ERCP fasaha ce mai mahimmanci ga ganewar asali da magani na cututtukan pancreatic. Da zarar ya fito, ya ba da sababbin dabaru da yawa don lura da biliary da pancreatic cututtuka. Ba a iyakance shi ga "faifai ba". Ya canza daga fasahar bincike na asali zuwa sabon nau'in. Hanyoyin magani sun haɗa da Sphinctotomy, Cire Dutse Dutse, Cua magudanar ruwa da sauran hanyoyin don magance bile da cututtukan magani.
Rashin nasarar da aka samu na zabin bile na zaba na ERCP zai iya kaiwa sama da 90%, amma har yanzu akwai wasu lokuta inda mai wahala ke haifar da gazawar Biluction mai wahala. Dangane da sabon yarda da cutar kan ganowa da lura da ercp, mai wahala eruction bile na babban na al'ada ercp ya fi minti 10 ko yawan batutuwa ya fi sau 5. Lokacin aiwatar da ESCP, idan duct duct yana da wahala a wasu yanayi, ya kamata a zaɓa masu inganci a cikin lokaci don inganta raguwar nasarar bile. Wannan labarin yana gudanar da tsarin bincike na dabarun da yawa na taimako na taimako da aka yi amfani da shi don magance dabarun da ke cikin asibiti don fuskantar hadari dillancin rarrabuwa ga ERCP.
I.Singdaguiverire, SGT
Tsarin SGT shine amfani da bambanci don ci gaba da ƙoƙarin sanya bututun billi bayan wannan jagorar ta shiga bututu mai rikicewa. A farkon zamanin ci gaban fasahar ERCP, SGT wata hanya ce ta yau da kullun don mai wahala Biliary Truary. Amfaninta shine cewa yana da sauki a aiki, yana gyara kan nono, kuma zai iya mamaye bude mafiƙan, kuma zai iya sauƙaƙa buɗe bututun bile.
Akwai rahotanni a cikin yanayin zabin da bayan lalacewar al'ada ta gaza, zabar abin da ke faruwa sgt-eaukaka su iya samun nasarar kammala ductation duct a kusan 70% -80%-% na shari'o'in. Rahoton ya kuma nuna cewa a lokuta na gazawar SGT, koda daidaitawa da aikace-aikace biyumashayaFasaha ba ta inganta ragin nasarar bile ba kuma ba a rage abin da ya faru ba na pollatetis (PEP).
Wasu karatun ma sun nuna cewa nasarar nasarar SGT ta kasance ƙasa da na ninki biyumashayaFasaha da Transpancanc na Papillary Fasaha Sphinceroty Spalation. Idan aka kwatanta da maimaita ƙoƙarin SGT, farkon aiwatar da ninki biyumashayaFasaha ko fasaha na pre-waftin na iya cimma sakamako mafi kyau.
Tunda ci gaban ESCP, an kirkiro sabbin fasahohi na fasahohi don irin wahayi. Idan aka kwatanta da gudamashayaFasaha, fa'idodi sun fi bayyanannu kuma nasarar nasara ita ce mafi girma. Saboda haka, auremashayaA halin yanzu ba a amfani da fasaha a asibiti.
II.DoBle-Jagora zane waya, DGT
DGT Za a iya kiran DGT Jagora Hanyar Aiki na MTCTOM. Zabar duct na zina.
Amfanin wannan hanyar sune:
(1) tare da taimakon Amashaya, Kwatancen bile yana da sauƙin samu, yin duct duct mai laushi;
(2) waya ta iya fisirin nono;
(3) A karkashin jagorancin bututun maimashaya, maimaita hangen nesa na bututun mai rikitarwa na pancreatic za'a iya magance shi, ta haka yana rage karfafawa buttucin da aka haifar ta hanyar maimaita saitse.
DumonceuAU et al. lura cewa jagora, an saka shi a cikin rami na biops a lokaci guda, sa'an nan kuma a ba da rahoton samun nasarar samun nasara, kuma ya kammala cewamashayamamaye hanyar da aka mamaye ta passactatic mai nasara don duct duct. kudi yana da tasiri mai kyau.
Nazarin a DGT ta LIU Deen Eten et al. An gano cewa bayan an yi DGT a kan marasa lafiya tare da wahalar kuskure na ERCP Bile ya kai 95.65% sama da kashi 59.69% na nasarar al'ada.
Nazarin mai yiwuwa ne ta hanyar Wang FOQUAN et al. An nuna cewa lokacin da DGT aka yi amfani da DGT ga marasa lafiya na ERCP bile ducle a cikin Gungun gwaji ya kasance kamar 96.0% na nasara.
Karatun na sama ya nuna cewa aikace-aikacen DGT ga marasa lafiya da ke cikin rikice-rikice na CILCP na iya inganta raguwar nasarar bile.
Gaji daga DGT galibi sun haɗa da waɗannan maki biyu:
(1) pacoreaticmashayawatakila rasa lokacin duct duct, ko na biyumashayana iya shigar da maki mai ban mamaki da kuma;
(2) Wannan hanyar ba ta dace da lokuta kamar pancreatic kai mai ban tsoro, da kuma wuraren shakatawa na pactatic.
Daga hangen nesa, da Pep ya fice daga DGT ya yi ƙasa da wannan na yanayin duhun al'ada. Binciken mai yiwuwa ya nuna cewa abin da ya faru na Pep bayan DGT ya kasance kawai 2.38% a cikin marasa lafiya na ESCP tare da rikice-rikicen bile. Wasu littattafai sun nuna cewa ko da yake DGT tana da babban rabo na dattin dattay, saboda aikin DGT na iya haifar da lalacewar duct da kuma budewa ta DGT. Duk da wannan, yarjejeniya a gida da kuma ƙasashen har yanzu suna nuna cewa a cikin lokuta na farko dist ducty, kuma a lokacin da aka yi amfani da shi na farko don sarrafawa.
Jagorar III.Wire Jagorar Cannular-Pan-Magana Stent, WGC-P5
WGC-PS za a iya kiranta ductcreatic duct stevent hanyar aiki. Wannan hanyar ita ce sanya duct pacticatic damashayacewa kuskure ya shiga buttctatic duct, sannan fitar damashayada kuma yin bututun duuch bile sama da scent.
Nazarin da Hakuta et al. ya nuna cewa ban da inganta ragin nasarar rashin nasara ta hanyar yin sa jagora, WGC-PS zai iya kuma kare bude butt kuma yana rage abin da ya faru na Pep.
Nazari a WGC-PS By Zou Chuanxin et al. Nuna cewa nasarar da aka samu na mawuyacin hali ta amfani da hanyar da ke wucin gadi ta hanyar wucin gadi da ke tarko, 9777%, da kuma abin da pep ya ragu sosai.
Nazarin daya da aka gano cewa lokacin da aka sanya daskararren bugun fenariact daidai, ana samun damar tsananin rauni pancraceatis a cikin shari'o'in cikin mawuyacin hali yana raguwa sosai.
Wannan hanyar har yanzu tana da wasu kasawa. Misali, ba a saka keɓaɓɓun duct yayin aikin ERCP ba; Idan sace yana buƙatar sanya shi na dogon lokaci bayan ERCP, za a sami damar titin tuki da bututu mai hawa. Rauni da sauran matsaloli zuwa karuwa a cikin abin da ya faru na Pep. Tuni, cibiyoyi sun fara karatun tayoyin duhun ruwa na wucin gadi waɗanda zasu iya motsawa ba tare da wani lokaci ba. Manufar ita ce amfani da tayoyin duhun ruwa don hana Pep. Baya ga rage yawan hadarin Pep, irin wannan tayin kuma zai iya nisantar wasu ayyukan don cire mai tawali'u da rage nauyi a kan marasa lafiya. Kodayake bincike ya nuna cewa tayoyin duhun na lokaci-lokaci suna da tasiri mai kyau a cikin rage Pep, har yanzu aikace-aikacen su har yanzu suna da manyan matsaloli. Misali, a cikin marasa lafiya da ke da na bakin ciki datchreatic dilles da rassan da yawa, yana da wuya a shigar da wani pancreatic duct. Matsalar za a ƙara wahala sosai, kuma wannan aikin yana buƙatar babban matakin ƙwararru masu ƙwararru. Hakanan ya dace da lura cewa ba da daɗewa ba ta sanya pactoratic ductatic ya sanya ya kamata ya yi tsawo a cikin duodenico lumen. Mai wuce haddi mai yawa na iya haifar da kayan duodal. Sabili da haka, zaɓin duct mai ban sha'awa yana buƙatar magance taka tsantsan.
IV.Trans-pancatesocsphinchinstomy, TPS
An yi amfani da fasahar TPS gaba ɗaya bayan wannan jagorar ta shiga cikin kuskuren bututun da kuskure. Septum a tsakiyar duct na panstatic ne tare da allon jagora mai kauri daga karfe 11 zuwa 12 sannan kuma an shigar da bututun mai har sai da waya ta shiga cikin bututun bile ya shiga bututun bile.
Mai binciken da Dai Xin et al. idan aka kwatanta TPS da sauran fasahar sadarwa guda biyu. Ana iya ganin cewa nasarar nasarar TPS tana da girma sosai, kai 96.74%, amma ba ta nuna ficewar sakamako idan aka gwada da sauran fasahar saiti biyu. Amfanin.
An ruwaito cewa halayen fasahar TPS sun hada da wadannan maki:
(1) Karkashin ya karami don septum na pancoreaticobus;
(2) Abin da ya faru da rikice-rikice na baya ya ragu;
(3) Zabi ga tsarin yankuna yana da sauki iko;
(4) Wannan hanyar za'a iya amfani dashi ga marasa lafiya tare da maimaita juzu'i na tsayewa ko nono a cikin juji.
Yawancin karatu sun nuna cewa tps ba kawai inganta yawan nasarar da ke da wahala ba, amma kuma baya ƙara abin da ya faru bayan ERCP. Wasu malamai sun ba da shawarar cewa idan har tsinkaye na ruɓaɓo ko kanananu papililililla yana faruwa akai-akai, ya kamata a yi la'akari da TPS da farko. Koyaya, lokacin amfani da TPS, ya kamata a biya shi ga yiwuwar pancreaticatic dugurce dunkulo, wanda zai yiwu haɗarin dogon lokaci na TPS.
V.precut sphincteroty, pst
PST dabara ta yi amfani da Papillary arcuate na Papillary artuse a matsayin babba na pre-waka da kuma 1-2 na bude papilla phincincter don nemo bude na Duoye phucincter don nemo wani Budewar Bile da Pancreatic duct. Anan pst musamman yana nufin daidaitaccen kan nono sphincter pre-inction ta amfani da wuka arcusion ta amfani da wuka arcusion. A matsayin dabarun magance cutar tarin bile don ERCP, an ɗauka fasaha na FST sosai don zama zaɓin farko don rashin wahala. Endoscopic nono Sphincter pre-inc inciction yana nufin intosscopic inchose na paphilla surface ta hanyar wuka incincter ta hanyar wuka na ciki don nemo bude bututu, sannan kuma amfani da amashayako catheter don lalata bututun bile.
Binciken na cikin gida ya nuna cewa nasarar nasarar PST tana da girma kamar 89.66%, wanda ba ya bambanta da DGT da TPS. Koyaya, abin da ya faru na Pep a PST yana da mahimmanci fiye da na DGT da TPS.
A halin yanzu, shawarar yin amfani da wannan fasahar ta dogara da abubuwa da yawa. Misali, rahoto guda ya bayyana cewa PST ya fi dacewa a lokuta a inda Duodual Papilla ba shi da mahaifa ko ɓoyayyen stenosis ko imilitancy.
Bugu da kari, idan aka kwatanta da sauran dabarun kofe, PST yana da tsayayyen abubuwan da suka faru kamar Pep, kuma bukatun aikin sun yi yawa, saboda haka wannan aikin zai yi kyau sosai da gogaggen Endoscopists.
Vi.needle-wuka papillotomy, NKP
NKP ne mai son wuka-wuka ne mai wuya. A lokacin da ciki yana da wahala, ana iya amfani da wuka allurar don incise wani ɓangare na papilililil ko sphincter daga bude papililililililla na 11-12, sannan kuma yi amfani da amashayako catheter zuwa zaba sa a cikin bututun bile gama gari. A matsayin dabarar coping don wahalar biluct duct, Nkp na iya inganta ragin nasarar nasarar bile duct. A da, an yi imani da cewa Nkp zai ƙara hadadden Pep a cikin 'yan shekarun nan. A cikin 'yan shekarun nan, da yawa rahoton bincike na bincike sun nuna cewa Nkp baya ƙara haɗarin rikicewar bayan. Yana da mahimmanci a lura cewa idan ana yin Nkp a farkon farkon rami mai wahala, zai taimaka sosai don inganta ragin nasarar shiga ciki. Koyaya, a halin yanzu babu yarjejeniya a lokacin da za a yi amfani da NKP don cimma sakamako mafi kyau. Nazarin daya ya ruwaito cewa ragi na NKP ya yi a lokacinERCPKasa da minti 20 ya kasance mafi mahimmanci fiye da na NKP da aka yi daga baya fiye da minti 20 daga baya.
Marasa lafiya tare da m cannuly cannul-cnulation zai amfana mafi yawa daga wannan dabarar idan suna da garkuwar kan nono ko kuma diljin billa mai mahimmanci. Bugu da kari, akwai rahotanni cewa lokacin da suke fuskantar mummunan yanayin yanayin TPS da NKP tana da rabo mafi girma fiye da amfani da shi kadai. Rashin kyau shine waccan fasahohin da yawa shafi zuwa ga nono zai kara abin da ya faru da rikice-rikice. Sabili da haka, ana buƙatar ƙarin bincike don tabbatarwa ko za a zabi farkon pre-in injaya don rage abubuwan da suka faru na rikitarwa ko haɗuwa da yawa don inganta raguwar nasarar da aka samu.
VII.NEDle-wuka
Hukumar NkF tana nufin amfani da wuka na allura don soki kan nono da 5mm a saman ƙwararrun don incise Layer a cikin shugabanci na yau da kullun don gano fitar da bile da inciisof nama. Za'a yi duct duct a cikin shafin jaundice. Nkf tiyata a sama da bude kan nono. Saboda wanzuwar sinadarin duct na billi, yana rage rage lalacewar zafi da lalacewar na inji ga bude bututu mai ban mamaki, wanda zai iya rage abin da ya faru na PEP.
Nazarin da Jin et al. Nuna fitar da nasarar da aka nuna na yawan bututu na NK na iya kaiwa 96.3%, kuma babu pep. Bugu da kari, nasarar nasarar NkF a cikin cire dutse yana da girma kamar 92.7%. Saboda haka, wannan binciken yana ba da shawarar NKF a matsayin zaɓi na farko don cirewa na dutse na cirewa. . Idan aka kwatanta shi da Papillyomyotomy na al'ada, har yanzu haɗarin aikin NkF har yanzu suna ƙaruwa, kuma yana da yawa ga rikice-rikice da zubar da jini, kuma yana buƙatar babban matakin aiki na Endoscopist. Matsayin buɗewar taga taga daidai, zurfin da ya dace, da kuma ingantaccen dabara dole ne a koya a hankali. Jagora.
Idan aka kwatanta da sauran hanyoyin da aka riga aka ambata, NkF hanya ce mai dacewa da babbar nasara. Koyaya, wannan hanyar tana buƙatar aiwatar da aiki na dogon lokaci da kuma ci gaba da tarawa ta hanyar ma'aikaci ya cancanta, don haka wannan hanyar ba ta dace da sabon shiga ba.
Viii.repeat-ercp
Kamar yadda aka ambata a sama, akwai hanyoyin da ake amfani da su don magance yanayin wahala. Koyaya, babu garanti na nasara 100%. Littattafan da suka dace sun nuna cewa lokacin da duct ductation yana da wuya a wasu lokuta, dogon lokaci da yawa ko tasirin shigar ciki na pre-yanke na iya haifar da popilla yanke zai iya haifar da guo'ala papilla edema. Idan aikin ya ci gaba, ba wai kawai za ta zama duhun Bile ba, ba a yi nasara ba, amma damar da rikice-rikice zasu kuma ƙaruwa. Idan lamarin da ya shafi sama ya faru, zaku iya la'akari da ƙare na yanzuERCPAiki da farko kuma yi ERCP na biyu a lokacin zaɓi. Bayan papilloedeema bace, aikin ERCP zai zama da sauƙin samun nasarar da aka samu.
Donllana et al. yi na biyuERCPAiki a kan marasa lafiya 51 wanda ERCP ya kasa bayan allura-wuƙa mai ci gaba, da kuma abin da ya faru da rikice-rikice ba su karu ba.
Kim et al. yi aiki na biyu na ERCP na biyu akan marasa lafiya 69 waɗanda suka gazaERCPBayan allura-wuka pre-ciki, da kuma kashi 53 sun yi nasara, tare da nasarar nasara na 76.8%. Sauran shari'ar da ba ta same su ba ma sun mamaye aikin ERCP na uku, tare da nasarar nasara na kashi 79.7%. , kuma ayyuka da yawa ba su ƙara faruwar rikice-rikice ba.
Yu li et al. yi sakandare na sakandareERCPA 70 marasa lafiya waɗanda suka kasa ERCP bayan wukaye-wuka pre-ciki, da kararraki 50 sun yi nasara. Matsakaicin nasara (farkon Ercp + na farko ERCP) ya karu zuwa 90.6%, kuma abin da ya faru na rikitarwa bai ƙaru sosai. . Kodayake rahotanni sun tabbatar da ingancin ayyukan sakandare, tazara tsakanin ayyukan ERCP guda biyu kada su yi tsayi da yawa, kuma a wasu lokuta na musamman, jinkirin jinkirta magudanar ƙasa na iya kara kara yanayin.
Ix.endoscopicAstrasound-Guide Ginin magudanar ruwa, Eus-BD
Eus-BD hanya ce mai rikitarwa wacce ke amfani da allura ta huda a cikin jagorancin Duodenal, sannan kuma na yi titu na BILEDE. Wannan dabarar ta hada da juna biyu da ke kusa da na gama-gari.
Binciken mai ba da rahoto ya ba da rahoton cewa nasarar nasarar Eus-BD ya kai 82%, da kuma abin da ya rikice-rikice na postolvealative 13%. A cikin binciken kwatankwacin karatu, EUS-BD idan aka kwatanta da fasahar riga ta pre-with, da kashi 98.3%, wanda ya fi kusan 90.3% na pre-ciki. Koyaya, ya zuwa yanzu, idan aka kwatanta da sauran fasahohi, har yanzu akwai rashin bincike akan aikace-aikacen eus don wahalaERCPshiga ciki. Babu isasshen bayanai don tabbatar da ingancin fasahar kututture na kaso ta zagiERCPshiga ciki. Wasu karatun sun nuna cewa ya rage rawar postopeactory Pep ba tabbatacce.
X.percut Wata
PTCD wata dabara ce mai rikitarwa wacce za'a iya amfani dashi a hade tare daERCPDon rashin daidaituwa bile duct, musamman a lokuta na bilinnnning bilinnnnant biliary. Wannan dabarar tana amfani da allura ta huda ta huda ta purcutya shiga cikin bututun bile, huda biliyan billa ructrandly ta hanyar da aka tanadamashaya. Nazarin daya nazarin masu karatu 47 da rashin lafiyar bile wadanda ke haifar da dabarun PTCD, kuma ragin nasara ya kai 94%.
Nazarin da Yang et al. An nuna cewa aikace-aikacen EUS-BD ya iyakance lokacin da ya zo hil starosis da kuma buƙatar aiwatar da dumin da ke cikin bile, yayin da ptcd yana da fa'idodi na dacewa da bututun bile. Ya kamata a yi amfani da duct duct cikin irin waɗannan marasa lafiya.
PTCD aiki ne mai wahala wanda ke buƙatar horo na tsari da na dogon lokaci da kuma kammala adadin adadin lokuta. Zai yi wuya ga novaye ne don kammala wannan aikin. PTCD ba kawai da wahala kawai gudanar da aiki, ammamashayakuma yana iya lalata bile duct lokacin ci gaba.
Kodayake hanyoyin da ke sama na iya haɓaka haɓaka nasarar nasarar bile duct, zaɓin yana buƙatar zaɓin da aka zaɓa sosai a lura. Lokacin yinERCP, SGT, DGT, WGC-PS da wasu dabaru za a iya la'akari; Idan fasahohin da ke sama sun kasa, manya da goguwa da masu haɓaka su na iya haifar da dabarun da aka riga aka riga su, kamar TPS, NKP, NkF, da sauransu.; Idan har yanzu idan za a iya kammala ductation ductation, sakandareERCPza a iya zaba; Idan babu wani daga cikin dabarun da ke sama da ke sama na iya magance matsalar rashin ƙarfi, ayyukan da ba za a iya yin watsi da PTCD idan za a iya magance matsalar tiyata idan za a iya magance matsalar.
Mu, Jiangxi Zhunuihua Aikin Media Co., Ltd., Mai kerarre ne a cikin kasashen waje, kamar kayan kwalliyar biopsy, gogewar sclerotip, gogewar cytolicy, goge-sclorymashaya, kwando mai hankali, hanci na hancida dai sauransu wanda aka yi amfani dashi sosai a Emr, ESD,ERCP. Kayan samfuranmu suna da tabbacin CED, kuma tsire-tsire na dabbobi sune baicin. An fitar da kayanmu zuwa Turai, Arewacin Amurka, Gabas ta Tsakiya da wani ɓangare na Asiya, kuma yakai abokin ciniki na girmamawa da yabo!
Lokaci: Jan-31-2024