ERCP ni tekinoroji y'ingenzi mu gusuzuma no kuvura indwara ya biliary na pancreatic.Bimaze gusohoka, yatanze ibitekerezo byinshi bishya byo kuvura indwara ya biliary na pancreatic.Ntabwo igarukira gusa kuri "radiografiya".Yahindutse kuva muburyo bwambere bwo gusuzuma bwo kwisuzumisha muburyo bushya.Ubuhanga bwo kuvura burimo sphincterotomy, kuvanaho amabuye y'umuyoboro, gukuramo amazi hamwe n'ubundi buryo bwo kuvura indwara zifata umwanda na pancreatic.
Intsinzi yo gutoranya imiyoboro ihindagurika ya ERCP irashobora kugera hejuru ya 90%, ariko haracyariho ibihe bigoye aho biliary igoye itera guhitamo imyanda ihitamo kunanirwa.Ukurikije ibyumvikanyweho vuba aha kubijyanye no gusuzuma no kuvura ERCP, intubation igoye irashobora gusobanurwa nku: igihe cyo gutoranya imyanda ihitamo intangiriro ya nipple nyamukuru ya ERCP isanzwe irenze iminota 10 cyangwa umubare wabagerageje intubation urenze inshuro 5.Mugihe ukora ERCP, niba intubation ya duct itoroshye mubihe bimwe na bimwe, ingamba zifatika zigomba gutoranywa mugihe cyo kunoza igipimo cyimyanya ndangagitsina.Iyi ngingo ikora isubiramo rifatika ryubuhanga butandukanye bwifashishwa mugukemura ibibazo bitoroshye byimyanya ndangagitsina, hagamijwe gutanga ishingiro ryamahame ya endoskopiste y’amavuriro kugirango bahitemo ingamba zo gusubiza mugihe bahuye nubushakashatsi bukomeye bwa ERCP.
I.Singleguidewire Tekinike, SGT
Tekinike ya SGT nugukoresha ibinyuranyo kugirango ukomeze ugerageze kwinjiza umuyoboro wa bili nyuma yuko insinga iyobora yinjiye mumiyoboro ya pancreatic.Mu minsi yambere yiterambere ryikoranabuhanga rya ERCP, SGT yari uburyo busanzwe bwo kumenya biliary intubation.Akarusho kayo nuko byoroshye gukora, gukosora ibere, kandi birashobora gufata umwanya wo gufungura umuyoboro wa pancreatic, bigatuma byoroha kubona ifungura ryumuyoboro.
Hariho raporo muri theliterature ko nyuma yubushakashatsi busanzwe bwananiranye, guhitamo SGT ifashwa na intubation birashobora kurangiza neza intubation ya bilide hafi 70% -80%.Raporo yerekanye kandi ko mu gihe SGT yananiwe, ndetse no guhindura no gushyira mu bikorwa kabirikuyoboraikoranabuhanga ntabwo ryazamuye igipimo cyo gutsinda kwa duct intubation kandi nticyagabanije kwandura indwara ya pancreatite nyuma ya ERCP (PEP).
Ubushakashatsi bumwe bwerekanye kandi ko intsinzi ya SGT intubation iri munsi yubwa kabirikuyoboratekinoroji na transpancreatic papillary sphincterotomy tekinoroji.Ugereranije no kugerageza kenshi kwa SGT, gushyira mubikorwa hakiri karekuyoboratekinoroji cyangwa tekinoroji ya pre-incision irashobora kugera kubisubizo byiza.
Kuva iterambere rya ERCP, tekinoroji zitandukanye zitandukanye zatejwe imbere kugirango intubation igoye.Ugereranije nubuseribaterikuyoboraikoranabuhanga, ibyiza biragaragara kandi igipimo cyo gutsinda kiri hejuru.Kubwibyo, ingaragukuyoboraikoranabuhanga kuri ubu rikoreshwa gake mubuvuzi.
II.Uburyo bubiri-buyobora tekinike, DGT
DGT irashobora kwitwa pancreatic duct guide wire occupation occupation, aribwo gusiga insinga ziyobora zinjira mumiyoboro ya pancreatic kugirango zishakishe kandi zigitware, hanyuma insinga ya kabiri iyobora irashobora kongera gukoreshwa hejuru yinsinga ziyobora pancreatic.Guhitamo umuyoboro wa intubation.
Ibyiza byubu buryo ni:
(1) Hifashishijwe akuyobora, gufungura umuyoboro wa bili biroroshye kubibona, bigatuma intubation ya duct intubation yoroshye;
(2) Umugozi uyobora urashobora guhuza ibere;
(3) Bayobowe numuyoboro wa pancreatickuyobora, gusubiramo inshuro nyinshi kumiyoboro ya pancreatic birashobora kwirindwa, bityo bikagabanya kubyutsa imiyoboro ya pancreatic iterwa no kwisubiramo inshuro nyinshi.
Dumonceau n'abandi.yabonye ko umurongo ngenderwaho hamwe na catheter itandukanye ushobora kwinjizwa mumwobo wa biopsy icyarimwe, hanyuma ukamenyesha ikibazo cyatsinzwe muburyo bwo gufata imiyoboro ya pancreatic.kuyoboragufata uburyo bwa pancreatic duct uburyo bwatsinze intubation ya bile.igipimo gifite ingaruka nziza.
Ubushakashatsi kuri DGT na Liu Deren n'abandi.yasanze nyuma yuko DGT ikorewe ku barwayi bafite ibibazo bya ERCP bigoye, intubation yageze kuri 95,65%, ibyo bikaba byari hejuru cyane ya 59.09% byatsinze intubation isanzwe.
Ubushakashatsi buteganijwe na Wang Fuquan n'abandi.yerekanye ko igihe DGT yakoreshwaga ku barwayi bafite ERCP ya duct intubation itoroshye mu itsinda ry’ubushakashatsi, intsinzi ya intubation yari hejuru ya 96.0%.
Ubushakashatsi bwavuzwe haruguru bwerekana ko ikoreshwa rya DGT ku barwayi bafite imiyoboro ihanitse ya ERCP ishobora kuzamura neza intsinzi y’imyanya ndangagitsina.
Inenge za DGT zirimo ingingo ebyiri zikurikira:
(1) pancreatickuyoborabirashoboka ko yatakaye mugihe cyo gukuramo intubation, cyangwa icya kabirikuyoborairashobora kongera kwinjira mu muyoboro wa pancreatic;
.
Urebye ibyorezo bya PEP, indwara ya PEP ya DGT iri munsi yubwa gakondo ya duct intubation.Ubushakashatsi buteganijwe bwerekanye ko indwara ya PEP nyuma ya DGT yari 2.38% gusa ku barwayi ba ERCP bafite intubation itoroshye.Ubuvanganzo bumwe bwerekana ko nubwo DGT ifite amahirwe menshi yo gutsinda imiyoboro y’imyanda, indwara ya pancreatite ya nyuma ya DGT iracyari myinshi ugereranije n’izindi ngamba zo gukosora, kubera ko imikorere ya DGT ishobora kwangiza umuyoboro wa pancreatic no gufungura.N'ubwo bimeze bityo ariko, ubwumvikane mu gihugu ndetse no hanze yacyo buracyerekana ko mugihe habaye intubation igoye, iyo intubation igoye kandi umuyoboro wa pancreatic ukaba warayobejwe inshuro nyinshi, DGT niyo ihitamo ryambere kuko ikoranabuhanga rya DGT rifite ibibazo bike mubikorwa, kandi byoroshye kugenzura.Bikoreshwa cyane muguhitamo intubation igoye.
III.Icyerekezo cyayobora cannulation-pan-creatic stent, WGC-P5
WGC-PS irashobora kandi kwitwa uburyo bwa spancreatic duct stent occupation occupation.Ubu buryo nugushira imiyoboro ya pancreatic stent hamwe nakuyoboraibyo bibeshya byinjira mu muyoboro wa pancreatic, hanyuma ukuramokuyoborahanyuma ukore umuyoboro wa bili hejuru ya stent.
Ubushakashatsi bwakozwe na Hakuta n'abandi.yerekanye ko usibye kuzamura igipimo rusange cyo gutsinda kwa intubation mu kuyobora intubation, WGC-PS irashobora kandi kurinda gufungura imiyoboro ya pancreatic kandi ikagabanya cyane kugaragara kwa PEP.
Ubushakashatsi kuri WGC-PS na Zou Chuanxin n'abandi.yerekanye ko intsinzi yo gutera intubation igoye ikoresheje uburyo bwigihe gito bwa pancreatic duct stent occupation yageze kuri 97.67%, kandi indwara ya PEP yagabanutse cyane.
Ubushakashatsi bumwe bwerekanye ko iyo imiyoboro ya pancreatic stent ishyizwe neza, amahirwe yo kwandura pancreatite ikabije nyuma yo kubagwa mugihe kitoroshye cya intubation aragabanuka cyane.
Ubu buryo buracyafite ibitagenda neza.Kurugero, imiyoboro ya pancreatic stent yinjijwe mugihe cya ERCP irashobora kwimurwa;niba stent ikeneye gushyirwaho umwanya muremure nyuma ya ERCP, hazabaho amahirwe menshi yo guhagarika stent no guhagarika imiyoboro.Gukomeretsa nibindi bibazo bitera kwiyongera kwandura PEP.Ubusanzwe, ibigo byatangiye kwiga imyanda yigihe gito ishobora guhita ikava mumiyoboro ya pancreatic.Ikigamijwe ni ugukoresha imiyoboro ya pancreatic stent kugirango wirinde PEP.Usibye kugabanya cyane impanuka ziterwa na PEP, stent irashobora kandi kwirinda ibindi bikorwa byo gukuraho stent no kugabanya umutwaro kubarwayi.Nubwo ubushakashatsi bwerekanye ko imiyoboro yigihe gito yifata igira ingaruka nziza mukugabanya PEP, ubuvuzi bwabo buracyafite imbogamizi zikomeye.Kurugero, kubarwayi bafite imiyoboro mito mito n'amashami menshi, biragoye gushyiramo stent pancreatic stent.Ingorane ziziyongera cyane, kandi iki gikorwa gisaba urwego rwohejuru rwumwuga wa endoscopiste.Birakwiye kandi kumenya ko stent pancreatic duct stent yashyizwe ntigomba kuba ndende cyane mumyanya ndangagitsina.Stent ndende cyane irashobora gutera intanga ebyiri.Kubwibyo, guhitamo uburyo bwa pancreatic duct stent umurimo wakazi biracyakenewe kwitonderwa.
IV.Trans-pancreatocsphincterotomy, TPS
Ikoranabuhanga rya TPS rikoreshwa muri rusange nyuma yo kuyobora insinga zinjiye mu muyoboro wa pancreatic wibeshye.Septum iri hagati yumuyoboro wa pancreatic ucometse ku cyerekezo cy’umugozi uyobora imiyoboro ya pancreatic kuva saa 11 kugeza saa 12, hanyuma umuyoboro winjizwa mu cyerekezo cyumuyoboro kugeza igihe insinga ziyobora zinjiye mu mara umuyoboro.
Ubushakashatsi bwakozwe na Dai Xin n'abandi.ugereranije TPS nubundi buryo bubiri bwikoranabuhanga intubation.Birashobora kugaragara ko intsinzi yikoranabuhanga rya TPS iri hejuru cyane, igera kuri 96,74%, ariko ntigaragaza ibisubizo byiza ugereranije nubundi buryo bubiri bwifashisha intubation.Ibyiza.
Byatangajwe ko ibiranga ikoranabuhanga rya TPS birimo ingingo zikurikira:
(1) Gutemagura ni bito kuri septum ya pancreaticobiliary septum;
(2) Ibibazo byingutu nyuma yibikorwa ni bike;
(3) Guhitamo icyerekezo cyo guca byoroshye kugenzura;
(4) Ubu buryo burashobora gukoreshwa kubarwayi bafite pancreatic duct intubation cyangwa insiples muri diverticulum.
Ubushakashatsi bwinshi bwerekanye ko TPS idashobora gusa kunoza neza igipimo cyogutsinda kwimyanda itoroshye, ariko kandi nticyongera ibibazo byikibazo nyuma ya ERCP.Intiti zimwe zivuga ko niba intanga ya pancreatic duct intubation cyangwa papila ntoya ya duodenal ibaho inshuro nyinshi, TPS igomba kubanza gusuzumwa.Ariko, mugihe ushyira TPS, hagomba kwitonderwa uburyo hashobora kubaho imiyoboro ya pancreatic duct stenosis no kugaruka kwa pancreatitis, bikaba bishoboka ko bishobora kuba igihe kirekire cya TPS.
V.Gukurikirana Sphincterotomy, PST
Tekinike ya PST ikoresha bande ya papillary arcuate nkumupaka wo hejuru wa pre-incision hamwe nicyerekezo cya 1-2 nkumupaka wo gufungura papilla sphincter duodenal kugirango tubone gufungura umuyoboro wa pisine na pancreatic.Hano PST yerekeza byumwihariko tekinike isanzwe ya nipple sphincter pre-incision tekinike ikoresheje icyuma cya arcuate.Ningamba zo guhangana ningirabuzimafatizo igoye ya ERCP, tekinoroji ya PST yafashwe nkuburyo bwambere bwo guhitamo intubation.Endoscopic nipple sphincter pre-incision bivuga kwangirika kwa endoskopi ya mucosa yo mu bwoko bwa papilla hamwe na mitsi mike ya sphincter ukoresheje icyuma cyo gutemagura kugirango ubone gufungura umuyoboro wa bili, hanyuma ukoreshe akuyoboracyangwa catheter kugirango intubate umuyoboro.
Ubushakashatsi bwakozwe mu gihugu bwerekanye ko intsinzi ya PST iri hejuru ya 89,66%, ibyo bikaba bitandukanye cyane na DGT na TPS.Ariko, indwara ya PEP muri PST irarenze cyane ugereranije na DGT na TPS.
Kugeza ubu, icyemezo cyo gukoresha iri koranabuhanga giterwa nimpamvu zitandukanye.Kurugero, raporo imwe yavuze ko PST ikoreshwa neza mugihe papilla duodenal idasanzwe idasanzwe cyangwa igoretse, nka stenosis duodenal cyangwa malignance.
Mubyongeyeho, ugereranije nizindi ngamba zo guhangana nazo, PST ifite ibibazo byinshi byingorabahizi nka PEP, kandi ibisabwa mubikorwa ni byinshi, kubwibyo bikorwa rero bikorwa neza na endoskopi babimenyereye.
VI.Icyuma-icyuma Papillotomy, NKP
NKP ni inshinge-icyuma ifashwa na intubation tekinike.Iyo intubation igoye, icyuma-inshinge kirashobora gukoreshwa mugukata igice cya papila cyangwa sphincter kuva gufungura papilla duodenal mu cyerekezo cya 11-12, hanyuma ugakoresha akuyoboracyangwa catheter to Guhitamo kwinjiza mumiyoboro isanzwe.Nuburyo bwo guhangana ningirabuzimafatizo igoye, NKP irashobora kunoza neza igipimo cyitsinzi ryimyanya ndangagitsina.Mubihe byashize, wasangaga abantu bizeraga ko NKP yakongera indwara ya PEP mumyaka yashize.Mu myaka yashize, raporo nyinshi zisesenguye zerekanye ko NKP itongera ibyago byo guhura nibibazo.Birakwiye ko tumenya ko niba NKP ikozwe mugihe cyambere cya intubation igoye, bizafasha cyane mukuzamura intsinzi ya intubation.Ariko, kuri ubu nta bwumvikane ku gihe cyo gusaba NKP kugirango ugere ku bisubizo byiza.Ubushakashatsi bumwe bwerekanye ko igipimo cya intubation ya NKP cyakoreshejwe mugiheERCPmunsi yiminota 20 yari hejuru cyane ugereranije na NKP yakoreshejwe nyuma yiminota 20.
Abarwayi bafite imiyoboro ihanitse ya kanseri irashobora kungukirwa nubu buhanga niba bafite ibibyimba byonsa cyangwa kwaguka gukomeye.Mubyongeyeho, hari amakuru avuga ko mugihe uhuye nibibazo bitoroshye bya intubation, gukoresha hamwe kwa TPS na NKP bifite igipimo kinini cyo gutsinda kuruta gusaba wenyine.Ingaruka ni uko tekinike nyinshi zo gutema zikoreshwa kuri nippe bizongera ibibazo byingutu.Niyo mpamvu, hakenewe ubushakashatsi bwinshi kugirango hamenyekane niba ugomba guhitamo hakiri kare kugirango ugabanye ibibazo bitoroshye cyangwa guhuza ingamba nyinshi zo gukosora kugirango tunonosore intsinzi ya intubation igoye.
VII. Icyuma-icyuma Fistulotomy, NKE
Tekinike ya NKF bivuga gukoresha icyuma cy'urushinge kugirango utobore mucosa nka 5mm hejuru yigitereko, ukoresheje umuyoboro uvanze kugirango utere umurongo ku cyerekezo cyerekezo cya saa 11 kugeza igihe imiterere imeze nka orifice cyangwa umwuzure wuzuye, hanyuma ugakoresha umugozi uyobora kugirango umenye isohoka rya bile hamwe no gutemagura ingirangingo.Guhitamo imiyoboro ya duct intubation yakorewe kurubuga rwa jaundice.Kubaga NKF bigabanya hejuru yo gufungura.Bitewe no kubaho kwa sinus ya bile, bigabanya cyane kwangirika kwubushyuhe no kwangirika kwubukorikori bwo gufungura imiyoboro ya pancreatic, ishobora kugabanya indwara ya PEP.
Ubushakashatsi bwakozwe na Jin n'abandi.yerekanye ko intsinzi ya NK tube intubation ishobora kugera kuri 96.3%, kandi nta PEP nyuma yo kubagwa.Mubyongeyeho, igipimo cya NKF mugukuraho amabuye kiri hejuru ya 92.7%.Kubwibyo, ubu bushakashatsi burasaba NKF nkuburyo bwambere bwo kuvanaho amabuye asanzwe..Ugereranije na papillomyotomy isanzwe, ibyago byo gukora NKF biracyari hejuru, kandi bikunda guhura nibibazo nko gutobora no kuva amaraso, kandi bisaba urwego rwo hejuru rwa endoskopi.Idirishya ryukuri rifungura, ubujyakuzimu bukwiye, hamwe nubuhanga busobanutse byose bigomba kwigwa buhoro buhoro.shobuja.
Ugereranije nubundi buryo bwabanjirije gutemwa, NKF nuburyo bworoshye hamwe nigipimo cyinshi cyo gutsinda.Nyamara, ubu buryo busaba imyitozo yigihe kirekire no kwegeranya byimazeyo nuwayikoresheje kugirango abashe kuba mwiza, ubwo buryo rero ntibukwiriye kubatangira.
VIII. Subiramo-ERCP
Nkuko byavuzwe haruguru, hariho inzira nyinshi zo guhangana nintubation igoye.Ariko, nta garanti yo gutsinda 100%.Ubuvanganzo bujyanye na bwo bwerekanye ko iyo intubation ya duct itoroshye mu bihe bimwe na bimwe, intubation y'igihe kirekire kandi myinshi cyangwa ingaruka zo kwinjiza amashyuza mbere yo gukata zishobora gutera indwara ya papilla duodenal.Niba ibikorwa bikomeje, ntabwo intubation ya duct itazagerwaho gusa, ariko amahirwe yo guhura nayo aziyongera.Niba ibintu byavuzwe haruguru bibaye, urashobora gutekereza kurangiza ikigezwehoERCPgukora mbere hanyuma ukore ERCP ya kabiri mugihe utabishaka.Nyuma ya papilloedema ibuze, imikorere ya ERCP izoroha kugera kuri intubation neza.
Donnellan n'abandi.yakoze isegondaERCPkubaga abarwayi 51 bafite ERCP yananiwe nyuma yo guterwa inshinge-icyuma, naho 35 baratsinze, kandi ibibazo by’ingutu ntibyiyongereye.
Kim n'abandi.yakoze igikorwa cya kabiri cya ERCP ku barwayi 69 bananiweERCPnyuma y'urushinge-icyuma mbere yo gutemwa, naho imanza 53 zatsinzwe, intsinzi ya 76.8%.Imanza zisigaye zitatsinzwe nazo zakozwe ku nshuro ya gatatu ERCP, intsinzi ya 79.7%., kandi ibikorwa byinshi ntabwo byongereye kubaho ibibazo.
Yu Li n'abandi.yakoze icyiciro cya kabiriERCPku barwayi 70 bananiwe ERCP nyuma yo guterwa inshinge-icyuma, kandi 50 baratsinze.Igipimo rusange cyatsinze (ERCP yambere + ERCP yambere) cyiyongereye kugera kuri 90,6%, kandi ibibazo byingutu ntibyiyongereye cyane..Nubwo raporo zerekanye imikorere ya ERCP ya kabiri, intera iri hagati yibikorwa bibiri bya ERCP ntigomba kuba ndende cyane, kandi mubihe bimwe na bimwe bidasanzwe, gutinda kwa biliary bishobora kongera ikibazo.
IX.Endoscopicultrasound-iyobowe na biliary drainage, EUS-BD
EUS-BD ni uburyo butera bukoresha urushinge rwacumita kugirango rutobore uruhago ruva mu gifu cyangwa mu nda ya duodenum ruyobowe na ultrasound, winjire muri duodenum unyuze kuri papila duodenal, hanyuma ukore intubation ya biliary.Ubu buhanga bukubiyemo inzira zidasanzwe ndetse nuburyo budasanzwe.
Ubushakashatsi bwisubireho bwerekanye ko intsinzi ya EUS-BD yageze kuri 82%, naho ibibazo by’indwara nyuma yo kubaga byari 13% gusa.Mu bushakashatsi bugereranije, EUS-BD ugereranije n’ikoranabuhanga rya pre-incision, igipimo cyayo cyo gutsinda intubation cyari hejuru, kigera kuri 98.3%, cyari hejuru cyane ya 90.3% ya pre-incision.Ariko, kugeza ubu, ugereranije nubundi buryo bwikoranabuhanga, haracyari ikibazo cyubushakashatsi ku ikoreshwa rya EUS bigoyeERCPintubation.Hano hari amakuru adahagije kugirango yerekane imikorere yubuhanga bwa EUS buyobowe na tekinoroji ya tekinorojiERCPintubation.Ubushakashatsi bumwe bwerekanye ko bwagabanije Uruhare rwa PEP nyuma yubuvuzi ntabwo rwemeza.
X.Imiyoboro ya transhepatike ya cholangial imiyoboro, PTCD
PTCD nubundi buryo bwo gupima ibizamini bushobora gukoreshwa hamweERCPkubibazo bigoye bya duct intubation, cyane cyane mugihe cya biliary mbi.Ubu buhanga bukoresha urushinge rwacumita kugirango rwinjire mu buryo butaziguye umuyoboro wa pisine, utobore umuyoboro wa pile unyuze muri papila, hanyuma winjize umuyoboro wa bili usubira inyuma binyuze mu bubikokuyobora.Ubushakashatsi bumwe bwasesenguye abarwayi 47 bafite intubation itoroshye yo mu nda bakoresheje tekinike ya PTCD, kandi intsinzi yageze kuri 94%.
Ubushakashatsi bwakozwe na Yang n'abandi.yerekanye ko ikoreshwa rya EUS-BD rigaragara ko ari rito iyo bigeze kuri hilar stenosis ndetse no gukenera gutobora umuyoboro w’iburyo wa intrahepatic, mu gihe PTCD ifite ibyiza byo guhuza imiyoboro y’imyanda kandi ikoroha cyane mu bikoresho biyobora.Bile duct intubation igomba gukoreshwa mubarwayi nkabo.
PTCD nigikorwa kitoroshye gisaba amahugurwa yigihe kirekire no kurangiza umubare uhagije wimanza.Biragoye kubashya kurangiza iki gikorwa.PTCD ntabwo igoye gukora gusa, ariko ikuyoborairashobora kandi kwangiza umuyoboro wa bile mugihe cyo gutera imbere.
Nubwo uburyo bwavuzwe haruguru bushobora kuzamura cyane igipimo cyo gutsinda kwa duct intubation igoye, guhitamo bigomba gusuzumwa neza.Iyo ukoraERCP, SGT, DGT, WGC-PS nubundi buhanga bushobora gutekerezwa;niba tekinike yavuzwe haruguru yananiwe, endoskopi nkuru kandi inararibonye irashobora gukora tekinike yo kubanza, nka TPS, NKP, NKF, nibindi.;niba bikiri Niba gutoranya umuyoboro wa intubation udashobora kurangira, guhitamo icyiciro cya kabiriERCPirashobora gutoranywa;niba nta tekinike nimwe yavuzwe haruguru ishobora gukemura ikibazo cya intubation igoye, ibikorwa byibasiye nka EUS-BD na PTCD birashobora kugeragezwa kugirango bikemure ikibazo, kandi ubuvuzi bwo kubaga bushobora gutoranywa nibiba ngombwa.
Twebwe, Jiangxi Zhuoruihua Medical Instrument Co., Ltd.kuyobora, igitebo cyo kugarura amabuye, izuru rya biliary drainage catheternibindi bikoreshwa cyane muri EMR, ESD,ERCP.Ibicuruzwa byacu byemewe na CE, kandi ibihingwa byacu byemewe na ISO.Ibicuruzwa byacu byoherejwe mu Burayi, Amerika y'Amajyaruguru, Uburasirazuba bwo hagati ndetse no muri Aziya, kandi bigera ku bakiriya bamenyekana kandi bashimwe!
Igihe cyo kohereza: Mutarama-31-2024