He ʻenehana koʻikoʻi ka ERCP no ka ʻike a me ka mālama ʻana i nā maʻi biliary a me ka pancreatic.I ka wā i puka mai ai, ua hāʻawi ʻo ia i nā manaʻo hou he nui no ka mālama ʻana i nā maʻi biliary a me ka pancreatic.ʻAʻole i kaupalena ʻia i ka "radiography".Ua hoʻololi ʻia mai ka ʻenehana diagnostic kumu i kahi ʻano hou.ʻO nā ʻenehana lapaʻau e pili ana i ka sphincterotomy, ka wehe ʻana i nā pōhaku bile duct, ka wai bile a me nā ʻano hana ʻē aʻe e mālama ai i nā maʻi bile a me ka ʻōnaehana pancreatic.
Hiki ke piʻi aku ka nui o ka holomua o ka koho bile duct intubation no ERCP ma luna o 90%, akā aia nō kekahi mau hihia kahi paʻakikī o ka loaʻa ʻana o ka biliary e hoʻokau i ka pau ʻole o ka intubation bile duct.Wahi a ka manaʻo hou loa e pili ana i ka maʻi a me ka mālama ʻana i ka ERCP, hiki ke wehewehe ʻia ka intubation paʻakikī e like me: ʻo ka manawa no ka koho koho bile duct intubation o ka nipple nui o ka ERCP maʻamau ma mua o 10 mau minuke a i ʻole ka nui o nā hoʻāʻo intubation ma mua o 5 mau manawa.I ka wā e hana ai i ka ERCP, inā paʻakikī ka intubation bile duct i kekahi mau hihia, pono e koho ʻia nā hoʻolālā kūpono i ka manawa e hoʻomaikaʻi ai i ka holomua o ka intubation bile duct.Ke alakaʻi nei kēia ʻatikala i kahi loiloi ʻōnaehana o kekahi mau ʻenehana intubation kōkua i hoʻohana ʻia no ka hoʻoponopono ʻana i ka intubation bile duct paʻakikī, me ka manaʻo e hāʻawi i ke kumu kumu no nā endscopists clinical e koho i kahi hoʻolālā pane ke kū i ka intubation bile duct paʻakikī no ERCP.
I.Singleguidewire Technique,SGT
ʻO ka ʻenehana SGT ʻo ia ka hoʻohana ʻana i kahi contrastcatheter e hoʻomau i ka hoʻāʻo ʻana e hoʻokomo i ka ʻawa bile ma hope o ke komo ʻana o ke kaula alakaʻi i ka ʻawa pancreatic.I nā lā mua o ka hoʻomohala ʻana i ka ʻenehana ERCP, ʻo SGT kahi ala maʻamau no ka intubation biliary paʻakikī.ʻO kona pōmaikaʻi ʻo ia ka maʻalahi o ka hana, hoʻoponopono i ka nipple, a hiki ke noho i ka wehe o ka pancreatic duct, e maʻalahi ka loaʻa ʻana o ka puka bile.
Aia nā moʻolelo i loko o ka puke ma hope o ka pau ʻole o ka intubation maʻamau, ke koho ʻana i ka intubation kōkua SGT hiki ke hoʻopau i ka intubation bile duct ma kahi o 70% -80% o nā hihia.Ua hōʻike pū ʻia ka hōʻike i nā hihia o ka hāʻule ʻole o SGT, ʻo ka hoʻoponopono ʻana a me ka hoʻohana ʻana i ka pāluauea alakaʻiʻAʻole i hoʻomaikaʻi ka ʻenehana i ka helu kūleʻa o ka intubation bile duct a ʻaʻole i hōʻemi i ka hopena o ka post-ERCP pancreatitis (PEP).
Ua hōʻike pū kekahi mau haʻawina i ka haʻahaʻa o ka holomua o ka intubation SGT ma mua o ka pāluauea alakaʻiʻenehana a me ka ʻenehana sphincterotomy papillary transpancreatic.Hoʻohālikelike ʻia me ka hoʻāʻo pinepine ʻana o SGT, hoʻokō mua i ka pāluauea alakaʻiʻenehana a i ʻole ʻenehana pre-incision hiki ke loaʻa nā hopena maikaʻi aʻe.
Mai ka hoʻomohala ʻana o ERCP, ua hoʻomohala ʻia nā ʻano ʻenehana hou no ka intubation paʻakikī.Hoʻohālikelike ʻia me ka hoʻokahiuea alakaʻiʻenehana, ʻoi aku ka maopopo o nā pōmaikaʻi a ʻoi aku ka kiʻekiʻe o ka holomua.No laila, hoʻokahiuea alakaʻiʻAʻole hoʻohana ʻia ka ʻenehana i kēia manawa ma ke kauka.
II. ʻenehana uea alakaʻi pālua,DGT
Hiki ke kapa ʻia ʻo DGT ʻo ke ʻano hana uea pancreatic duct alakaʻi, ʻo ia ka haʻalele ʻana i ka uea alakaʻi e komo ana i ka duct pancreatic e ʻimi a noho iā ia, a laila hiki ke hoʻopili hou ʻia ka uea alakaʻi ʻelua ma luna o ka uea alakaʻi pancreatic duct.ʻO ka hoʻokomo ʻana i ka bile duct intubation.
ʻO nā pōmaikaʻi o kēia ala:
(1) Me ke kokua ana auea alakaʻi, ʻoi aku ka maʻalahi o ka wehe ʻana o ka bile duct, e ʻoi aku ka maʻalahi o ka intubation bile;
(2) Hiki i ka uea alakaʻi ke hoʻoponopono i ka nipple;
(3) Ma lalo o ke alakaʻi ʻana o ka ʻōpū pancreaticuea alakaʻi, hiki ke ʻalo ʻia ka ʻike pinepine ʻana o ka ʻāʻī pancreatic, no laila e hōʻemi ai i ka hoʻoulu ʻana o ka pancreatic duct i hana ʻia e ka intubation mau.
Dumonceau et al.Ua ʻike ʻo ia e hiki ke hoʻokomo ʻia kahi alakaʻi alakaʻi a me kahi catheter hoʻohālikelike i loko o ka lua biopsy i ka manawa like, a laila hōʻike ʻia kahi hihia kūleʻa o ka pancreatic duct guidewire e noho ana, a ua manaʻo ʻo ia kauea alakaʻiʻO ka noho ʻana i ke ala pancreatic he kūleʻa no ka intubation bile duct.He hopena maikaʻi ka pākēneka.
He haʻawina ma DGT na Liu Deren et al.ua ʻike ʻia ma hope o ka hana ʻana o DGT i nā poʻe maʻi me ka paʻakikī o ka ERCP bile duct intubation, ua hōʻea ka helu kūleʻa intubation i 95.65%, ʻoi aku ka kiʻekiʻe ma mua o ka 59.09% kūleʻa o ka intubation maʻamau.
ʻO kahi haʻawina kūpono e Wang Fuquan et al.i kuhikuhi ʻia i ka wā i hoʻohana ʻia ai ka DGT i nā poʻe maʻi me ka paʻakikī ERCP bile duct intubation i ka hui hoʻokolohua, ʻoi aku ka kiʻekiʻe o ka holomua intubation e like me 96.0%.
Hōʻike nā haʻawina ma luna nei i ka hoʻohana ʻana o DGT i nā poʻe maʻi me ka paʻakikī o ka bile duct intubation no ERCP hiki ke hoʻomaikaʻi maikaʻi i ka helu kūleʻa o ka intubation bile duct.
ʻO nā hemahema o DGT ka nui o nā mea ʻelua:
(1) ʻO ka pancreaticuea alakaʻiua nalowale paha i ka wā o ka hoʻokomo ʻana i ka bile duct, a i ʻole ka luauea alakaʻihiki ke komo hou i ka pancreatic duct;
(2) ʻAʻole kūpono kēia ala no nā hihia e like me ka maʻi maʻi poʻo pancreatic, tortuosity duct pancreatic, a me ka fission pancreatic.
Mai ka hiʻohiʻona o ka hopena PEP, ʻoi aku ka haʻahaʻa o ka PEP o DGT ma mua o ka intubation bile duct maʻamau.Ua hōʻike ʻia kahi noiʻi e pili ana i ka hopena o ka PEP ma hope o DGT he 2.38% wale nō i nā maʻi ERCP me ka intubation paʻakikī bile duct.Hōʻike kekahi mau palapala, ʻoiai ʻoi aku ka nui o ka lanakila o ka DGT o ka intubation bile duct, ʻoi aku ka nui o ka maʻi o ka maʻi pancreatic post-DGT i hoʻohālikelike ʻia me nā hana hoʻoponopono ʻē aʻe, no ka mea hiki i ka hana DGT ke hōʻino i ka duct pancreatic a me kona wehe.Eia nō naʻe, ʻo ka ʻae ʻana ma ka home a me nā ʻāina ʻē aʻe ke kuhikuhi nei i nā hihia o ka intubation bile paʻakikī, i ka wā paʻakikī ka intubation a ua kuhi hewa pinepine ʻia ka pancreatic duct, ʻo DGT ka koho mua no ka mea ʻoi aku ka paʻakikī o ka ʻenehana DGT i ka hana, a maʻalahi hoʻi. E hoʻohana nui ʻia i ka intubation paʻakikī koho.
III.Wire alakai cannulation-pan-creatic stent,WGC-P5
Hiki ke kapa ʻia ʻo WGC-PS i ke ʻano hana hana stent pancreatic.ʻO kēia ʻano hana ke kau ʻana i ka stent pancreatic duct me kauea alakaʻikomo kuhihewa i ka auwai pancreatic, a laila huki i kauea alakaʻia hoʻokō i ka cannulation bile duct ma luna o ka stent.
He haʻawina na Hakuta et al.hōʻike i ka hoʻomaikaʻi ʻana i ka holomua holomua intubation ma ke alakaʻi ʻana i ka intubation, hiki i ka WGC-PS ke pale aku i ka wehe ʻana o ka pancreatic duct a hoʻemi nui i ka hanana o PEP.
ʻO kahi haʻawina ma WGC-PS na Zou Chuanxin et al.Ua kuhikuhi ʻo ia ua hiki i ka 97.67% ka holomua o ka intubation paʻakikī me ka hoʻohana ʻana i ka pancreatic duct stent occupation method, a ua hoʻemi nui ʻia ka hopena o ka PEP.
Ua ʻike ʻia kahi noiʻi i ka wā i kau pono ʻia ai kahi stent pancreatic duct, e hōʻemi nui ʻia ka manawa o ka pancreatitis postoperative koʻikoʻi i nā hihia intubation paʻakikī.
He mau hemahema no keia ano.No ka laʻana, hiki ke hoʻoneʻe ʻia ka stent duct pancreatic i hoʻokomo ʻia i ka wā o ka hana ERCP;inā pono e hoʻokomo i ka stent no ka manawa lōʻihi ma hope o ka ERCP, e nui ka manawa o ka stent blockage a me ka duct obstruction.ʻO kaʻeha a me nā pilikia'ē aʻe e alakaʻi i ka piʻiʻana o ka PEP.I kēia manawa, ua hoʻomaka nā ʻoihana e aʻo i nā stents pancreatic duct i hiki ke neʻe koke i waho o ka duct pancreatic.ʻO ke kumu ka hoʻohana ʻana i nā stents duct pancreatic e pale ai i ka PEP.Ma waho aʻe o ka hoʻohaʻahaʻa nui ʻana i ka nui o nā ulia PEP, hiki i ia mau stents ke pale aku i nā hana ʻē aʻe e wehe i ka stent a hoʻemi i ke kaumaha o nā maʻi.ʻOiai ua hōʻike ʻia nā haʻawina he hopena maikaʻi nā stents pancreatic duct i ka hōʻemi ʻana i ka PEP, ʻo kā lākou noi lapaʻau he mau palena nui.No ka laʻana, i nā poʻe maʻi me nā duct pancreatic lahilahi a me nā lālā he nui, paʻakikī ke hoʻokomo i kahi stent pancreatic duct.E hoʻonui nui ʻia ka paʻakikī, a pono kēia hana i kahi pae ʻoihana kiʻekiʻe o nā endoskopist.He mea pono hoʻi e ʻike ʻaʻole lōʻihi ka lōʻihi o ka duct pancreatic stent i ka duodenal lumen.Hiki i ka stent lōʻihi loa ke kumu i ka perforation duodenal.No laila, pono e mālama pono ʻia ke koho ʻana o ka pancreatic duct stent occupation method.
IV. Trans-pancreatocsphincterotomy, TPS
Hoʻohana pinepine ʻia ka ʻenehana TPS ma hope o ke komo hewa ʻana o ka uea alakaʻi i ka duct pancreatic.Hoʻokomo ʻia ka septum i waenakonu o ka ʻauwai pancreatic ma ke ala o ka uea alakaʻi aʻoaʻo pancreatic mai ka hola 11 a hiki i ka hola 12, a laila hoʻokomo ʻia ka paipu ma ka ʻaoʻao o ka pahu bile a hiki i ke komo ʻana o ka uea alakaʻi i ka bile. auwai.
ʻO kahi haʻawina na Dai Xin et al.hoʻohālikelike i ka TPS a me ʻelua mau ʻenehana intubation kōkua.Hiki ke ʻike ʻia he kiʻekiʻe loa ka holomua o ka ʻenehana TPS, a hiki i ka 96.74%, akā ʻaʻole ia e hōʻike i nā hopena koʻikoʻi ke hoʻohālikelike ʻia me nā ʻenehana intubation kōkua ʻelua.ʻO nā pōmaikaʻi.
Ua hōʻike ʻia ʻo nā hiʻohiʻona o ka ʻenehana TPS e pili ana i kēia mau helu:
(1) He liʻiliʻi ka ʻoki no ka pancreaticobiliary septum;
(2) He haʻahaʻa ka nui o nā pilikia postoperative;
(3) He maʻalahi ke koho ʻana i ke kuhikuhi ʻoki ʻana;
(4) Hiki ke hoʻohana ʻia kēia ʻano hana no nā poʻe maʻi me ka intubation duct pancreatic hou a i ʻole nā nipples i loko o ka diverticulum.
Ua hōʻike ʻia nā haʻawina he nui ʻaʻole hiki i ka TPS ke hoʻomaikaʻi maikaʻi i ka holomua o ka intubation bile duct paʻakikī, akā ʻaʻole hoʻi e hoʻonui i ka hopena o nā pilikia ma hope o ERCP.Manaʻo kekahi poʻe ʻepekema inā ʻike pinepine ʻia ka pancreatic duct intubation a i ʻole ka duodenal papilla liʻiliʻi, pono e noʻonoʻo mua ʻia ka TPS.Eia nō naʻe, i ka wā e hoʻohana ai i ka TPS, pono e uku ʻia i ka hiki ke hiki i ka pancreatic duct stenosis a me ka hoʻi hou ʻana o ka pancreatitis, kahi hiki ke loaʻa i ka TPS lōʻihi.
V.Precut Sphincterotomy,PST
Ke hoʻohana nei ka ʻenehana PST i ka papillary arcuate band ma ke ʻano he palena kiʻekiʻe o ka ʻoki mua ʻana a me ke kuhikuhi o ka hola 1-2 ma ke ʻano he palena e wehe ai i ka duodenal papilla sphincter e ʻike ai i ka wehe ʻana o ka bile a me ka duct pancreatic.Maʻaneʻi, pili pono ka PST i ka hana maʻamau o ka nipple sphincter pre-incision me ka pahi arcuate.Ma ke ʻano he hoʻolālā e hana ai i ka intubation bile duct paʻakikī no ERCP, ua manaʻo nui ʻia ka ʻenehana PST ʻo ia ka koho mua no ka intubation paʻakikī.ʻO ka endoscopic nipple sphincter pre-incision e pili ana i ka endoscopic incision o ka papilla surface mucosa a me kahi liʻiliʻi o ka ʻiʻo sphincter ma o ka pahi incision e ʻike ai i ka wehe ʻana o ka ʻawa bile, a laila hoʻohana i kahiuea alakaʻia i ʻole ka catheter e hoʻokomo i ka ʻawa bile.
Ua hōʻike ʻia kahi noiʻi kūloko i ka nui o ka holomua o ka PST e like me 89.66%, ʻaʻole ia he ʻokoʻa loa mai DGT a me TPS.Eia naʻe, ʻoi aku ka kiʻekiʻe o ka PEP ma PST ma mua o ka DGT a me TPS.
I kēia manawa, pili ka hoʻoholo e hoʻohana i kēia ʻenehana i nā kumu like ʻole.No ka laʻana, ua hōʻike kekahi hōʻike e hoʻohana maikaʻi ʻia ka PST i nā hihia i ʻike ʻole ʻia ai ka papilla duodenal, e like me ka duodenal stenosis a i ʻole malignancy.
Eia kekahi, ke hoʻohālikelike ʻia me nā hoʻolālā hoʻoponopono ʻē aʻe, ʻoi aku ka nui o ka PST o nā pilikia e like me PEP, a he kiʻekiʻe nā koi o ka hana, no laila ʻoi aku ka maikaʻi o kēia hana e nā endoskopist ʻike.
VI.Papillotomy, NKP
ʻO ka NKP kahi ʻenehana hoʻokomo ʻia i ka pahi i kōkua ʻia.I ka paʻakikī o ka intubation, hiki ke hoʻohana ʻia ka pahi nila e ʻoki ai i kahi ʻāpana o ka papilla a i ʻole sphincter mai ka wehe ʻana o ka duodenal papilla ma ke kuhikuhi o ka hola 11-12, a laila hoʻohana i kahiuea alakaʻia i ʻole ka catheter i ka hoʻokomo koho ʻana i loko o ka ʻauwai bile maʻamau.Ma ke ʻano he hoʻolālā hoʻoponopono no ka hoʻopili ʻana i ka bile duct paʻakikī, hiki i ka NKP ke hoʻomaikaʻi maikaʻi i ka helu kūleʻa o ka intubation bile duct paʻakikī.I ka wā ma mua, ua manaʻo nui ʻia e hoʻonui ka NKP i ka nui o ka PEP i nā makahiki i hala.I nā makahiki i hala iho nei, ua hōʻike ʻia ka nui o nā hōʻike loiloi retrospective ʻaʻole i hoʻonui ka NKP i ka pilikia o ka hoʻopiʻi postoperative.He mea pono ke hoʻomaopopo ʻia inā hana ʻia ka NKP i ka wā mua o ka intubation paʻakikī, e kōkua nui ia i ka hoʻomaikaʻi ʻana i ka holomua o ka intubation.Eia nō naʻe, ʻaʻohe manaʻo i kēia manawa i ka wā e noi ai i ka NKP e loaʻa ai nā hopena maikaʻi loa.Ua hōʻike ʻia kahi haʻawina e pili ana ka intubation rate o NKP i ka wāERCPʻoi aku ka kiʻekiʻe ma lalo o 20 mau minuke ma mua o ka NKP i noi ʻia ma hope o 20 mau minuke ma hope.
ʻO ka poʻe maʻi me ka paʻakikī o ka hoʻoheheʻe ʻana i ka bile duct e pōmaikaʻi nui lākou mai kēia ʻano hana inā loaʻa iā lākou nā nipple bulges a i ʻole ka hoʻomāhuahua nui ʻana o ka bile duct.Eia kekahi, aia nā hōʻike i ka wā e hālāwai ai i nā hihia intubation paʻakikī, ʻoi aku ka kiʻekiʻe o ka hoʻohana ʻana o TPS a me NKP ma mua o ka noi wale ʻana.ʻO ka hemahema, ʻo ka hoʻohana ʻana i nā ʻenehana incision he nui i ka nipple e hoʻonui i ka hiki ʻana o nā pilikia.No laila, ʻoi aku ka nui o ka noiʻi ʻana e hōʻoia inā koho mua ʻia ka hoʻohaʻahaʻa ʻana i nā pilikia a i ʻole e hoʻohui i nā hana hoʻoponopono he nui e hoʻomaikaʻi ai i ka holomua o ka intubation paʻakikī.
VII.Fistulotomy, NKE
ʻO ka ʻenehana NKF e pili ana i ka hoʻohana ʻana i ka pahi nila e hou ai i ka mucosa ma kahi o 5mm ma luna o ka nipple, me ka hoʻohana ʻana i ka au i hui ʻia e ʻoki i ka papa ma ka papa ma ke kuhikuhi o ka hola 11 a hiki i ka loaʻa ʻana o ke ʻano like me ka puka a i ʻole ke kahe ʻana o ka bile, a laila hoʻohana. he uea alakaʻi e ʻike ai i ke kahe ʻana o ka bile a me ka ʻoki ʻana o ka ʻiʻo.Ua hana ʻia ka intubation bile duct koho ma ka pūnaewele jaundice.ʻOki ʻia ʻo NKF ma luna o ka wehe ʻana o ka nipple.Ma muli o ke ola ʻana o ka bile duct sinus, hoʻemi nui ia i ka pōʻino wela a me ka pōʻino mechanical i ka wehe ʻana o ka pancreatic duct, hiki ke hōʻemi i ka hopena o ka PEP.
He haʻawina na Jin et al.i kuhikuhi ʻia e hiki i ka helu kūleʻa o ka NK tube intubation ke hiki i 96.3%, ʻaʻohe PEP postoperative.Eia kekahi, ʻoi aku ka kiʻekiʻe o ka holomua o NKF i ka wehe ʻana i nā pōhaku e like me 92.7%.No laila, paipai kēia haʻawina i ka NKF ma ke ʻano he koho mua no ka wehe ʻana i nā pōhaku ʻawaʻawa bile..Ke hoʻohālikelike ʻia me ka papillomyotomy maʻamau, ʻoi aku ka kiʻekiʻe o ka hana NKF, a ua maʻalahi ia i nā pilikia e like me ka perforation a me ke kahe ʻana o ke koko, a pono ia i ka pae hana kiʻekiʻe o nā endoscopists.Pono e aʻo mālie ʻia ka wahi wehe puka makani kūpono, ka hohonu kūpono, a me ka ʻenehana pololei.haku.
Ke hoʻohālikelike ʻia me nā ʻano hana pre-incision ʻē aʻe, ʻoi aku ka maʻalahi o ka NKF me ka helu kūleʻa kiʻekiʻe.Eia nō naʻe, pono kēia ʻano hana i ka hoʻomaʻamaʻa lōʻihi a me ka hōʻiliʻili mau ʻana e ka mea hoʻohana e mākaukau, no laila ʻaʻole kūpono kēia ʻano no ka poʻe hoʻomaka.
VIII.Repeat-ERCP
E like me ka mea i ʻōlelo ʻia ma luna, he nui nā ala e hoʻoponopono ai i ka intubation paʻakikī.Eia naʻe, ʻaʻohe mea hōʻoia o 100% kūleʻa.Ua kuhikuhi ʻia nā palapala e pili ana i ka wā e paʻakikī ai ka intubation bile duct i kekahi mau hihia, hiki ke alakaʻi i ka edema papilla duodenal a i ʻole ka hopena komo wela o ka pre-cut.Inā hoʻomau ka hana, ʻaʻole e kūleʻa wale ka intubation bile duct, akā e piʻi aʻe ka manawa o nā pilikia.Inā hiki ke kūlana i luna, hiki iā ʻoe ke noʻonoʻo e hoʻopau i kēia manawaERCPhana mua a hana i ka ERCP lua i ka manawa koho.Ma hope o ka nalo ʻana o ka papilloedema, e maʻalahi ka hana ERCP e hoʻokō i ka intubation kūleʻa.
Donnellan et al.hana kekonaERCPʻO ka hana ma luna o 51 mau maʻi i hāʻule ʻole ka ERCP ma hope o ka preincision o ka nila-knife, a ua kūleʻa nā hihia 35, ʻaʻole i hoʻonui ʻia ka nui o nā pilikia.
ʻO Kim et al.hana i ka hana ERCP lua ma 69 mau maʻi i hāʻuleERCPma hope o ka ʻoki ʻana i ka pahi kui, a ua kūleʻa nā hihia he 53, me ka helu kūleʻa o 76.8%.ʻO ke koena o nā hihia i kūleʻa ʻole i hana ʻia i ke kolu o ka hana ERCP, me ka helu kūleʻa o 79.7%., a me nā hana he nui ʻaʻole i hoʻonui i ka loaʻa ʻana o nā pilikia.
ʻO Yu Li et al.hana ʻia i ke kula kiʻekiʻe electiveERCPma 70 mau maʻi i hāʻule i ka ERCP ma hope o ka ʻoki ʻana o ka pahi kui, a he 50 mau hihia i kūleʻa.ʻO ka nui o ka holomua holoʻokoʻa (first ERCP + secondary ERCP) piʻi i 90.6%, a ʻaʻole i piʻi nui ka nui o nā pilikia..ʻOiai ua hōʻike nā hōʻike i ka maikaʻi o ka ERCP lua, ʻaʻole pono e lōʻihi ka manawa ma waena o nā hana ERCP ʻelua, a i kekahi mau hihia kūikawā, hiki ke hoʻonui i ke ʻano o ka wai biliary lohi.
IX.Endoscopicultrasound-guided biliary drainage,EUS-BD
ʻO ka EUS-BD kahi hana invasive e hoʻohana ana i ka nila puncture e hou i ka gallbladder mai ka ʻōpū a i ʻole ka duodenum lumen ma lalo o ke alakaʻi ultrasound, komo i ka duodenum ma o ka duodenal papilla, a laila hana i ka biliary intubation.Aia kēia ʻenehana i nā ala intrahepatic a me extrahepatic.
Ua hōʻike ʻia kahi haʻawina retrospective ua hiki i ka helu kūleʻa o EUS-BD i 82%, a ʻo ka nui o nā pilikia postoperative he 13% wale nō.Ma kahi haʻawina hoʻohālikelike, ua hoʻohālikelike ʻia ʻo EUS-BD me ka ʻenehana pre-incision, ʻoi aku ka kiʻekiʻe o ka holomua intubation, hiki i ka 98.3%, ʻoi aku ka kiʻekiʻe ma mua o ka 90.3% o ka pre-incision.Eia nō naʻe, i kēia manawa, ke hoʻohālikelike ʻia me nā ʻenehana ʻē aʻe, aia nō ka nele o ka noiʻi e pili ana i ka noi ʻana o EUS no ka paʻakikī.ERCPintubation.ʻAʻole lawa ka ʻikepili e hōʻoia i ka maikaʻi o ka ʻenehana puncture duct bile alakaʻi EUS no ka paʻakikīERCPintubation.Ua hōʻike kekahi mau haʻawina i hōʻemi ʻia ʻAʻole maopopo ka hana o ka postoperative PEP.
X.Percutaneous transhepatic cholangial drainage,PTCD
ʻO ka PTCD kekahi hana hoʻokolohua invasive hiki ke hoʻohana pū meERCPno ka hoʻokomo ʻana i ka bile duct paʻakikī, ʻoi aku hoʻi i nā hihia o ke keʻakeʻa biliary malignant.Ke hoʻohana nei kēia ʻenehana i ka nila e hoʻokomo pono ai i loko o ka ʻawa bile, e hou i ka ʻawa bile ma loko o ka papilla, a laila e hoʻokomo hou i ka ʻawa bile ma o kahi mea i mālama ʻia.uea alakaʻi.Ua hoʻopaʻa ʻia kahi noiʻi i nā mea maʻi 47 me ka intubation bile duct paʻakikī i loaʻa i ka ʻenehana PTCD, a hiki i ka 94%.
ʻO kahi haʻawina na Yang et al.Ua kuhikuhi ʻia ʻo ka hoʻohana ʻana o EUS-BD i kaupalena ʻia i ka wā e pili ana i ka hilar stenosis a me ka pono e hoʻopaʻa i ka pono intrahepatic bile duct, ʻoiai ʻo PTCD nā mea maikaʻi o ka hoʻohālikelike ʻana i ka axis duct bile a ʻoi aku ka maʻalahi i nā mea alakaʻi.Pono e hoʻohana ʻia ka intubation bile i loko o ia mau maʻi.
He hana paʻakikī ʻo PTCD e koi ana i ka hoʻomaʻamaʻa ʻōnaehana lōʻihi a me ka hoʻopau ʻana i kahi helu kūpono o nā hihia.He mea paʻakikī i ka poʻe novice ke hoʻopau i kēia hana.ʻAʻole paʻakikī wale ka PTCD e hana, akā ʻo kauea alakaʻihiki ke hoʻopōʻino i ka bile duct i ka wā e holomua ai.
ʻOiai hiki i nā ala i luna ke hoʻomaikaʻi nui i ka holomua o ka intubation bile duct paʻakikī, pono e noʻonoʻo ʻia ke koho.I ka hana anaERCP, SGT, DGT, WGC-PS a me nā ʻenehana ʻē aʻe hiki ke noʻonoʻo ʻia;inā ʻaʻole i hāʻule nā ʻenehana i luna, hiki i nā endoskopist kiʻekiʻe a mākaukau ke hana i nā ʻenehana pre-incision, e like me TPS, NKP, NKF, etc.;inā ʻaʻole hiki ke hoʻopau ʻia ka intubation bile duct koho, koho luaERCPhiki ke koho;inā ʻaʻole hiki i kekahi o nā ʻenehana i luna ke hoʻoponopono i ka pilikia o ka intubation paʻakikī, hiki ke hoʻāʻo ʻia nā hana invasive e like me EUS-BD a me PTCD e hoʻoponopono i ka pilikia, a hiki ke koho ʻia ka lāʻau lapaʻau inā pono.
ʻO mākou, ʻo Jiangxi Zhuoruihua Medical Instrument Co., Ltd., he mea hana ma Kina i mea kūikawā i nā mea endoscopic consumables, e like me biopsy forceps, hemoclip, polyp snare, sclerotherapy needle, spray catheter, cytology brushes,uea alakaʻi, hīnaʻi kiʻi pōhaku, ihu biliary drainage catheteretc. i hoʻohana nui ʻia ma EMR, ESD,ERCP.ʻO kā mākou huahana i hōʻoia ʻia ʻo CE, a ua hōʻoia ʻia kā mākou mea kanu.Ua lawe ʻia kā mākou waiwai i ʻEulopa, ʻAmelika ʻAmelika, Middle East a me kahi hapa o Asia, a loaʻa nui i ka mea kūʻai aku o ka ʻike a me ka hoʻomaikaʻi!
Ka manawa hoʻouna: Jan-31-2024