ERCP ni ikoranabuhanga ry'ingenzi mu gusuzuma no kuvura indwara z'inkari n'indurwe. Imaze gusohoka, yatanze ibitekerezo bishya byinshi mu kuvura indwara z'inkari n'indurwe. Ntabwo ari "radiography" gusa. Yahindutse kuva ku ikoranabuhanga rya mbere ryo gusuzuma yerekeza ku bundi buryo bushya. Uburyo bwo kuvura burimo gucibwamo amenyo, gukuraho amabuye mu miyoboro y'inkari, gusohora amazi mu ntoki n'ubundi buryo bwo kuvura indwara z'inkari n'indurwe.
Igipimo cy’intsinzi yo gushyira mu muyoboro w’amaraso mu buryo bw’ibanga (selective bile duct intubation) kuri ERCP gishobora kugera ku kigero cya 90%, ariko hari aho uburyo bwo kwinjira mu muyoboro w’amaraso mu buryo bw’ibanga butuma habaho kunanirwa kwinjiza mu muyoboro w’amaraso mu buryo bw’ibanga. Dukurikije ibyo abantu baheruka gusuzuma no kuvura ERCP, gushyira mu muyoboro w’amaraso mu buryo bw’ibanga .... Dukurikije ibyo abantu baheruka gusuzuma ku bijyanye no gusuzuma no kuvura ERCP, gushyira mu muyoboro w’amaraso mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga bishobora gusobanurwa nk’ibi: igihe cyo gushyira mu muyoboro w’amaraso mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu buryo bw’ibanga mu
I.Ubuhanga bwa Singleguidewire, SGT
Uburyo bwa SGT ni ugukoresha contrastcatheter kugira ngo ukomeze kugerageza gushyira mu cyuma cy’inyongo nyuma y’uko insinga y’ubuyobozi yinjiye mu cyuma cy’inyongo. Mu ntangiriro z’iterambere ry’ikoranabuhanga rya ERCP, SGT yari uburyo busanzwe bwo gushyira mu cyuma cy’inyongo bigoranye. Akamaro kayo ni uko yoroshye kuyikoresha, igasana ibere, kandi ikaba ishobora gufata umwobo w’inyongo y’inyongo, bigatuma byoroha kubona umwobo w’inyongo y’inyongo.
Hari raporo mu bitabo zivuga ko nyuma yo kunanirwa gufunga imiyoboro isanzwe, guhitamo gufunga imiyoboro ifashishwa na SGT bishobora kurangiza neza gufunga imiyoboro y'amaraso mu buryo bungana na 70%-80%. Raporo kandi yagaragaje ko mu gihe SGT yananiwe, ndetse no guhindura no gukoresha doubleinsinga y'ubuyoboziIkoranabuhanga ntiryazamuye igipimo cyo gutera imbere kw'imiyoboro y'amaraso kandi ntiryagabanyije umubare w'abarwara pancreatitis nyuma ya ERCP (PEP).
Hari ubushakashatsi bwagaragaje kandi ko igipimo cyo gutsinda kwa SGT intubation kiri hasi ugereranyije n'icyiciro cya kabiriinsinga y'ubuyoboziikoranabuhanga n'ikoranabuhanga rya transpancreatic papillary sphincterotomy. Ugereranije n'igerageza rya SGT rikomeje, habanje gushyirwa mu bikorwa uburyo bwa kabiriinsinga y'ubuyoboziikoranabuhanga cyangwa ikoranabuhanga ribanziriza gukata bishobora gutanga umusaruro mwiza.
Kuva ERCP yatera imbere, hashyizweho ikoranabuhanga rishya ritandukanye rituma habaho uburyo bworoshye bwo gushyiramo umuyoboro w'amashanyarazi. Ugereranyije n'uburyo bworoshye bwo gushyiramo umuyoboro w'amashanyarazi.insinga y'ubuyoboziikoranabuhanga, ibyiza biragaragara cyane kandi igipimo cy'intsinzi kiri hejuru. Bityo rero, umuntu umweinsinga y'ubuyoboziUbu ikoranabuhanga ntirikoreshwa cyane mu buvuzi.
II.Uburyo bubiri-buyobora tekinike, DGT
DGT ishobora kwitwa uburyo bwo gukoresha umuyoboro w’amaraso uyobora pancreas, aribwo gusiga umuyoboro w’amaraso winjira mu muyoboro w’amaraso ugakomeza kuwukurikirana no kuwufata, hanyuma umuyoboro w’amaraso uyobora wa kabiri ukongera gushyirwa hejuru y’umuyoboro w’amaraso uyobora pancreas. Uburyo bwo gushyiramo umuyoboro w’amaraso mu miyoboro y’amaraso.
Ibyiza by'ubu buryo ni ibi bikurikira:
(1) Hamwe n'ubufasha bwainsinga y'ubuyobozi, umwobo w'imiyoboro y'inyongo uraboneka byoroshye, bigatuma uburyo bwo gusohora imiyoboro y'inyongo bugenda neza;
(2) Insinga iyobora ishobora gufunga ipfundo ry'umunwa;
(3) Iyobowe n'umuyoboro w'indurweinsinga y'ubuyobozi, kureba inshuro nyinshi umuyoboro wa pancreas bishobora kwirindwa, bityo bigabanye gukangura umuyoboro wa pancreas bitewe no gukubitwa inshuro nyinshi.
Dumonceau n'abandi babonye ko insinga ziyobora hamwe na catheter yo kugabanya urugero bishobora gushyirwa mu mwobo wa biopsy icyarimwe, hanyuma bavuga ko insinga ziyobora imikorere ya pancreas zagenze neza, maze bemeza koinsinga y'ubuyoboziGukoresha uburyo bwo gufunga imiyoboro ya pancreas bitanga umusaruro mwiza mu gutuma imiyoboro y'amaraso ijya mu mubiri. bigira ingaruka nziza.
Ubushakashatsi bwakozwe kuri DGT bwakozwe na Liu Deren n'abandi bwagaragaje ko nyuma y'uko DGT ikorewe abarwayi bafite ikibazo cyo gufunga imiyoboro y'amaraso ya ERCP, igipimo cyo gutsinda cyo gufunga imiyoboro cyageze kuri 95.65%, cyari hejuru cyane ugereranyije n'igipimo cyo gutsinda cya 59.09% cyo gufunga imiyoboro isanzwe.
Ubushakashatsi bwakozwe na Wang Fuquan n'abandi bwagaragaje ko igihe DGT yashyirwaga ku barwayi bafite ikibazo cyo gufunga imiyoboro y'amaraso ya ERCP mu itsinda ry'igerageza, igipimo cyo gutsinda cyo gufunga imiyoboro cyari hejuru cyane kigera kuri 96.0%.
Ubushakashatsi bwavuzwe haruguru bwerekana ko gukoresha DGT ku barwayi bafite ikibazo cyo gufunga imiyoboro y'amaraso muri ERCP bishobora kunoza neza igipimo cyo gufunga imiyoboro y'amaraso muri nyo.
Intege nke za DGT zirimo ahanini ingingo ebyiri zikurikira:
(1) Pancreasinsinga y'ubuyoboziwenda yatakaye mu gihe cyo gushyiramo imiyoboro y'amaraso mu muyoboro w'amaraso, cyangwa iya kabiriinsinga y'ubuyoboziishobora kongera kwinjira mu muyoboro wa pancreas;
(2) Ubu buryo ntibukwiriye ku bantu nka kanseri y'umutwe wa pancreas, gucika kw'imiyoboro ya pancreas, no gucika kw'umuyoboro wa pancreas.
Ukurikije uko PEP igaragara, DGT ikwirakwira muri PEP iri hasi ugereranyije n’uko DGT ikoreshwa mu gutera umuti usanzwe. Ubushakashatsi bwakozwe bwagaragaje ko PEP nyuma ya DGT yari 2.38% gusa ku barwayi ba ERCP bafite ikibazo cyo gutera umuti utari mwiza. Hari inyandiko zigaragaza ko nubwo DGT ifite igipimo cyo hejuru cyo gutera umuti utari mwiza, umubare w’abarwaye pancreatitis nyuma ya DGT uracyari munini ugereranije n’izindi ngamba zo kuvura, kuko kubaga DGT bishobora kwangiza umuyoboro wa pancreas no kuwufungura. Nubwo bimeze bityo, ubwumvikane mu gihugu no mu mahanga buracyagaragaza ko mu gihe habayeho ikibazo cyo gutera umuti utari mwiza, iyo gutera umuti utari mwiza kandi umuyoboro wa pancreas ukunze kwibasirwa nabi, DGT ni yo mahitamo ya mbere kuko ikoranabuhanga rya DGT ridafite ikibazo kinini mu gukora, kandi ryoroshye kugenzura. Rikoreshwa cyane mu gutera umuti utari mwiza.
III. Insinga ziyobora cannulation-pan-creatic stent, WGC-P5
WGC-PS ishobora kandi kwitwa uburyo bwo gufata stent ya pancreatique. Ubu buryo ni ugushyira stent ya pancreatique hamweinsinga y'ubuyobozibyinjira mu muyoboro wa pancreas mu buryo butari bwo, hanyuma bigakuramoinsinga y'ubuyobozikandi ugakora uburyo bwo gufunga imiyoboro y'amaraso hejuru y'umuyoboro w'amaraso.
Ubushakashatsi bwakozwe na Hakuta n'abandi bwagaragaje ko uretse kunoza igipimo rusange cyo gutsinda mu gutera amenyo binyuze mu kuyobora gutera amenyo, WGC-PS ishobora no kurinda ifunguka ry'umuyoboro wa pancreas no kugabanya cyane ikwirakwira rya PEP.
Ubushakashatsi bwakozwe kuri WGC-PS bwakozwe na Zou Chuanxin n'abandi bwagaragaje ko igipimo cyo gutsinda cyo gukurura imiyoboro ikoresha uburyo bw'agateganyo bwo gufata stent ya pancreas cyageze kuri 97.67%, kandi umubare w'abandura PEP waragabanutse cyane.
Ubushakashatsi bumwe bwagaragaje ko iyo stent y'umuyoboro w'indurwe ishyizwe neza, amahirwe yo kurwara pancreatitis ikomeye nyuma yo kubagwa mu bihe bigoye byo gupfuka imiyoboro agabanuka cyane.
Ubu buryo buracyafite inenge zimwe na zimwe. Urugero, stent ya pancreas duct ishyirwa mu gihe cyo kubaga ERCP ishobora kwimurwa; niba stent igomba gushyirwaho igihe kirekire nyuma ya ERCP, hazabaho amahirwe menshi yo kuziba stent no kuziba imiyoboro y'amaraso. Gukomereka n'ibindi bibazo bituma PEP yiyongera. Ibigo byatangiye kwiga stent z'igihe gito za pancreas duct zishobora kuva mu miyoboro y'amaraso. Intego ni ugukoresha stent za pancreas duct mu gukumira PEP. Uretse kugabanya cyane impanuka za PEP, stent nk'izo zishobora no kwirinda ubundi buryo bwo gukuraho stent no kugabanya umutwaro ku barwayi. Nubwo ubushakashatsi bwagaragaje ko stent z'igihe gito za pancreas duct zigira ingaruka nziza mu kugabanya PEP, ikoreshwa ryazo mu buvuzi riracyafite imbogamizi zikomeye. Urugero, ku barwayi bafite imiyoboro y'amaraso yoroheje n'amashami menshi, biragoye gushyiramo stent ya pancreas duct. Ingorane zizongera kwiyongera cyane, kandi iki gikorwa gisaba abahanga mu by'ubuvuzi. Ni ngombwa kandi kumenya ko stent y'imiyoboro ya pancreas ishyirwamo idakwiye kuba ndende cyane mu gice cy'imbere cya duodenal. Stent ndende cyane ishobora gutuma duodenal ibomoka. Kubwibyo, guhitamo uburyo bwo gukoresha stent y'imiyoboro ya pancreas bigomba kwitonderwa.
IV. Trans-pancreatocsphincterotomy, TPS
Ikoranabuhanga rya TPS rikoreshwa muri rusange nyuma y’uko insinga y’ubuyobozi yinjiye mu muyoboro wa pancreas ku buryo butari bwo. Agace kari hagati mu muyoboro wa pancreas gashyirwa mu cyerekezo cy’insinga y’ubuyobozi ya pancreas kuva saa kumi n’imwe kugeza saa kumi n’ebyiri z’umugoroba, hanyuma umuyoboro ugashyirwa mu cyerekezo cy’umuyoboro wa pancreas kugeza igihe insinga y’ubuyobozi yinjiye mu muyoboro wa pancreas.
Ubushakashatsi bwakozwe na Dai Xin n'abandi bwagereranije TPS n'ubundi buhanga bubiri bwo gushyiramo intubation. Byagaragaye ko igipimo cy'iterambere ry'ikoranabuhanga rya TPS kiri hejuru cyane, kigera kuri 96.74%, ariko ntabwo kigaragaza umusaruro utangaje ugereranije n'ubundi buhanga bubiri bwo gushyiramo intubation. Ibyiza byabwo.
Byatangajwe ko imiterere y'ikoranabuhanga rya TPS irimo ingingo zikurikira:
(1) Icyuho ni gito kuri septum ya pancreatobiliary;
(2) Umubare w'ibibazo nyuma yo kubagwa ni muto;
(3) Guhitamo icyerekezo cyo gukata biroroshye kugenzura;
(4) Ubu buryo bushobora gukoreshwa ku barwayi bafite imiyoboro ya pancreas isubiramo cyangwa ibere riri muri diverticulum.
Ubushakashatsi bwinshi bwagaragaje ko TPS idafasha gusa mu kunoza neza igipimo cyo gutera inda mu miyoboro y’amaraso igoye, ahubwo inatuma ibibazo bivuka nyuma ya ERCP bigabanuka. Hari abahanga bavuga ko iyo gutera inda mu miyoboro y’amaraso cyangwa papilla nto ya duodenal bikunze kugaragara kenshi, TPS igomba kubanza kwitabwaho. Ariko, mu gihe cyo gukoresha TPS, hakwiye kwitabwaho cyane ku buryo bwo gutera inda mu miyoboro y’amaraso no kongera kurwara pancreatitis, ibyo bikaba ari ingaruka mbi zishobora guterwa na TPS mu gihe kirekire.
V. Precut Sphincterotomy, PST
Uburyo bwa PST bukoresha agace ka arcuate ka papillary nk'aho ari ho hejuru y'aho uca mbere yo gukata no mu cyerekezo cya saa 1-2 z'ijoro nk'umupaka wo gufungura sphincter ya duodenal papilla kugira ngo haboneke aho umwobo w'inyongo n'umuyoboro wa pancreas uherereye. Aha PST yerekeza cyane cyane ku buryo busanzwe bwo guca sphincter y'inyongo hakoreshejwe icyuma gifata imbunda. Nk'ingamba zo guhangana n'ikibazo cyo gufunga imiyoboro y'inyongo kigoye kuri ERCP, ikoranabuhanga rya PST ryakunze gufatwa nk'amahitamo ya mbere ku gufunga imiyoboro bigoranye. Guca sphincter y'inyongo mbere yo gukata bivuga guca sphincter y'umuyoboro w'imbere wa papilla n'umutsi muto wa sphincter binyuze mu cyuma gifata imbunda kugira ngo haboneke aho umwobo w'inyongo, hanyuma ugakoresha uburyo bwainsinga y'ubuyobozicyangwa catheter kugira ngo inyure umuyoboro w'inyongo.
Ubushakashatsi bwakozwe mu gihugu bwagaragaje ko igipimo cyo gutsinda kwa PST kiri hejuru ya 89.66%, ibi bikaba bidatandukanye cyane na DGT na TPS. Ariko, umubare wa PEP muri PST uri hejuru cyane ugereranije n'uwa DGT na TPS.
Muri iki gihe, icyemezo cyo gukoresha iri koranabuhanga gishingiye ku bintu bitandukanye. Urugero, raporo imwe yavuze ko PST ikoreshwa neza mu gihe papilla ya duodenal idasanzwe cyangwa idasobanutse neza, nko kurwara indwara ya duodenal stenosis cyangwa kanseri.
Byongeye kandi, ugereranyije n'izindi ngamba zo guhangana n'ikibazo, PST ifite ibibazo byinshi nka PEP, kandi ibisabwa mu kubaga ni byinshi, bityo iki gikorwa gikorwa neza n'abaganga b'inararibonye mu by'ubuvuzi.
VI. Imbugita yo gupima urushinge, NKP
NKP ni uburyo bwo gukamura icyuma gikoresha icyuma. Iyo gukamura icyuma bigoye, icyuma gikoresha icyuma gishobora gukoreshwa mu gukata igice cya papilla cyangwa sphincter uhereye ku mwenge wa duodenal papilla mu cyerekezo cya saa 11-12, hanyuma ugakoreshainsinga y'ubuyobozicyangwa catheter kugira ngo ikoreshwe mu muyoboro w’amaraso usanzwe. Nk’uburyo bwo guhangana n’ikibazo cyo gufunga imiyoboro y’amaraso igoye, NKP ishobora kunoza neza igipimo cyo gutsinda cyo gufunga imiyoboro y’amaraso igoye. Mu bihe byashize, muri rusange byari byitezwe ko NKP yakongera umubare w’abantu barwaye PEP mu myaka ya vuba aha. Mu myaka ya vuba aha, raporo nyinshi z’isesengura ryagaragaje ko NKP idakomeza ibyago byo kugira ibibazo nyuma yo kubagwa. Ni ngombwa kumenya ko niba NKP ikozwe mu ntangiriro z’ikibazo cyo gufunga imiyoboro igoye, bizafasha cyane mu kunoza igipimo cyo gutsinda cyo gufunga imiyoboro. Ariko, ubu nta bwumvikane buriho ku gihe cyo gukoresha NKP kugira ngo haboneke umusaruro mwiza. Ubushakashatsi bumwe bwagaragaje ko igipimo cyo gufunga imiyoboro y’amaraso cya NKP cyakoreshejwe mu giheERCPmunsi y'iminota 20 yari hejuru cyane ugereranyije n'iya NKP yakoreshejwe nyuma y'iminota 20.
Abarwayi bafite ikibazo cyo gukata inyo ku buryo bugoye bazakungukira cyane muri ubu buryo niba bafite ibibyimba by'inkari cyangwa imiyoboro y'inkari yagutse cyane. Byongeye kandi, hari raporo zivuga ko iyo bahuye n'ibibazo bikomeye byo gukata inyo, gukoresha TPS na NKP hamwe bitanga umusaruro mwinshi kuruta gukoresha byonyine. Ingorane ni uko uburyo bwinshi bwo gukata inyo butuma habaho ibibazo. Kubwibyo, hakenewe ubushakashatsi bwinshi kugira ngo hamenyekane niba hagomba gutorwa hakiri kare mbere yo gukata inyo kugira ngo bigabanye ibibazo cyangwa hagashyirwaho ingamba nyinshi zo gukosora kugira ngo hongerwe umusaruro mwiza wo gukata inyo ku buryo bugoye.
VII. Icyuma-icyuma Fistulotomy, NKE
Uburyo bwa NKF buvuga gukoresha icyuma cy'urushinge kugira ngo utobore mucosa hafi mm 5 hejuru y'ibere, ukoresheje amashanyarazi avanze kugira ngo utobore urwego ku rundi mu cyerekezo cya saa kumi n'imwe kugeza igihe imiterere isa n'inyuma cyangwa ibere ryuzuye, hanyuma ugakoresha insinga iyobora kugira ngo umenye aho ibere risohoka n'aho ibere rica. Uburyo bwo gufatira imiyoboro y'ibere bwakorewe ahantu harwaye indwara ya jaundice. Kubaga NKF bigabanya hejuru y'umwobo w'ibere. Bitewe n'uko hariho umwijima w'ibere, bigabanya cyane kwangirika k'ubushyuhe n'ubwangirike bw'ibere ku mwobo w'ibere, bishobora kugabanya umubare wa PEP.
Ubushakashatsi bwakozwe na Jin n'abandi bwagaragaje ko igipimo cy'intsinzi yo gushyiramo umuyoboro wa NK gishobora kugera kuri 96.3%, kandi nta PEP nyuma yo kubagwa ibaho. Byongeye kandi, igipimo cy'intsinzi yo gukuramo amabuye ya NKF kiri hejuru ya 92.7%. Kubera iyo mpamvu, ubu bushakashatsi busaba ko NKF ari yo mahitamo ya mbere yo gukuramo amabuye y'imiyoboro isanzwe y'amaraso. Ugereranyije na papillomyotomy isanzwe, ibyago byo kubagwa kwa NKF biracyari byinshi, kandi ikunze kugira ingorane nko gutobora no kuva amaraso, kandi bisaba urwego rwo hejuru rw'abaganga b'inzobere mu kubaga. Aho idirishya rifungukira neza, uburebure bukwiye, n'ubuhanga bunoze byose bigomba kwigwa buhoro buhoro.
Ugereranyije n'ubundi buryo bwo gukata mbere yo gukata, NKF ni uburyo bworoshye kandi bufite igipimo cyo gutsinda kinini. Ariko, ubu buryo busaba imyitozo y'igihe kirekire no gukusanya buri gihe kugira ngo umuntu abe ashoboye, bityo ubu buryo ntibukwiriye abatangiye.
VIII. Isubiramo-ERCP
Nkuko byavuzwe haruguru, hari uburyo bwinshi bwo guhangana n’ikibazo cyo gufunga amenyo bigoranye. Ariko, nta gihamya y’uko bizagenda neza 100%. Inyandiko zifatika zagaragaje ko iyo gufunga amenyo bigoranye mu bihe bimwe na bimwe, gufunga amenyo mu gihe kirekire no mu buryo bwinshi cyangwa ingaruka zo kwinjira mu bushyuhe bw’ibiza bishobora gutera kubyimba kwa duodenal papilla. Niba igikorwa gikomeje, gufunga amenyo mu buryo butazagenda neza gusa, ahubwo n’amahirwe yo kugira ibibazo na yo azagenda yiyongera. Niba ibi byavuzwe haruguru bibaye, ushobora gutekereza guhagarika amashanyarazi.ERCPoperasiyo ya ERCP ya kabiri hanyuma ukore ERCP ya kabiri mu gihe runaka. Nyuma y'uko papilloedema irangiye, operasiyo ya ERCP izoroha kuyikoresha neza.
Donnellan n'abandi bakoze igice cya kabiriERCPKubaga abarwayi 51 bakorewe ERCP nyuma yo gukata icyuma, kandi 35 babikoze neza, kandi ingaruka z’ibyo bibazo ntizariyongera.
Kim n'abandi bakoze operation ya kabiri ya ERCP ku barwayi 69 bananiweERCPnyuma yo gukata urushinge mbere yo gukata, maze abantu 53 batsinda, ku kigero cya 76.8%. Abandi bakinnyi batsinze nabo bakorewe operasiyo ya ERCP ku nshuro ya gatatu, ku kigero cya 79.7%., kandi kubagwa inshuro nyinshi ntibyongereye ibibazo.
Yu Li n'abandi bakoze ikizamini cya kabiri cy'imyitozo ngororamubiri (electal secondary secondary)ERCPku barwayi 70 bananiwe gukoresha ERCP nyuma yo gucibwa urushinge mbere yo gucibwamo, kandi abantu 50 baratsinze. Igipimo cy'intsinzi muri rusange (ERCP ya mbere + ERCP ya kabiri) cyariyongereye kigera kuri 90.6%, kandi ingaruka ntizariyongera cyane. Nubwo raporo zagaragaje ko ERCP ya kabiri ikora neza, igihe kiri hagati y'ibikorwa bibiri bya ERCP ntigikwiye kuba kirekire cyane, kandi mu bihe bimwe na bimwe byihariye, gutinda gusohora amazi mu nda bishobora kongera ikibazo.
IX. Gusohora amazi mu nda biyobowe na Endoscopicultrasound, EUS-BD
EUS-BD ni uburyo bwo gutobora bukoresha urushinge rwo gutobora agasabo k'inkari mu gifu cyangwa mu gifu hifashishijwe ikoranabuhanga rya ultrasound, bukinjira muri duodenum bunyuze muri papilla ya duodenal, hanyuma bugakoresha amenyo. Ubu buryo burimo uburyo bwo gutobora mu gifu no mu gice cyo hanze y'umwijima.
Ubushakashatsi bwakozwe nyuma bwagaragaje ko igipimo cyo gutsinda kwa EUS-BD cyageze kuri 82%, kandi ko ingaruka zo kubagwa nyuma yo kubagwa zari 13% gusa. Mu bushakashatsi bwakozwe ku kigereranyo, EUS-BD ugereranije n'ikoranabuhanga ryakozwe mbere yo gukata, igipimo cyo gutsinda kwayo mu gukaraba cyari hejuru, kigera kuri 98.3%, cyari hejuru cyane ugereranyije na 90.3% by'ikoreshwa mbere yo gukata. Ariko, kugeza ubu, ugereranije n'ubundi ikoranabuhanga, haracyari ikibazo cy'ubushakashatsi ku ikoreshwa rya EUS mu buryo bugoye.ERCPgusohora umuyoboro w'amaraso. Nta makuru ahagije agaragaza imikorere y'ikoranabuhanga rya EUS-guided bile duct puncture ku buryo bigoyeERCPGushyiramo imiyoboro y'amaraso mu muyoboro w'amaraso. Hari ubushakashatsi bwagaragaje ko byagabanyije uruhare rwa PEP nyuma yo kubagwa ntabwo yemeza.
X. Gutemba kw'amazi hakoreshejwe icyuma gikingira umwijima, PTCD
PTCD ni ubundi buryo bwo gusuzuma indwara zishobora gukoreshwa hamwe naERCPku buryo bigoye kwinjira mu miyoboro y'indyo, cyane cyane mu gihe cy'inzibacyuho mbi. Ubu buryo bukoresha urushinge rwo gutobora kugira ngo rwinjire mu miyoboro y'indyo, rutobore umuyoboro w'indyo unyuze mu gahu, hanyuma rukongerere umuyoboro w'indyo inyuma unyuze mu mwanya wabugenewe.insinga y'ubuyoboziUbushakashatsi bumwe bwasesenguye abarwayi 47 bafite ikibazo cyo gufunga imiyoboro y'amaraso bakorewe tekiniki ya PTCD, maze igipimo cyo gutsinda kigera kuri 94%.
Ubushakashatsi bwakozwe na Yang n'abandi bwagaragaje ko ikoreshwa rya EUS-BD rigaragara ko ritoroshye iyo bigeze kuri stenosis ya hilar no gukenera gutobora umuyoboro w'inyongo mu mwijima, mu gihe PTCD ifite ibyiza byo guhuza n'umurongo w'inyongo no kuba yoroshye mu bikoresho biyobora. Uburyo bwo gusohora insinga z'inyongo bukwiye gukoreshwa muri abo barwayi.
PTCD ni igikorwa kigoye gisaba amahugurwa y’igihe kirekire no kurangiza umubare uhagije w’abakiri bato. Biragoye ku bakiri bato kurangiza iki gikorwa. PTCD ntabwo igoye kuyikora gusa, ahubwo iragoye noinsinga y'ubuyobozibishobora no kwangiza umuyoboro w'inyongo mu gihe cyo gutera imbere.
Nubwo uburyo bwavuzwe haruguru bushobora kongera cyane igipimo cyo gutsinda cyo gufunga imiyoboro y'amaraso igoye, amahitamo agomba gusuzumwa neza.ERCP, SGT, DGT, WGC-PS n'ubundi buryo bushobora gusuzumwa; niba uburyo bwavuzwe haruguru budakora neza, abaganga b'inzobere bakuru n'inararibonye bashobora gukora uburyo bwo gukata mbere y'uko hakorwa ikizamini, nka TPS, NKP, NKF, nibindi; niba bikiri uko biri Niba uburyo bwo gukata amenyo budashobora kurangizwa, uburyo bwo gukata amenyo bushobora gukorwa nyuma y'igihe runaka.ERCPishobora gutoranywa; niba nta buryo na bumwe muri ubu buhanga bwavuzwe haruguru bushobora gukemura ikibazo cyo gukurura icyuma gifunga imiyoboro y'amaraso, hashobora kugeragezwa kubaga abantu benshi nka EUS-BD na PTCD kugira ngo ikibazo gikemuke, kandi hashobora gutoranywa ubuvuzi bwo kubaga bibaye ngombwa.
Twebwe, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ni uruganda rukora ibikoresho byo mu Bushinwa rwihariye mu bikoresho byo mu nda, nka biopsy forceps, hemoclip, polyp snare, sclerotherapy energetic, spray catheter, cytology brushes,insinga y'ubuyobozi, agasanduku ko gukurura amabuye, katheteri itwara amazi mu mazurun'ibindi bikoreshwa cyane muri EMR, ESD,ERCPIbicuruzwa byacu bifite icyemezo cya CE, naho inganda zacu zifite icyemezo cya ISO. Ibicuruzwa byacu byoherejwe mu Burayi, Amerika ya Ruguru, Uburasirazuba bwo Hagati no mu gice kimwe cya Aziya, kandi birushaho kumenyekana no gushimwa n'abakiriya!
Igihe cyo kohereza: 31 Mutarama 2024