ERCP tekinoroji yakakosha yekuongorora nekurapa zvirwere zvenyongo nepancreas. Payakangobuda, yakapa mazano matsva akawanda ekurapa zvirwere zvenyongo nepancreas. Hazvigumiri pa "radiography". Yakachinja kubva pahunyanzvi hwekutanga hwekuongorora kuenda kune imwe mhando itsva. Nzira dzekurapa dzinosanganisira sphincterotomy, kubvisa matombo muduct bile, kubvisa bile nedzimwe nzira dzekurapa nyongo nepancreas.
Mwero wekubudirira kwekusarudza nzira yekupinda muchubhu yebhiri yeERCP unogona kusvika pamusoro pe90%, asi kuchine dzimwe nguva apo kuoma kwekupinda muchubhu yebhiri kunokonzera kusashanda kwekusarudza nzira yekupinda muchubhu yebhiri. Zvichienderana nekubvumirana kwazvino pamusoro pekuongororwa nekurapwa kweERCP, kuoma kwekupinda muchubhu kunogona kutsanangurwa seizvi: nguva yekusarudza nzira yekupinda muchubhu yebhiri yenipple huru yeERCP inopfuura maminetsi gumi kana huwandu hwekuedza kwekupinda muchubhu inodarika kashanu. Pakuita ERCP, kana kuoma kwekupinda muchubhu yebhiri muchubhu mune dzimwe nguva, nzira dzinoshanda dzinofanira kusarudzwa nenguva kuti dzivandudze kubudirira kwekupinda muchubhu yebhiri. Chinyorwa chino chinoita ongororo yakarongeka yenzira dzinoverengeka dzekubatsira dzinoshandiswa kugadzirisa kuoma kwekupinda muchubhu yebhiri, nechinangwa chekupa hwaro hwedzidziso kune vanachiremba vekiriniki kuti vasarudze nzira yekupindura kana vakatarisana nedambudziko rekupinda muchubhu yebhiri muchubhu yeERCP.
I. Nzira yeSingleguidewire, SGT
Nzira yeSGT ndeyekushandisa contrastcatheter kuti urambe uchiedza kupinza duct ye bile mushure mekunge waya yekutungamira yapinda muduct yepancreatic. Mumazuva ekutanga ekuvandudzwa kwetekinoroji yeERCP, SGT yaive nzira yakajairika yekupinza duct ye biliary yakaoma. Zvakanakira zvayo ndezvekuti iri nyore kushandisa, inogadzirisa nipple, uye inogona kugara pakavhurika duct yepancreatic, zvichiita kuti zvive nyore kuwana pakavhurika duct ye bile.
Mune mishumo mumabhuku inoti kana nzira dzemazuva ese dzekuisa machubhu dzichikundikana, kusarudza nzira dzekuisa machubhu dzinobatsirwa neSGT kunogona kubudirira kupedza nzira dzekuisa machubhu muchubhu dzinenge 70%-80%. Mushumo wacho wakataurawo kuti kana SGT ikakundikana, kunyange kugadzirisa nekushandisa nzira dzekuisa machubhu maviri.waya yekufambisatekinoroji haina kuvandudza mwero wekubudirira kwekupinda kwe bile duct uye haina kuderedza kuwanda kwepancreatitis mushure meERCP (PEP).
Dzimwe ongororo dzakaratidzawo kuti mwero wekubudirira kweSGT intubation wakaderera pane wedoublewaya yekufambisatekinoroji uye tekinoroji ye transpancreatic papillary sphincterotomy. Zvichienzaniswa nekuyedza kwakaitwa kakawanda kweSGT, kushandiswa kwekutanga kwe "double"waya yekufambisatekinoroji kana tekinoroji yekutanga kuchekwa kweganda inogona kuwana mhedzisiro iri nani.
Kubva pakatanga kushandiswa kweERCP, matekinoroji matsva akasiyana-siyana akagadzirwa kuti zvive zvakaoma kuisa machubhu. Zvichienzaniswa ne singlewaya yekufambisatekinoroji, zvakanakira zviri pachena uye mwero wekubudirira wakakwira. Saka,waya yekufambisatekinoroji iyi haiwanzo shandiswa pakurapa pari zvino.
II.Double-guide waya nzira,DGT
DGT inogona kunzi nzira yekubata tambo yepancreatic duct guide wire, iyo ndeyekusiya tambo yekutungamira ichipinda mu duct yepancreatic kuti iite zvakanyorwa uye igare mairi, uye ipapo tambo yechipiri yekutungamira inogona kuiswazve pamusoro petambo yepancreatic duct guide. Kuisa duct yebile yakasarudzwa.
Zvakanakira nzira iyi ndeizvi:
(1) Nerubatsiro rwewaya yekufambisa, mukana wemugero wenyongo uri nyore kuwana, zvichiita kuti kupinda kwemugero wenyongo kuve nyore;
(2) Waya yekufambisa inogona kugadzirisa nipple;
(3) Pasi pekutungamirirwa kwemugero wepancreaswaya yekufambisa, kuona duct yepancreatic kakawanda kunogona kudzivirirwa, nokudaro zvichideredza kukurudzira duct yepancreatic kunokonzerwa nekupinda muchubhu kakawanda.
Dumonceau nevamwe vake vakaona kuti waya yekufambisa uye catheter yekuenzanisa zvinogona kuiswa muburi rebiopsy panguva imwe chete, uye vakazotaura nezvenyaya yakabudirira yenzira yekubatanidza waya yekufambisa pancreatic duct, uye vakagumisa kutiwaya yekufambisaKushandisa nzira yekugaya duct yepancreatic kunobudirira pakuisa bile duct muchubhu. Kuwanda kwemasero emuchubhu kunobatsira zvikuru.
Ongororo yakaitwa paDGT naLiu Deren nevamwe vake yakawana kuti mushure mekunge DGT yaitwa pavarwere vane ERCP bile duct intubation yakaoma, mwero wekubudirira kweintubation wakasvika 95.65%, iyo yaive yakakwira zvakanyanya kupfuura mwero wekubudirira we59.09% weintubation yakajairika.
Ongororo yakaitwa naWang Fuquan nevamwe vake yakaratidza kuti DGT payakashandiswa kuvarwere vane ERCP bile duct intubation yakaoma muboka rekuyedza, mwero wekubudirira kweintubation wakakwira kusvika ku96.0%.
Zvidzidzo zviri pamusoro apa zvinoratidza kuti kushandiswa kweDGT kuvarwere vane dambudziko rekupinda muchubhu yenyongo paERCP kunogona kuvandudza kubudirira kwekupinda muchubhu yenyongo.
Zvikanganiso zveDGT zvinosanganisira zvinhu zviviri zvinotevera:
(1) Chipembenene chepancreaswaya yekufambisapamwe inorasika panguva yekupinza bile duct, kana yechipiriwaya yekufambisainogona kupinda mudumbu repancreas zvakare;
(2) Nzira iyi haina kukodzera vanhu vane kenza yemusoro wepancreas, pancreatic duct tortuosity, uye pancreatic fission.
Kubva pamaonero ePEP, kuwanda kwePEP kweDGT kwakaderera pane kwekushandiswa kwemushonga wenyongori. Ongororo yakaitwa yakaratidza kuti kuwanda kwePEP mushure meDGT kwaingova 2.38% chete muvarwere veERCP vane mushonga wenyongori wakaoma. Mamwe mabhuku anotaura kuti kunyangwe DGT iine mwero wekubudirira wakakwira wekushandisa mumuromo wenyongori, kuwanda kwepancreatitis mushure meDGT kuchiri kwakakwira zvichienzaniswa nedzimwe nzira dzekurapa, nekuti kuvhiyiwa kweDGT kunogona kukonzera kukuvara kwemushonga wenyongori nekuvhurwa kwawo. Pasinei neizvi, kubvumirana munyika nekune dzimwe nyika kuchiri kuratidza kuti kana mumatambudziko emushonga wenyongori wakaoma, kana mushonga wenyongori wakaoma uye mushonga wenyongori uchigara uchikanganiswa, DGT ndiyo sarudzo yekutanga nekuti tekinoroji yeDGT haina kuoma kushanda, uye iri nyore kudzora. Inoshandiswa zvakanyanya mukushandisa mumishonga yakaoma yakasarudzwa.
III.Nzira yekufambisa stent ye cannulation-pan-creatic, WGC-P5
WGC-PS inogonawo kunzi nzira yekubata pancreatic duct stent. Nzira iyi ndeyekuisa pancreatic duct stent pamwe chete newaya yekufambisainopinda netsaona muduri repancreas, yobva yaburitsawaya yekufambisauye kuita duct ye bile cannulation pamusoro pe stent.
Ongororo yakaitwa naHakuta nevamwe yakaratidza kuti pamusoro pekuvandudza kubudirira kwenzira yekupinda nayo muchubhu nekutungamira nzira yekupinda nayo muchubhu, WGC-PS inogonawo kudzivirira kuvhurika kwemugero wepancreas uye kuderedza zvakanyanya kuitika kwePEP.
Ongororo yakaitwa paWGC-PS naZou Chuanxin nevamwe vake yakaratidza kuti mwero wekubudirira kwekupinza kwakaoma kwemasero uchishandisa nzira yekukurumidza yepancreatic duct stent occupation wakasvika 97.67%, uye kuwanda kwePEP kwakadzikira zvakanyanya.
Imwe ongororo yakawana kuti kana stent yepancreatic duct ikaiswa nemazvo, mukana wekuti pancreatitis ipinde mumuviri wakanyanya mushure mekuvhiyiwa muzviitiko zvakaoma zvekuisa matubhu unodzikira zvakanyanya.
Nzira iyi ichiri nezvikanganiso. Semuenzaniso, stent yepancreatic duct yakaiswa panguva yekuvhiyiwa kweERCP inogona kubviswa; kana stent ichida kuiswa kwenguva yakareba mushure meERCP, pachava nemukana mukuru wekuvharika kwestent uye kuvharika kweduct. Kukuvara nezvimwe zvinetso zvinokonzera kuwedzera kwehuwandu hwePEP. Masangano atotanga kudzidza nezve stent dzepancreas dzenguva pfupi dzinogona kubuda dzoga kubva muduct yepancreas. Chinangwa ndechekushandisa stent dzepancreas kudzivirira PEP. Pamusoro pekuderedza zvakanyanya kuwanda kwetsaona dzePEP, stent dzakadaro dzinogonawo kudzivirira mamwe maoparesheni ekubvisa stent uye kuderedza mutoro pavarwere. Kunyangwe zvidzidzo zvakaratidza kuti stent dzepancreas dzenguva pfupi dzine mhedzisiro yakanaka mukuderedza PEP, kushandiswa kwadzo mukiriniki kuchiri nemiganhu mikuru. Semuenzaniso, kune varwere vane ducts dzakatetepa dzepancreas nemapazi mazhinji, zvakaoma kuisa stent yepancreatic duct. Dambudziko racho richawedzera zvakanyanya, uye kuvhiyiwa uku kunoda nyanzvi yepamusoro ye endoscopists. Zvakakoshawo kuziva kuti stent yepancreatic duct yakaiswa haifanirwe kunge yakareba zvakanyanya mu duodenal lumen. Stent yakareba zvakanyanya inogona kukonzera kubooka kwe duodenal. Saka, sarudzo yenzira yekushandisa pancreatic duct stent ichiri kufanira kurapwa nekungwarira.
IV. Kuvhiyiwa kweTrans-pancreatocsphincterotomy, TPS
Tekinoroji yeTPS inowanzo shandiswa mushure mekunge waya yekutungamira yapinda mugwara repancreas netsaona. Septum iri pakati pegwara repancreas inochekwa nedivi rewaya yekutungamira yepancreas kubva na11 o'clock kusvika na12 o'clock, uye chubhu inopinzwa nedivi regwara re bile kusvika waya yekutungamira yapinda mugwara re bile.
Ongororo yakaitwa naDai Xin nevamwe vake yakaenzanisa TPS nedzimwe nzira mbiri dzekubatsira vanhu vanopinda muchubhu. Zvinoonekwa kuti mwero wekubudirira kweTPS tekinoroji wakakwira zvikuru, uchisvika 96.74%, asi hauna kuratidza mhedzisiro yakanaka kana uchienzaniswa nedzimwe nzira mbiri dzekubatsira vanhu vanopinda muchubhu. Zvakanakira.
Zvakataurwa kuti hunhu hwetekinoroji yeTPS hunosanganisira zvinotevera:
(1) Kuchekwa kwacho kudiki kune pancreaticobiliary septum;
(2) Kuwanda kwematambudziko mushure mekuvhiyiwa kwakaderera;
(3) Kusarudzwa kwenzira yekucheka kuri nyore kudzora;
(4) Nzira iyi inogona kushandiswa kune varwere vane pancreatic duct intubation inodzokororwa kana kuti nipples mukati me diverticulum.
Ongororo dzakawanda dzakaratidza kuti TPS haingogone chete kuvandudza mwero wekubudirira kwekupinda kwe bile duct yakaoma, asiwo haiwedzere kuwanda kwematambudziko mushure meERCP. Dzimwe nyanzvi dzinoti kana pancreatic duct intubation kana small duodenal papilla zvikaitika kakawanda, TPS inofanira kufungwa nezvayo kutanga. Zvisinei, pakushandisa TPS, kutarisisa kunofanirwa kupihwa mukana wekuti pancreatic duct stenosis uye kudzoka kwepancreatitis, izvo zvinogona kukonzera njodzi dzenguva refu dzeTPS.
V. Precut Sphincterotomy,PST
Nzira yePST inoshandisa papillary arcuate band semuganho wepamusoro we pre-incision uye nzira ye1-2 o'clock semuganhu wekuvhura duodenal papilla sphincter kuti uwane kuvhurika kwe bile nepancreatic duct. Pano PST inoreva zvakananga nzira yakajairika ye nipple sphincter pre-incision uchishandisa banga rakavhurika. Senzira yekugadzirisa kuoma kwe bile duct intubation yeERCP, tekinoroji yePST yave ichionekwa zvakanyanya sesarudzo yekutanga ye encoding intubation. Endoscopic nipple sphincter pre-incision inoreva endoscopic incision ye papilla surface mucosa uye huwandu hushoma hwe sphincter muscle kuburikidza ne incision banga kuti uwane kuvhurika kwe bile duct, uye wobva washandisa awaya yekufambisakana catheter yekupinza duct ye bile.
Ongororo yemuno yakaratidza kuti mwero wekubudirira kwePST wakakwira kusvika pa89.66%, izvo zvisina kusiyana zvakanyanya neDGT neTPS. Zvisinei, kuwanda kwePEP muPST kwakakwira zvakanyanya kupfuura kweDGT neTPS.
Parizvino, sarudzo yekushandisa tekinoroji iyi inoenderana nezvinhu zvakasiyana-siyana. Semuenzaniso, mumwe mushumo wakataura kuti PST ndiyo inonyanya kushandiswa kana duodenal papilla isina kujairika kana kuti yakakanganisika, senge duodenal stenosis kana mongernancy.
Pamusoro pezvo, kana tichienzanisa nedzimwe nzira dzekugadzirisa dambudziko, PST ine huwandu hwakawanda hwematambudziko akadai sePEP, uye zvinodiwa pakuvhiya zvakanyanya, saka kuvhiya uku kunoitwa zvakanaka nevanoongorora endoscopist vane ruzivo.
VI. Kuvhiyiwa kwetsono nebanga repapillotomy, NKP
NKP inzira yekuisa chipfuva ichibatsirwa nebanga. Kana kupinza chipfuva kwakaoma, banga rinogona kushandiswa kucheka chikamu chepapilla kana sphincter kubva pakavhurika duodenal papilla kuenda kumaawa 11-12, wobva washandisa awaya yekufambisakana catheter kuSelective insertion mu common bile duct. Senzira yekugadzirisa dambudziko rekupinzwa kwe bile duct yakaoma, NKP inogona kuvandudza kubudirira kwekubudirira kwe bile duct yakaoma. Kare, zvaifungidzirwa kuti NKP yaizowedzera kuwanda kwePEP mumakore achangopfuura. Mumakore achangopfuura, mishumo yakawanda yekuongorora yakaratidza kuti NKP haiwedzere njodzi yematambudziko mushure mekuvhiyiwa. Zvakakosha kuziva kuti kana NKP ikaitwa pakutanga kwepinzwa yakaoma, zvichabatsira zvikuru kuvandudza kubudirira kwepinzwa. Zvisinei, parizvino hapana kubvumirana kuti riini rekushandisa NKP kuti uwane mhedzisiro yakanaka. Imwe ongororo yakashuma kuti huwandu hweNKP hwepinzwa hwakashandiswa panguvaERCPmaminitsi asingasviki makumi maviri akanga akakwirira zvakanyanya kupfuura eNKP akashandiswa mushure memaminitsi makumi maviri.
Varwere vane dambudziko rekubvisa bile duct yakaoma vachabatsirwa zvikuru neiyi nzira kana vaine mabundu emazamu kana kuti duct yebile duct yakakura. Pamusoro pezvo, kune mishumo yekuti kana vakasangana nematambudziko akaoma ekuisa tube, kushandiswa pamwe chete kweTPS neNKP kune mwero wekubudirira wakakwira pane kuisa chete. Dambudziko nderekuti nzira dzakawanda dzekucheka dzinoshandiswa pabeche dzichawedzera kuitika kwematambudziko. Saka, kutsvagurudza kwakawanda kunodiwa kuti kuonekwe kana kusarudza kutanga kwekucheka usati watanga kuderedza kuitika kwematambudziko kana kubatanidza matanho akawanda ekugadzirisa kuti kuwedzere kubudirira kwekubata kwakaoma kwekuisa tube duct.
VII.tsono-banga Fistulotomy,NKE
Maitiro eNKF anoreva kushandisa banga retsono kubaya mucosa anenge 5mm pamusoro penipple, uchishandisa mixed current kucheka jira nejira munzira ye11 o'clock kusvika chimiro chakaita sechokubuda kana kuti bile rakawandisa zvawanikwa, uye wobva washandisa waya yekutungamira kuona kubuda kwenyongo nekucheka kwenyama. Kuisa nyongo muchubhu chenduru kwakaitwa panzvimbo yejaundice. Kuvhiyiwa kweNKF kunocheka pamusoro peburi renipple. Nekuda kwekuvapo kwe bile duct sinus, kunoderedza zvakanyanya kukuvara kwekupisa uye kukuvara kwemuchina pakuvhura pancreatic duct, izvo zvinogona kuderedza kuwanda kwePEP.
Ongororo yakaitwa naJin nevamwe yakaratidza kuti mwero wekubudirira kweNK tube intubation unogona kusvika 96.3%, uye hapana PEP mushure mekuvhiyiwa. Pamusoro pezvo, mwero wekubudirira kweNKF mukubvisa matombo wakakwira kusvika 92.7%. Nokudaro, chidzidzo ichi chinokurudzira NKF sesarudzo yekutanga yekubvisa matombo emudumbu. Kana tichienzanisa nepapillomyotomy yakajairika, njodzi dzekuvhiyiwa kweNKF dzichiri dzakakwira, uye inowanzova nematambudziko akadai sekuboorwa uye kubuda ropa, uye inoda huwandu hwakanyanya hwevashandi ve endoscopist. Nzvimbo chaiyo yekuvhura hwindo, kudzika kwakakodzera, uye nzira chaiyo zvese zvinoda kudzidzwa zvishoma nezvishoma.
Kana tichienzanisa nedzimwe nzira dzekutanga kuchekwa, NKF inzira iri nyore uye ine mwero wekubudirira wakakwira. Zvisinei, nzira iyi inoda kudzidzira kwenguva refu uye kuunganidzwa nguva dzose neanoshanda kuti ave neunyanzvi, saka nzira iyi haina kukodzera kune vanotanga.
VIII.Dzokorora-ERCP
Sezvambotaurwa pamusoro apa, kune nzira dzakawanda dzekugadzirisa dambudziko rekupinza dumbu muchubhu. Zvisinei, hapana vimbiso yekubudirira kwe100%. Mabhuku akakodzera akataura kuti kana kuputika kwedumbu muchubhu yemuchubhu kwakaoma mune dzimwe nguva, kuputika kwenguva refu uye kakawanda kana kupisa kwemuviri kunopinda muchubhu yemuchubhu kunogona kukonzera edema ye duodenal papilla. Kana kuvhiyiwa kukaramba kuripo, kuputika kwedumbu muchubhu yemuchubhu hakuzobudiriri chete, asi mukana wematambudziko uchawedzerawo. Kana mamiriro ezvinhu ari pamusoro apa akaitika, unogona kufunga nezvekumisa kubuda kwemvura.ERCPKutanga, tanga wavhiya woita ERCP yechipiri panguva yaunoda. Kana papilloedema yapera, ERCP ichava nyore kuti ibudirire pakupinza dumbu.
Donnellan nevamwe vake vakaita kechipiriERCPKuvhiyiwa kwevarwere makumi mashanu nerimwe vane ERCP yakakundikana mushure mekuchekwa nebanga, uye nyaya makumi matatu neshanu dzakabudirira, uye kuwanda kwematambudziko hakuna kuwedzera.
Kim nevamwe vake vakaita oparesheni yechipiri yeERCP pavarwere makumi matanhatu nevapfumbamwe vakatadza.ERCPmushure mekuchekwa nebanga, uye nyaya 53 dzakabudirira, ne76.8%. Dzimwe nyaya dzisina kubudirira dzakaitwawo kechitatu keERCP, ne79.7%, uye kuvhiyiwa kakawanda hakuna kuwedzera kuitika kwematambudziko.
Yu Li nevamwe vake vakaita sarudzo yechipiriERCPpavarwere makumi manomwe vakatadza kuita ERCP mushure mekuchekwa nebanga, uye vanhu makumi mashanu vakabudirira. Huwandu hwekubudirira (ERCP yekutanga + ERCP yechipiri) hwakawedzera kusvika pa90.6%, uye kuwanda kwematambudziko hakuna kuwedzera zvakanyanya. . Kunyangwe mishumo yakaratidza kushanda kweERCP yechipiri, nguva iri pakati pekuvhiyiwa kweERCP mbiri haifanirwe kunge yakareba, uye mune dzimwe nguva, kunonoka kubuda kwemvura mudumbu kunogona kuwedzera mamiriro acho ezvinhu.
IX. Kuyerera kwemvura yemudumbu kunotungamirirwa neEndoscopicultrasound, EUS-BD
EUS-BD inzira inoshandiswa pakurwisa chirwere inoshandisa tsono yekuboorwa nduru kubva mudumbu kana duodenum lumen ichitungamirirwa neultrasound, yopinda muduodenum kuburikidza neduodenal papilla, uye yozoisa nyongo mukati medumbu. Nzira iyi inosanganisira nzira dzemukati mehepatic nedzekunze kwehepatic.
Ongororo yakaitwa kare yakaratidza kuti mwero wekubudirira kweEUS-BD wakasvika 82%, uye kuwanda kwematambudziko mushure mekuvhiyiwa kwaingova 13%. Muongororo yekuenzanisa, EUS-BD kana ichienzaniswa netekinoroji yepre-incision, mwero wekubudirira kwayo muintubation wakakwira, kusvika 98.3%, iyo yaive yakakwira zvakanyanya kupfuura 90.3% yepre-incision. Zvisinei, kusvika pari zvino, zvichienzaniswa nedzimwe tekinoroji, kuchine kushomeka kwekutsvaga pakushandiswa kweEUS pamatambudziko akaoma.ERCPKupinza machubhu. Hapana ruzivo rwakakwana rwekuratidza kushanda kwetekinoroji yekubvisa bile inotungamirwa neEUS kune zvakaomaERCPKuiswa kwechubhu. Dzimwe ongororo dzakaratidza kuti zvakadzikira. Basa rePEP mushure mekuvhiyiwa harigutsi.
X. Kuyerera kwemvura inoyerera nehepatic cholangial, PTCD
PTCD imwe nzira yekuongorora inopindira inogona kushandiswa pamwe chete neERCPkana paine kuoma kwekupinza duct yenyongori, kunyanya kana paine kuvharika kwenyongori. Nzira iyi inoshandisa tsono yekuboorwa kuti ipinde muduct yenyongori, kuboorwa duct yenyongori kuburikidza nepapilla, uye yozopinda muduct yenyongori kuburikidza nepapilla yakachengetwa.waya yekufambisaImwe ongororo yakaongorora varwere 47 vaiva nedambudziko rekupinda muchubhu yemudumbu vakaitwa PTCD, uye mwero wekubudirira wakasvika 94%.
Ongororo yakaitwa naYang nevamwe yakaratidza kuti kushandiswa kweEUS-BD kuri pachena kuti hakunei nekuoma kwetsinga yeropa uye kudiwa kwekuboorwa kwenzira yekupinda muchiropa, nepo PTCD ine zvakanakira zvekutevedzera nzira yekupinda muchiropa uye kuva inochinjika muzvishandiso zvinotungamira. Kupinda kwenzira yekupinda muchiropa kunofanira kushandiswa muvarwere vakadaro.
PTCD ibasa rakaoma rinoda kudzidziswa kwenguva refu uye kupedzisa huwandu hwakakwana hwezviitiko. Zvakaoma kune vatsva kuti vapedze basa iri. PTCD haisi yakaoma chete kushanda, asiwowaya yekufambisazvinogonawo kukuvadza duct ye bile panguva yekukura kwayo.
Kunyangwe nzira dziri pamusoro dzichigona kuvandudza zvakanyanya mwero wekubudirira kwekubvisa bile duct yakaoma, sarudzo yacho inofanira kufungwa nezvayo zvizere.ERCP, SGT, DGT, WGC-PS nedzimwe nzira dzinogona kufungwa nezvadzo; kana nzira dziri pamusoro dzikatadza, vanachiremba ve endoscopist vane ruzivo uye vane ruzivo vanogona kuita nzira dzekutanga kuchekwa, dzakadai seTPS, NKP, NKF, nezvimwewo; kana zvichiripo Kana nzira yekubvisa bile duct isingakwanise kupedzwa, nzira yekuwedzera yekuwedzeraERCPinogona kusarudzwa; kana pasina imwe yenzira dziri pamusoro apa inogona kugadzirisa dambudziko rekuoma kwekuisa nhubhu, maoparesheni ekudzivirira chirwere akadai seEUS-BD nePTCD anogona kuyedzwa kugadzirisa dambudziko racho, uye kurapwa kwekuvhiya kunogona kusarudzwa kana zvichidikanwa.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., tinogadzira zvinhu muChina zvine chekuita ne endoscopic consumables, zvakaita se biopsy forceps, hemoclip, polyp snare, sclerotherapy needle, spray catheter, cytology brushes,waya yekufambisa, tswanda yekutorwa kwematombo, katheta yekubuditsa mvura yemumhinonezvimwewo zvinoshandiswa zvakanyanya muEMR, ESD,ERCPZvigadzirwa zvedu zvakanyoreswa neCE, uye mafekitori edu akanyoreswa neISO. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East nedzimwe nzvimbo dzeAsia, uye zviri kuita kuti mutengi azivikanwe uye arumbidzwe zvikuru!
Nguva yekutumira: Ndira-31-2024