stect kugirango wirinde pep. Usibye kugabanya cyane impanuka yimpanuka za pep, stentes nkiyi irashobora kandi kwirinda ibindi bikorwa kugirango ikureho stent no kugabanya umutwaro ku barwayi. Nubwo ubushakashatsi bwerekanye ko Sticts yigihe gito ya pancreatiya ifite ingaruka nziza mukugabanya Pep, porogaramu ya kavukire iracyafite aho zigarukira. Kurugero, mubarwayi bafite imiyoboro ya pancreatike nto hamwe namashami menshi, biragoye kwinjiza pancreatic stent. Ingorane ziziyongereye cyane, kandi iki gikorwa gisaba urwego rwo hejuru rwa Endoscopiste. Birakwiye kandi kubona ko pancreatic PERNET PNEnt yashyizwe mugihe kirekire cyane muri duodenal lumen. Intera ndende cyane irashobora gutera DEODENATIL DUODENAL. Kubwibyo, guhitamo uburyo bwa pancreatic bwerekana uburyo bwakazi bukenewe bugomba kuvurwa no kwitonda.
Iv.trans-pancreatocsphincterotomy, tps
Ikoranabuhanga rya TPS muri rusange rikoreshwa nyuma yumunsi uyobora winjiye muri pancreatic duct yibeshye. Septum hagati ya pancreatic yashizwe mu cyerekezo cya Pancreatic Thuct Umuyoboro wa Pancreatic uyobora saa kumi n'ebyiri kugeza saa 12 z'uburebure, hanyuma umuyoboro winjizwa mu cyerekezo cy'imiyoboro y'ibinini kugeza umubyin uyobora winjiye mu gika cy'ibirungo.
Kwiga na Dai Xin et al. Ugereranije TPs hamwe nizindi nzego ebyiri zifasha. Birashobora kugaragara ko igipimo cyo gutsinda cyikoranabuhanga cya TPS ari hejuru cyane, kigera kuri 96.74%, ariko ntabwo byerekana ibisubizo bidasanzwe ugereranije nundi buryo bubiri bwumugauxique. Ibyiza.
Byavuzwe ko ibiranga tekinoroji ya TPS birimo ingingo zikurikira:
(1) Gukuramo ni bito kuri septum ya pandumu;
.)
(3) Guhitamo icyerekezo cyo gukata biroroshye kugenzura;
.
Ubushakashatsi bwinshi bwerekanye ko TPS idashobora kunoza neza igipimo cyatsinzwe cyigituba cya bigoye, ariko kandi ntabwo byongera ibibazo byo guhura nyuma ya ErCP. Intiti zimwe zivuga ko niba papila ya papilla cyangwa ntoya ya duplilla iboneka inshuro nyinshi, TPS igomba gufatwa nkuwa mbere. Ariko, mugihe usaba TPS, hagomba kwitabwaho amahirwe yo guhagarika paticreatic Planosis na Pancreatis, birashobora kugira ingaruka zigihe kirekire zigihe kirekire.
V.precut sphincterototomy, pst
Tekinike ya PST ikoresha igishushanyo cya papillary nkurugero rwo hejuru rwibintu mbere na 1-2 byamasaha kugirango afungure dupilla papilla papilla ya dupilla kugirango afungure ibirangisho bya bile na pancreatic. Hano pst muburyo bwihariye bivuga sphincter sphincter mbere yuburemere hakoreshejwe icyuma gihoga. Nkingamba kugirango ukemure uruziga rugoye rwibisimba kuri Ercp, Pst Technology yafatwaga cyane ni uguhitamo kwambere kugirango ubone ibitekerezo bigoye. Endoscopic Nipple Sphincter Mbere yo gutema kwa motoscopic ya papilla hejuru ya mucosa hamwe numubiri muto wa sphincter unyuze mucyuma cyo gutondeka kugirango ushake imiyoboro ya bile, hanyuma ukoreshe akuyoboracyangwa catheter kugirango uceceke.
Inyigisho yo mu rugo yerekanaga ko igipimo cyo gutsinda cya PST kiri hejuru ya 89,66%, kidatandukanye cyane na DGT na TPS. Ariko, indwara ya pep muri pst iri hejuru cyane kurenza iya DGT na TPS.
Kugeza ubu, icyemezo cyo gukoresha iki ikoranabuhanga giterwa nibintu bitandukanye. Kurugero, raporo imwe yavuze ko PST ikoreshwa neza mugihe cya dupilla ariho papilla idasanzwe cyangwa igoretse, nka diyadenal stenosis cyangwa malignant.
Byongeye kandi, ugereranije nizindi ngamba zo guhangana, PST ifite ibibazo byinshi nkibintu bya Pep, kandi ibikorwa bisabwa ni byinshi, bityo iki gikorwa gikorwa neza, bityo iki gikorwa gikorwa neza na Endoscopiste.
Vi.Needle-icyuma papillotomy, NKP
NKP ni umushishozi-icyuma gifashwa. Iyo inzitizi zigoye, icyuma-urushinge kirashobora gukoreshwa muguhagarika igice cya papilla cyangwa sphincter uhereye gufungura pagilla ya dupilla cyangwa sphincter ya DIPANLAL PAPINAL mu gufungura saa 11-12, hanyuma ukoreshe akuyoboracyangwa catheter kugirango uhitemo kwinjiza mumiyoboro isanzwe. Nkingamba zo guhangana na Fouctution yigikombe cya bigoye, NKP irashobora kunoza neza igipimo cyatsindwa cyigituba cya bigoye. Kera, muri rusange byari byemejwe ko NKP yongera ibya pep mumyaka yashize. Mu myaka yashize, amakuru menshi yo gusesengura yagaragaje ko NKP itengera ibyago byo kugorana nyuma. Birakwiye ko tumenya ko niba NKP ikorwa mugihe cyambere cyimitekerereze igoye, bizaba byiza kugirango utezimbere igipimo cyimyitozo. Ariko, kuri ubu nta bwumvikane mugihe cyo gusaba NKP kugirango ugere kubisubizo byiza. Ubushakashatsi bumwe bwatangaje ko igipimo cya NKP cyakoreshejwe mugiheErcpIminota itarenze 20 yari hejuru cyane kurenza iya NKP ikoreshwa nyuma yiminota 20.
Abarwayi bafite ibibyimba bitonyanga byibibyimba bizingukirwa nubu buhanga niba bafite i quil yihuta cyangwa imiyoboro ikomeye. Mubyongeyeho, hari amakuru avuga ko guhura nimanza zigoye, gukoresha hamwe na Tps na NKP bifite umubare munini wo gutsinda kuruta gusaba wenyine. Ingaruka ni uko tekinike nyinshi zo guteganwa zikoreshwa kuri nipple izongera kubaho kubibazo. Kubwibyo, ubushakashatsi bwinshi burakenewe kugirango tugaragaze niba duhitamo mbere yo kugabanya ibisabwa cyangwa guhuza ingamba nyinshi zo gukosora kugirango tunoze igipimo cyitsinzi kitoroshye.
Vii.Needle-icyuma fistulotomy, NKE
Ubuhanga bwa NKF bivuga gukoresha icyuma gishishoza kugirango utobore mucosa nka 5mm hejuru yinzobere, hanyuma ukoreshe imiterere ya orifice kugirango utange umurongo wa bile na incisionof. Guhitamo Igicucu Igicucu cyakozwe kurubuga rwa Jaundice. Kubaga NKF kugabanya hejuru yintoki. Bitewe no kubaho kwigomeka bya kera, bikagabanya cyane ibyangiritse cyane hamwe na plavical byangiritse kubifungura pancreatic, bishobora kugabanya ibya pep.
Ubushakashatsi bwa jin et al. yerekanwe ko umubare w'itsinzi wa NK TUBUBATION ITUBA Irashobora kugera kuri 96.3%, kandi nta pepe isubiye inyuma. Byongeye kandi, intsinzi ya NKF mumabuye yo gukuraho ibuye iri hejuru ya 92.7%. Kubwibyo, ubu bushakashatsi burasaba NKF nkuguhitamo kwambere kwigituni rusange. . Ugereranije na PapilYototomy, ingaruka zisanzwe za NKF ziracyari hejuru, kandi zikunda guhura nko gutobora no kuva amaraso, kandi bisaba urwego rwibikomeye rwa Endoscopiste. Idirishya ryukuri gufungura, ubujyakuzimu bukwiye, nubuhanga busobanutse byose byose bigomba kwiga buhoro buhoro. Umwigisha.
Ugereranije nundi buryo mbere yo guteganwa, NKF nuburyo bworoshye bwo gutsinda cyane. Ariko, ubu buryo busaba imyitozo ndende no gukomeza kwiyubaka kubakoresha kuba abishoboye, ubwo buryo rero ntabwo bukwiye kubatangiye.
Viii.Repeat-ercp
Nkuko byavuzwe haruguru, ngaho inzira zikuze zo guhangana ninkubaho zigoye. Ariko, nta garanti yatsinze 100%. Ubuvanganzo bubigaragaje ko iyo hactuvation yigituba bigoye mubihe bimwe, incuvation hamwe nibyinshi byimiterere cyangwa ingaruka zo kwisiga za papilla edema. Niba ikibariko gikomeje, intego yumuyoboro wibinini gusa ntizatsinzwe, ariko amahirwe y'ibibazo nayo iziyongera. Niba ibintu byavuzwe haruguru bibaye, urashobora gusuzuma guhagarika ubuErcpIgikorwa Ubanza no gukora ercp ya kabiri mugihe gikwiye. Nyuma ya Papilloedema irazimira, igikorwa cya Ercp kizoroha kugera kubuntu neza.
Donnellan et al. yakoze isegondaErcpIgikorwa ku barwayi 51 bananiwe nyuma y'inyuguti-y'icyuma, kandi haratsinze imanza 35, kandi ibibazo by'ibibazo bitayongereye.
Kim et al. yakoze igikorwa cya kabiri cya ErCP ku barwayi 69 batsinzweErcpNyuma y'inyuguti-yicyuma mbere, kandi imanza 53 zagenze neza, zifite igipimo cyo gutsinda 76.8%. Imanza zisigaye zirananirana nazo zikorwa na gatatu ya ercp, hamwe nitsinzi ya 79.7%. , kandi ibikorwa byinshi ntabwo byongereye ibibaho.
Yu Li et al. byakozwe kabiriErcpKu barwayi 70 bananiwe ercp nyuma y'urushinge-icyuma mbere, kandi imanza 50 zagenze neza. Ikigereranyo rusange cyatsinze (ERCP ya mbere + Ercp) cyiyongereye kugera kuri 90,6%, kandi ibibazo byingorane bitayongereye cyane. . Nubwo raporo zerekanye ko Ercp ya kabiri ya Ercp, intera iri hagati y'ibikorwa bibiri bya ERCP ntibigomba kuba birebire, kandi mu manza zimwe na zimwe, mu mashanyarazi yatinze, yatinze imiyoboro y'iririmbayi irashobora kwiyongera.
IX.EndoscopicLund-iyobowe na wiliary
Eus-bd nuburyo butera urushinge bwo gucuranga gutobora gallbladder mu gifu cyangwa duodenum lumen mu gifu cyangwa duodenum banyuze mu gifu cyangwa duodonum lumen muri pagilla, hanyuma bagakora insanganyamatsiko z'iribari. Ubu buhanga burimo uburyo bworoshye kandi bugera kuri morepatique.
Inyigisho yo gusubira inyuma yatangaje ko igipimo cyo gutsinda Eus-Bd cyageze kuri 82%, kandi ibibazo by'ibibazo by'iposita byari 13% gusa. Mu bushakashatsi bugereranya, Eus-Bd Ugereranije n'ikoranabuhanga mbere yo gushinga, igipimo cy'imitsindire cyari kinini, kigera kuri 98.3% cyane kuruta 90.3% yo gutema 9.3%. Ariko, kugeza ubu, ugereranije niyindi ikoranabuhanga, haracyariho ubushakashatsi kuri porogaramu ya eus bigoyeErcpIntubation. Hano hari amakuru adahagije kugirango yerekane neza imikorere ya eus-dist teklic teklicture ikoranabuhanga kugirango bigoyeErcpIntubation. Ubushakashatsi bumwe bwerekanye ko bwagabanije uruhare rwa Pep ya nyuma ntabwo yemeza.
X.Pers mutaneous thepapatiage yamashanyarazi, PTCD
PTCD nubundi buryo bwo gusuzuma bushobora gukoreshwa muburyo bwo guhuzaErcpKubanganga uruziga rugoye, cyane cyane mubihe byo kwizihiza ibigari. Ubu butunganya bukoresha urushinge rwo gucuranga kugirango ujye winjira mu gihimbano cy'igisimba, utumiza uruziga runyuze muri papilla, hanyuma tukagira umutsima w'ibindi usubiramokuyobora. Ubushakashatsi bumwe bwasesenguye abarwayi 47 bafite umuyoboro w'igihangange bigoye usanzwe wa PTCD tekinike, kandi igipimo cyagezweho cyageze kuri 94%.
Ubushakashatsi bwang et al. yerekanye ko gusaba eus-bd biragaragara ko bigarukira iyo bigeze kuri stenose ya h Hillage kandi ko ari ngombwa gucumizo mu mwobo wigihangano kandi mugihe cya PTCD gifite ibyiza byo guhuza imiyoboro iboneye kandi mugihe cyo guhinduka mubikoresho biyobora. Intuc Ductation IntuBation igomba gukoreshwa mubarwayi nkabo.
PTCD nigikorwa kitoroshye gisaba amahugurwa yigihe kirekire no kurangiza umubare uhagije wimanza. Biragoye kubiro byuzuza iki gikorwa. PTCD ntabwo bigoye gukora gusa, ahubwo nikuyoborairashobora kandi kwangiza imiyoboro y'ibinini mugihe cyo gutera imbere.
Nubwo uburyo bwavuzwe haruguru bushobora kunoza cyane igipimo cyatsinzwe cyigituni cya bigoye, guhitamo bigomba kumvikana. Iyo ukoraErcp, Sgt, DGT, WGC-PS nubundi buryo burashobora gusuzumwa; Niba tekinike yavuzwe haruguru yananiwe, abakuru kandi b'inararibonye za Endoscopiste zirashobora gukora tekinike ibanziriza mbere, nka TPS, NKP, NKF, nibindi .; Niba ari ibikenewe niba guhitamo uruziga rw'ibisigi ntibishobora kurangira, kwisumbuyeErcpirashobora gutoranywa; Niba nta tekinike yavuzwe haruguru ishobora gukemura ikibazo cyimirire igoye, ibikorwa bitera nka Eus-Bd na PTCD birashobora kuburanishwa kugirango bikemure ikibazo, kandi kubaga birashobora gutorwa nibiba ngombwa.
Twe, Jiangxi ZhuoruHhua Igikoresho cy'ubuvuzi CO., Ltd., Ni uruganda mu Bushinwakuyobora, Igitebo cya rene, Amashanyarazi ya Izurunibindi bikoreshwa cyane muri EMR, ESD,Ercp. Ibicuruzwa byacu ni byemewe, kandi ibimera byacu ni ISO yemewe. Ibicuruzwa byacu byoherejwe mu Burayi, Amerika ya Ruguru, Uburasirazuba bwo hagati n'igice cya Aziya, kandi ibona cyane umukiriya kumenyekana no guhimbaza!
Igihe cyo kohereza: Jan-31-2024