ERCP izita rakakosha rekuongororwa uye kurapwa kwezvirwere zvebhaibheri uye pancreatic. Kamwe zvangobuda, zvakapa mazano matsva mazhinji ekurapa kwehutachiona hwebhaibheri uye pancreatic. Haina kugumira ku "radio areji". Iyo yakashandura kubva kune yekutanga yekuongorora tekinoroji kune imwe mhando nyowani. Maitiro ekurapa anosanganisira Sphincteteromy, Bile duct low kubvisa, bile dhiza uye dzimwe nzira dzekurapa zvirwere uye pancreatic system.
Muyero wekubudirira wekusarudza Bile Duct Intubation yeErcp inogona kusvika 90%, asi pachine zvimwe zviitiko zvinowanikwa zvakawandisa zvinokonzeresa desticucess kukundikana. Maererano nekubvunzurudzwa kwekuongororwa uye kurapwa kweVELCP, nguva yakaoma inogona kutsanangurwa Paunenge uchiita ERCP, kana Bile Duct Intencuation yakaoma mune dzimwe nguva, zviyero zvinobudirira zvinofanirwa kusarudzwa nenguva yekuvandudza huwandu hwekubudirira dule. Chinyorwa ichi chinoita ongororo yakashamisika yehunyanzvi hwakawanda hwekutengesa hwakashandiswa kugadzirisa dule duct thocess
I.Singleguidewire maitiro, Sgt
Iyo SGT maitiro ndeyekushandisa kusarudzika kuti uenderere mberi nekuedza kugunun'una iyo bile duct mushure mekutungamira waya waya inopinda muPancreatic duct. Mumazuva ekutanga ekuvandudzwa kweTekinoroji yeErCP, SGT yaive nzira yakajairika yekunetseka kwebhandi. Kubatsira kwayo ndekwekuti kuri nyore kushanda, kugadzirisa iyo nipple, uye inogona kutora kuvhurwa kweiyo pancreattic duct, zvichiita kuti zvive nyore kuwana kuvhurwa kweiyo bile duck.
Kune mishumo muTheliturature iyo yekunyora kwekunze inokundikana, kusarudza sgt-yakabatsirwa intubation inogona kubudirira kupedzisa bile duct intubation mune anenge 70% -80% yezviitiko. Chirevo chakanongedzerawo icho mune zvekutadza kweSGT, kunyangwe iyo gadziriso uye kushandisa kaviriKutungamiraTekinoroji haina kuvandudza huwandu hwekubudirira kweBile Duct Intubation uye haina kuderedza chiitiko chePost-ercp pancreatitis (PEP).
Zvimwe zvidzidzo zvakaratidzawo kuti huwandu hwebudiriro hweSGT Extube hwakaderera pane izvo zvakapetwa kaviriKutungamiraTekinoroji uye transpancreatc papillary sphincteteroty tekinoroji. Kuenzaniswa nekudzokorora kwekuedza kweSGT, kutanga kuitwa kweaviriKutungamiraTekinoroji kana pre-incision tekinoroji inogona kuwana mhedzisiro iri nani.
Sezvo kukura kweErcp, mhando dzakasiyana dzehunyanzvi hutsva hwakagadziridzwa pakunetseka kwekutenderera. Zvichienzaniswa neyakaitwaKutungamiraTekinoroji, zvakanakira zviri pachena uye chiyero chekubudirira chakakwira. Saka, singleKutungamiraTekinoroji ikozvino haawanzo kushandiswa clinty.
II.Dolum-Gwara Wire Technque, Dgt
DGT inogona kunzi iyo pancreattic duct gwara rei wire yekugara nzira, iyo ndeyekutungamira yaisai dhiri rekuteedzera uye kuisazve, uyezve iyo yechipiri inotungamira inogona kuiswazve pamusoro pePancreatic duct Sarudza Bile Duct Intenbation.
Zvakanakira nzira iyi ndeiyi:
(1) nerubatsiro rweKutungamira, iyo bile duct kuvhurwa kuri nyore kuwana, kugadzira bile duct intubation inotsvedza;
(2) Wireya waya inogona kugadzirisa nipple;
(3) pasi pekutungamirirwa kweiyo pancreate ductKutungamira.
Dumonceau et al. ndakaona kuti anotungamiraKutungamiraKugara pancreattic duct nzira inobudirira kune bile duct intention. chiyero chine hunhu hwakanaka.
Chidzidzo paDgt naLiu deren et al. Wakawana kuti mushure mekunge DGT yakaitwa pane varwere vane yakaoma ELCP Bile Duct Intubation, huwandu hwekubudirira hwekubudirira hwakasvika 95.65%, izvo zvaive zvakakwirira kupfuura 59.09% chiyero chekubudirira kwekutapudza.
Chidzidzo chichava chidzidzo na wang fuquan et al. akataura kuti DGT yakaiswa kune varwere vane yakaoma ERCP Bile Duct Intubation muboka rekuedza, huwandu hwekupedzisira hwekupedzisira hwakawedzera kusvika 96,0%.
Zvidzidzo zvepamusoro zvinoratidza kuti kushandiswa kweDgt kune varwere vane vakaoma bile duct intubation yeErcp inogona kubatsira zvinobudirira chiyero cheBile Duct Intence.
Kupfupika kweDgt kunonyanya kusanganisira iyo inotevera mapoinzi maviri:
(1) pancreaticKutungamirapamwe yakarasika panguva yeblue duct intubation, kana yechipiriKutungamirainogona kupinda muPancreatic duct zvakare;
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Kubva pamaonero ePep chiitiko, iyo PEP chiitiko cheDgt yakaderera pane iyo yeiyo yeiyo comtil bile duct intention. Chidzidzo chekutanga chakaratidza kuti chiitiko chepashure chaicho cheDgt chaingova chete 2.38% mu ercp varwere vane yakaoma bile duct intence duct int Mamwe mabhuku anonongedzera kuti kunyangwe Dgt ane huwandu hwepamusoro hwekuita bile duct intubation, dgt pancreatitis ichiri kuenzaniswa nemamwe matanho ekugadzirisa, nekuti iyo DGT kushanda kunogona kukonzera kukuvara kwePancreatic duct uye kuvhura kwacho. Pasinei neizvi, kubvumirana kumba uye kune dzimwe nyika kuchiri kunongedza kuti mune zvakaoma Bile Duct Intention, Dgt tekinoroji yakanyanya kuoma mukushanda, uye zviri nyore kudzora.ERI
III.ITI Kutungamira Connulation-Pan-gadzira Stent, WGC-P5
WGC-PS inogona zvakare kunzi iyo yepancreattic duct stent yekugadzirisa nzira. Iyi nzira ndeye kuisa iyo pancreattic duct stent neKutungamiraizvo zvinokanganisa zvinopinda muPancreate Duct, wobva waburitsa kunzeKutungamiraUye ita bile duct connulation pamusoro pehunhu.
Chidzidzo neHakuta et al. yakaratidza kuti kuwedzera mukuvandudza huwandu hwekuwedzera kwekutungamira nekutungamira kwekutungamira, WGC-PS rinogona zvakare kudzivirira kuvhurwa kwePancreattic duct uye zvakanyanya kuderedza chiitiko chePP.
Chidzidzo paWGC-Ps by Zou chuanxin et al. yakataura kuti iyo budiriro yekubhuroka kwekunetseka uchishandisa iyo yenguva pfupi pancreate duct Stent Stent Stent nzira yakasvika 97.67%, uye chiitiko chePP chakange chakaderedzwa zvakanyanya.
Imwe ongororo yakawana kuti kana pancreattic duct sten inoiswa nenzira kwayo, mukana weakanyanya postoperative pancreatitis mumatare akaomarara akaderedzwa zvakanyanya.
Iyi nzira ichine zvimwe zvikanganiso. Semuenzaniso, iyo pancreattic duct sten yakaiswa panguva yekushanda kwe ercp kunogona kutamiswa; Kana iyo stent ichingoda kuiswa kwenguva yakareba mushure mekunge ERCP, pachave nemukana wepamusoro wekutungamira kwehurumende uye duct kuvharirwa. Kukuvara uye mamwe matambudziko kune kuwedzera mune huwandu hwep. Yatova, masangano atove kutanga kudzidza kwenguva pfupi pancreattic duct stents iyo inogona kungobuda kunze kwepancreate duct. Chinangwa ndechekushandisa pancreattic duct stents kudzivirira pet. Pamusoro pekuwedzera zvakanyanya kuderedza chiitiko chetsaona dzepep Kunyangwe zvidzidzo zvakaratidza kuti kwenguva pfupi pancreate duct stents vane mhedzisiro mukuderedza PEP, chishandiso chavo chekiriniki zvichiri zvausingakwanisi. Semuenzaniso, mune varwere vane mutete mapancreate ducts uye matavi mazhinji, zvakaoma kuisa iyo pancreatic duct stent. Iko kuoma kuchawedzera kwazvo, uye kuvhiyiwa uku kunoda huwandu hwenyanzvi hwepamusoro hwe endoscopist. Zvakakoshawo kuziva kuti iyo pancreate duct stent yakaiswa haifanirwe kuve yakareba kwazvo mu duodenal lumen. Yakanyanya kureba stent inogona kukonzera duodenal performaration. Naizvozvo, sarudzo ye pancreattic duct stent yekugadzirisa nzira ichiri kufanira kubatwa nekuchenjerera.
Iv.trans-pancreatecsphinctelomy, TPS
TPS tekinoroji inowanzoshandiswa mushure mekutungamira waya inopinda muPancreatic duct nekukanganisa. Septum iri pakati pePancreate Duct yakaiswa padanho rekutungamira
Chidzidzo cheDai Xin et al. Kuenzaniswa TPS uye maviri mamwe ebetsero tekinoroji. Zvinogona kuoneka kuti huwandu hwekubudirira kweTPS tekinoroji yakanyanya kukwirira kwazvo, inosvika makumi masere neshanu muzana, asi hazviratidzi zvakanakira kuenzaniswa nedzimwe mbiri dzebetsero. Zvakanakira.
Izvo zvataurwa kuti hunhu hweTPS tekinoroji zvinosanganisira zvinotevera pfungwa:
(1) Incision idiki kune iyo pancreateobial septum;
(2) zviitiko zvekupedza zvinetso zvakadzama zvakaderera;
(3) kusarudzwa kwekucheka kuteterera kuri nyore kudzora;
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Zvidzidzo zvakawanda zvakaratidza kuti TPS haigone kuvandudza chete muyero wekubudirira wechiitiko duct Vamwe vadzidzi vanofunga kuti kana pancreate duct intubation kana diki duodenal papilla inoitika, TPS inofanira kutariswa. Nekudaro, kana uchinyorera TPS, kutarisirwa kunofanirwa kubhadharwa kune mukana wepancreate duct stenosis uye kudzokorora kwePancreatitis, iyo inogoneka njodzi-yakareba njodzi yeTPS.
V.Precut Sphincteteroty, PST
Iyo PST maitiro anoshandisa iyo papillary arcalary bhendi seyekumusoro muganho weiyo pre-incision uye iyo 1-2 olcision nhungamiro yekuvhura papilla papilla kuti uwane kuvhurwa kweiyo bile uye pancreatic duct. Pano pst inonyatsoreva kune iyo standard nipple sphincter pre-incision maitiro uchishandisa banga rekutora. Sechirongwa chekubata neyakaoma bile duct intuubation ye ercp, ps tekinoroji yakafarirwa zvakanyanya kuve sarudzo yekutanga yekunetseka kwekutenderera kwekunetseka. Endoscopic nipple sphincter pre-incision inoreva nezve endoscopic incision yePapillo mucosa uye chidiki cheSponaKutungamirakana catheter kuti inyunzi iyo bile duct.
Chidzidzo chomudzimba chakaratidza kuti huwandu hwebudiriro hwakawedzera kusvika 89.66%, izvo zvisina kusiyana zvakanyanya neDgt uye TPS. Nekudaro, chiitiko chePP mune pst chakanyanya kukwirira kupfuura iyo yeDGT uye TPS.
Parizvino, sarudzo yekushandisa iyi tekinoroji zvinoenderana nezvakasiyana zvinhu. Semuenzaniso, mumwe mushumo wakataurwa kuti PST inoshandiswa zvakanyanya mune zviitiko apo iyo papillal papilla haina kujairika kana kuti yakakanganiswa, senge duodeny stenosis kana kuti yakaipa.
Pamusoro pezvo, kana uchienzaniswa nedzimwe nzira dzekutsungirira, PST ine huwandu hwepamusoro hwekutambudzika kwakadai sep, uye zvinodikanwa zvekuvhiya zvakakwira, saka kushanda uku kunoitwa neakasarudzika endoscopists.
V.Needle-banga papillotomy, nkp
NKP iphire-banga-rakabatsirwa maitiro ekunzwisisa. Kana kudengenyeka kwakaoma, banga-ripi rinogona kushandiswa kuti riite chikamu chePapilla kana Sphincter kubva pakuvhurwa kweiyo daudenal papeji 11-12 nguva, uye wobva washandisa aKutungamirakana catheter yekusarudza kuisirwa muBile Bile Duct. Sechirongwa chekutsiva chechiitiko chakaoma bile duct intubation, nkp inogona kugadzirisa zvinobudirira huwandu hwekubudirira kweiyo yakaoma bile duct intention. Munguva yakapfuura, yaiwanzotendwa kuti nkp inozowedzera huwandu hweper mumakore achangopfuura. Mumakore achangopfuura, mishumo yakawanda yekuongorora yakataura kuti NKP haawedzere njodzi yekudzora matambudziko. Zvakakosha kucherechedza kuti kana nkp inoitwa munguva yekutanga yekunetseka kwekunze, zvichave zvakanaka kuti uvandudze mukana wekubudirira. Nekudaro, hapana parizvino hapana kubvumirana pane kana kushandisa nkp kuzadzisa zvakanakisa mibairo. Imwe fundo yakataura kuti huwandu hwekupedzisira hweNKP hwakaiswa panguvaErcpAsingasviki maminitsi makumi maviri aive akanyanya kukwirira kupfuura iyo yeNKP yakaiswa gare gare kupfuura maminitsi makumi maviri gare gare.
Varwere vane vakaoma bile duct convulation vachabatsirwa kubva kune iyi nzira kana vane nipple bullges kana yakakosha bile dura dhaiti. Uyezve, pane mishumo iyo kana ichisangana nematanho akaoma ekupedzisira, kushandiswa kweTPS uye NKP ine chiyero chakakura chekubudirira pane kushandisa wega. Iko kushushikana ndeyekuti maitiro mazhinji eIndia anoshandiswa kune nipple achawedzera kuitika kwekunetseka kwemanzwiro. Naizvozvo, kutsvagisa kwakawanda kunodiwa kuti usarudze kutanga kwekutanga-kwekutanga kuderedza kuitika kwemanzwiro kana kusanganisa matanho mazhinji ekugadzirisa ekubudirira kwekutambudzika.
Vii.nseedle-banga fistulototy, NKE
Iyo NKF maitiro anoreva kushandisa banga remberi kuti ribourwe muCofa anenge 5 mangwanani. Sarudza Bile Duct Intubation yakaitwa pane iyo Jaundice saiti. NKF yekuvhiya inocheka pamusoro pekuvhura nipple kuvhura. Nekuda kwekuvapo kweiyo bile duct sinus, inoderedza zvakanyanya kukuvara uye manhamba kukuvadzwa kune iyo yekuvhurwa kweiyo pancreattic duct, iyo inogona kuderedza huwandu hwePEP.
Chidzidzo naJin et al. yakanongedzera kunze kwekubudirira kweiyo nk tube intubation inogona kusvika 96.3%, uye hapana postoperative pep. Uye zvakare, iyo budiriro yeNKF iri mumatombo kubviswa yakakwira se92,7%. Naizvozvo, chidzidzo ichi chinokurudzira NKF sekutanga sarudzo yekuzivikanwa Bile Duct Little Kubviswa Kwemwero. . Kuenzaniswa neNguva dzePapillomyotomy, NKF Socent of Njodzi dzichiri kukwirira, uye zvinowanzoitika pane zvakadai sekutsanangurwa uye kubuda ropa, uye zvinoda mwero wakanyanya wekushanda we endoscopist. Iyo chaiyo yekuvhura yewindows yekuvhura, kudzika kwakakodzera, uye chaiyo nzira dzese dzinoda kudzidziswa zvishoma nezvishoma. tenzi.
Kuenzaniswa nedzimwe nzira pre-incision, NKF inzira yakanyanya nyore neyakanyanya kubudirira. Nekudaro, nzira iyi inoda kudzidzira kwenguva refu uye kuenderera mberi nekuunganidzwa neanoshanda kuti uve nehunyanzvi, saka nzira iyi haina kukodzera kune vanotanga.
Viii.repeat-ercp
Sezvataurwa pamusoro apa, kune nzira dzine nzira dzekubata nekuomerwa kwekunze. Nekudaro, hapana vimbiso ye100% kubudirira. Mabhuku akakodzera akataura kuti kana bile duct intubation yakaoma mune dzimwe nguva, refu-intubation yekupinda kana iyo yekubatidza kuputika kwekutuka kunogona kutungamira papilla. Kana iko kuvhiya kuchiramba, kwete chete iyo bile yekubhuroka intubation haina kubudirira, asi mukana wezvinetso zvichawedzerawo. Kana mamiriro ari pamusoro apa ikaitika, unogona kufunga nezvekugumisa ikozvinoErcpkushanda kutanga uye ita yechipiri ercp panguva yekusarudzika. Pashure pokunge papillloedema inonyangarika, kushanda kwe ercp kuchave nyore kuita zvakabudirira.
Donyenla et al. akaita sekondiErcpKushanda pavarwere 51 vane ercp vakatadza mushure mekunge tsono-banga rekushora, uye 35 nyaya dzakabudirira, uye zviitiko zvezvematambudziko hazvina kuwedzera.
Kim et al. akaita sekondi ercp kushanda pane 69 varwere vakatadzaErcpMushure mekunge tsono-banga pre-incision, uye mazana mashanu nemakumi mashanu emakesi akabudirira, aine budiriro ye76.8%. Nyaya dzasara dzisingawirirani dzisingabudisike zvakare dzishande yechitatu ercp kushanda, ine budiriro ye79.7%. , uye mashandiro akawanda haana kuwedzera chiitiko chekunetseka.
Yu li et al. akaita sarudzo yechipiriErcpVarwere 70 vakakundikana Ercp mushure mekunge tsono-banga pre-incision, uye mazana mashanu emakore akabudirira. Iyo yakazara kubudirira muyero (yekutanga ERCP + sekondari ERCP) yakawedzera kusvika kuma 90.6%, uye zviitiko zvemanzwiro hazvina kuwedzera zvakanyanya. . Kunyangwe mishumo yakaratidza kushanda kwechipiri ESCP, kupindirana pakati pemashandisirwo maviri ercp hakufanirwe kuve kwenguva refu, uye mune zvimwe zviitiko zvakakosha, kunonoka kudhiraera kwaigona kuwedzera mamiriro ezvinhu.
Ix.endoscopicultrasound-inotungamirirwa biliary drainage, eus-bd
EUS-BD ndeyekushanyira nzira inoshandisa iyo puncture sindano yekuisa gallbladder kubva mudumbu. Iyi nzira inosanganisira ese mostrahepatic uye extreshipatic nzira.
Chidzidzo chekudzokorora chakasvitsa kuti huwandu hwekubudirira reEUS-BD yasvika 82%, uye zviitiko zvezvekushandisa zvevashandi zvaingova 13%. Mukudzidza kwekufananidza, eus-bd zvichienzaniswa neyekutanga-tekinoroji yehukama Nekudaro, kusvika zvino, zvichienzaniswa nedzimwe tekinoroji, kuchine kushayikwa kwekutsvagisa pane kushandiswa kweeus kuti zviomeErcpintubation. Iko kune isina kukwana data kuratidza kushanda kweiyo eus-inotungamirwa bile duct puncture tekinoroji yakaomaErcpintubation. Dzimwe zvidzidzo zvakaratidza kuti zvakadzora basa rePostoperative Pep harisi kugutsa.
X..percutaneous transhepatic cholangial drainage, PTCD
PTCD ndeimwe inosvikirwa yekuongorora maitiro ayo anogona kushandiswa mukubatanidzwa naErcpKuti uenderere mberi Bile Duct Intenube, kunyanya mune zviitiko zvinokuvadza blighary besant. Iyi nzira inoshandisa danda rekupunzika kuti riwedzere kupinda muBile Duct, puncture iyo Bile Duct kuburikidza nepapilla, uyezve intubate iyo bile ducrogradaly kuburikidza yakachengetedzwaKutungamira. Imwe ongororo yakaongororwa varwere 47 vane yakaoma bile duct intubation iyo understont ptcd maitiro, uye huwandu hwekubudirira hwasvika 94%.
Chidzidzo cheYang et al. akataura kuti kushandiswa kweEUS-BD zviri pachena kana zvasvika kune hilar stenosis uye nepo ptcd ine zvakanakira kuenderana neBile duct axis uye kuve nekuchinjika mumidziyo yekutungamira. Bile Duct Intubation inofanira kushandiswa muvarwere vakadaro.
PTCD iri kuoma kushanda kunoda kudzidziswa kwenguva refu uye kupedzwa kwehuwandu hwakakwana hwezviitiko. Zvakaoma kuti Novie kupedzisa kushanda uku. PTCD haina kungooma kushanda, asi iyoKutungamiraDai zvakare kukuvadza iyo bile duck panguva yekufambira mberi.
Kunyangwe iyo nzira dziri pamusoro dzinogona kugadzirisa zvakanyanya kukosha kwebudiriro yeiyo yakaoma bile duct intubation, sarudzo inoda kusanzwisisika. Kana uchiitaErcp, Sgt, Dgt, WGC-PS uye dzimwe nzira dzinogona kutariswa; Kana iyo nzira dziri pamusoro dzikatadza, vakuru uye vane ruzivo endoscopists vanogona kuita maitiro e-exision, senge tps, nkp, nkf, etc.; Kana ichiri kana ichisarudza bile duct intubation haigoni kupedzwa, kusarudza sekondariErcpinogona kusarudzwa; Kana pasina imwe yehunyanzvi hwokugona kugadzirisa dambudziko rekutenderera
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Kutumira Nguva: Jan-31-2024