ERCP ndiyo tekinoroji yakakosha yekuongororwa uye kurapwa kwechirwere chebiliary uye pancreatic. Payakangobuda, yakapa mazano mazhinji matsva ekurapa biliary uye pancreatic zvirwere. Izvo hazvina kuganhurirwa ku "radiography". Yakashandura kubva kune yepakutanga tekinoroji yekuongorora kune imwe mhando. Maitiro ekurapa anosanganisira sphincterotomy, bile duct dombo kubviswa, bile drainage uye dzimwe nzira dzekurapa bile uye pancreatic system zvirwere.
Kubudirira kwekusarudza bile duct intubation yeERCP inogona kusvika pamusoro pe90%, asi pachine zvimwe zviitiko apo kuoma kwebiliary kunokonzera kusarudza bile duct intubation kukundikana. Zvinoenderana nekubvumirana kwazvino pamusoro pekuongororwa uye kurapwa kweERCP, intubation yakaoma inogona kutsanangurwa se: nguva yekusarudza bile duct intubation yemuzamu mukuru weyakajairika ERCP inopfuura maminitsi gumi kana nhamba yekuedza intubation inodarika kashanu. Paunenge uchiita ERCP, kana bile duct intubation yakaoma mune dzimwe nguva, nzira dzinoshanda dzinofanira kusarudzwa munguva yekuvandudza kubudirira kwe bile duct intubation. Ichi chinyorwa chinoitisa ongororo yakarongeka yemaitiro akati wandei ekubatsira intubation anoshandiswa kugadzirisa yakaoma bile duct intubation, nechinangwa chekupa hwaro hwekufungidzira kune vekiriniki endoscopists kusarudza nzira yekupindura kana vatarisana nekuoma bile duct intubation yeERCP.
I.Singleguidewire Technique,SGT
Iyo SGT tekinoroji ndeyekushandisa inosiyanisa catheter kuenderera mberi nekuyedza kupinza bile duct mushure mekunge waya yekutungamira yapinda mupancreatic duct. Mumazuva ekutanga ekuvandudzwa kweERCP tekinoroji, SGT yaive nzira yakajairika yekunetsa biliary intubation. Kubatsira kwayo ndekwekuti iri nyore kushanda, inogadzirisa zamu, uye inogona kutora kuvhurwa kwepancreatic duct, zvichiita kuti zvive nyore kuwana kuvhurwa kweiyo bile duct.
Pane mishumo mumabhuku ekuti mushure menguva yakajairika intubation yatadza, kusarudza SGT-yakabatsirwa intubation inogona kubudirira kupedzisa bile duct intubation munenge 70% -80% yemakesi. Chirevo chakaratidzawo kuti mune zviitiko zvekutadza kweSGT, kunyangwe kugadziridzwa uye kushandiswa kwekaviriguidewiretekinoroji haina kuvandudza mwero wekubudirira kwe bile duct intubation uye haina kuderedza chiitiko chepost-ERCP pancreatitis (PEP).
Zvimwe zvidzidzo zvakaratidzawo kuti budiriro yeSGT intubation yakaderera pane iya yakapetwa kaviriguidewiretekinoroji uye transpancreatic papillary sphincterotomy tekinoroji. Kuenzaniswa nekuedza kwakadzokororwa kweSGT, kutanga kuitiswa kwekaviriguidewiretekinoroji kana pre-incision tekinoroji inogona kuwana mhedzisiro iri nani.
Kubva pakuvandudzwa kweERCP, dzakasiyana siyana matekinoroji akagadzirwa kuitira kunetsa intubation. Kuenzaniswa ne singleguidewiretekinoroji, zvakanakira zviri pachena uye mwero wekubudirira wakakwira. Naizvozvo, kurooraguidewiretekinoroji parizvino haiwanzo kushandiswa mukiriniki.
II.Double-guide waya nzira,DGT
DGT inogona kunzi pancreatic duct guide wire occupation nzira, iri yekusiya gwara waya ichipinda mupancreatic duct kuti itevedze uye igare mairi, uyezve yechipiri gidhi waya inogona kuiswa zvakare pamusoro peiyo pancreatic duct giidhi waya. Kusarudza bile duct intubation.
Zvakanakira nzira iyi ndezvi:
(1) Nerubatsiro rweaguidewire, iyo bile duct kuvhura iri nyore kuwana, zvichiita kuti bile duct intubation iite nyore;
(2) Waya inotungamira inogona kugadzirisa zamu;
(3) Pasi pekutungamirirwa kwepancreatic ductguidewire, kudzokororwa kwekuona kwepancreatic duct kunogona kudziviswa, nokudaro kuderedza kukurudzirwa kwepancreatic duct inokonzerwa nekudzokorora intubation.
Dumonceau et al. akaona kuti gwara uye catheter yekusiyanisa inogona kuiswa mugomba rebiopsy panguva imwe chete, uye ndokushuma nyaya yakabudirira yepancreatic duct guidewire occupying nzira, uye akagumisa kutiguidewirekubata iyo pancreatic duct nzira inobudirira kune bile duct intubation. chiyero chine simba rakanaka.
Chidzidzo paDGT naLiu Deren et al. vakawana kuti mushure mekunge DGT yaitwa kune varwere vane yakaoma ERCP bile duct intubation, iyo intubation budiriro yakasvika 95.65%, iyo yaive yakakwira zvakanyanya kupfuura iyo 59.09% yekubudirira kweyakajairwa intubation.
Chidzidzo chinotarisirwa naWang Fuquan et al. yakaratidza kuti DGT payakashandiswa kune varwere vane yakaoma ERCP bile duct intubation muboka rekuyedza, intubation yekubudirira yakakwira kusvika 96.0%.
Zvidzidzo zviri pamusoro zvinoratidza kuti kushandiswa kweDGT kune varwere vane yakaoma bile duct intubation yeERCP kunogona kunyatso kuvandudza mwero webudiriro ye bile duct intubation.
Izvo zvinokanganisa zveDGT zvinonyanya kusanganisira zvinotevera mapoinzi maviri:
(1) Chirwatataguidewirepamwe yakarasika panguva bile duct intubation, kana yechipiriguidewireinogona kupinda pancreatic duct zvakare;
(2) Iyi nzira haina kukodzera kumatare akadai sepancreatic musoro cancer, pancreatic duct tortuosity, uye pancreatic fission.
Kubva pakuona kwechiitiko chePEP, chiitiko chePEP cheDGT chakaderera pane icho cheyakajairwa bile duct intubation. Chidzidzo chinotarisirwa chakaratidza kuti chiitiko chePEP mushure meDGT chaingova 2.38% muvarwere veERCP vane yakaoma bile duct intubation. Mamwe mabhuku anoratidza kuti kunyangwe DGT iine budiriro yepamusoro ye bile duct intubation, chiitiko chepost-DGT pancreatitis chichiri chakakwira zvichienzaniswa nemamwe matanho ekugadzirisa, nekuti mashandiro eDGT anogona kukonzera kukuvadzwa kwepancreatic duct uye kuvhurwa kwayo. Pasinei neizvi, kubvumirana kumba nekune dzimwe nyika kuchiri kuratidza kuti mumamiriro ezvinhu akaoma bile duct intubation, kana intubation yakaoma uye pancreatic duct ichidzokororwa zvisizvo, DGT ndiyo sarudzo yekutanga nokuti tekinoroji yeDGT haina kuoma mukushanda, uye zviri nyore. to control.Iyo inoshandiswa zvakanyanya mukusarudza intubation yakaoma.
III.Waya gwara cannulation-pan-creatic stent,WGC-P5
WGC-PS inogona zvakare kunzi thepancreatic duct stent occupation nzira. Iyi nzira ndeyekuisa iyo pancreatic duct stent neguidewireiyo inopinda zvisirizvo mupancreatic duct, wobva waburitsa iyoguidewireuye ita bile duct cannulation pamusoro pe stent.
Chidzidzo chakaitwa naHakuta et al. yakaratidza kuti kunze kwekuvandudza huwandu hwehuwandu hwekubudirira kuburikidza nekutungamira intubation, WGC-PS inogonawo kuchengetedza kuvhurwa kwepancreatic duct uye kuderedza zvakanyanya kuitika kwePEP.
Chidzidzo paWGC-PS naZou Chuanxin et al. yakaratidza kuti kubudirira kwehuwandu hwekuoma intubation uchishandisa nzira yenguva pfupi yepancreatic duct stent occupation yakasvika 97.67%, uye chiitiko chePEP chakaderedzwa zvakanyanya.
Imwe ongororo yakawana kuti kana pancreatic duct stent ikaiswa nemazvo, mukana weakanyanya postoperative pancreatitis mune yakaoma intubation kesi wakadzikira zvakanyanya.
Iyi nzira ichine zvimwe zvinokanganisa. Semuenzaniso, iyo pancreatic duct stent yakaiswa panguva yeERCP kushanda inogona kubviswa; kana stent ichida kuiswa kwenguva yakareba mushure meERCP, pachava nemukana wakakura wekuvharika kwe stent uye kuvharwa kwenzira. Kukuvara uye mamwe matambudziko anokonzera kuwedzera kwechiitiko chePEP. Nechekare, masangano atanga kudzidza kwenguva pfupi pancreatic duct stents anogona kubuda ega mupancreatic duct. Chinangwa ndechekushandisa pancreatic duct stents kudzivirira PEP. Pamusoro pekuderedza zvakanyanya kuitika kwetsaona dzePEP, stents akadaro anogona kudzivirira mamwe maoparesheni ekubvisa stent uye kuderedza mutoro pavarwere. Kunyangwe zvidzidzo zvakaratidza kuti temporary pancreatic duct stents ine mhedzisiro yakanaka mukuderedza PEP, kukiriniki kwekushandisa kwavo kuchine mipimo mikuru. Semuenzaniso, muvarwere vane pancreatic ducts yakaonda uye akawanda mapazi, zvakaoma kuisa pancreatic duct stent. Iyo yakaoma ichawedzerwa zvakanyanya, uye kuvhiya uku kunoda hunyanzvi hwepamusoro hweendoscopists. Izvo zvakakoshawo kucherechedza kuti iyo pancreatic duct stent yakaiswa haifanirwe kunge yakareba mu duodenal lumen. Kureba kwenguva refu kunogona kukonzera duodenal perforation. Naizvozvo, sarudzo yepancreatic duct stent occupation nzira ichiri kufanira kurapwa nekuchenjerera.
IV.Trans-pancreatocsphincterotomy,TPS
TPS tekinoroji inowanzo shandiswa mushure mekunge waya yekutungamira yapinda mupancreatic duct nekukanganisa. Iyo septum iri pakati pepancreatic duct inoiswa munzira yepancreatic duct guide waya kubva 11 o'clock kusvika 12 o'clock, uye ipapo chubhu inopinzwa munzira ye bile duct kusvika iyo dhizaini waya yapinda mubile. duct.
Chidzidzo chakaitwa naDai Xin et al. akaenzanisa TPS uye mamwe maviri anobatsira intubation matekinoroji. Zvinogona kuoneka kuti budiriro yeTPS tekinoroji yakakwira zvakanyanya, inosvika 96.74%, asi hairatidze mibairo yakatanhamara kana ichienzaniswa nemamwe maviri ebetsero intubation matekinoroji. Zvakanakira.
Zvinonzi maitiro eTPS tekinoroji anosanganisira anotevera mapoinzi:
(1) The incision idiki kune pancreaticobiliary septum;
(2) Chiitiko chezvinetso zvepashure zvakaderera;
(3) Kusarudzwa kwekutungamira kwekucheka kuri nyore kudzora;
(4) Iyi nzira inogona kushandiswa kune varwere vane kudzokorora pancreatic duct intubation kana mazamu mukati me diverticulum.
Zvidzidzo zvakawanda zvakaratidza kuti TPS haingogone kuvandudza zvinobudirira mwero weiyo yakaoma bile duct intubation, asi zvakare haina kuwedzera chiitiko chematambudziko mushure meERCP. Dzimwe nyanzvi dzinoti kana pancreatic duct intubation kana diki duodenal papilla ikaitika kakawanda, TPS inofanirwa kutanga yatariswa. Nekudaro, kana uchiisa TPS, kutarisisa kunofanirwa kubhadharwa kune mukana wepancreatic duct stenosis uye kudzokorora kwepancreatitis, izvo zvinogoneka njodzi dzenguva refu dzeTPS.
V.Precut Sphincterotomy,PST
Nzira yePST inoshandisa papillary arcuate band semuganho wepamusoro we pre-incision uye 1-2 o'clock direction semuganho wekuvhura duodenal papilla sphincter kuti uwane kuvhura kwe bile uye pancreatic duct. Pano PST inonyatso nongedzera kune yakajairwa nipple sphincter pre-incision technique uchishandisa arcuate banga. Senzira yekubata neyakaoma bile duct intubation yeERCP, tekinoroji yePST yakaonekwa zvakanyanya seyokutanga sarudzo yekunetsa intubation. Endoscopic nipple sphincter pre-incision inoreva kuchekwa kwe endoscopic kwepapilla surface mucosa uye kashoma kesphincter tsandanyama kuburikidza nebanga rekuchekwa kutsvaga pakavhurika bile duct, wobva washandisaguidewirekana catheter kuti intubate bile duct.
Ongororo yemumba yakaratidza kuti budiriro yePST yakakwira se89.66%, iyo isina kunyanya kusiyana neDGT neTPS. Nekudaro, chiitiko chePEP muPST chakakura zvakanyanya kupfuura icho cheDGT neTPS.
Parizvino, sarudzo yekushandisa tekinoroji iyi inotsamira pane zvakasiyana siyana. Somuenzaniso, mumwe mushumo wakataura kuti PST inonyanya kushandiswa mumamiriro ezvinhu apo duodenal papilla inenge isina kujairika kana kuti yakamonyaniswa, zvakadai seduodenal stenosis kana kuti kurwara.
Mukuwedzera, kana ichienzaniswa nemamwe mazano ekugadzirisa, PST ine chiitiko chepamusoro chezvinetso zvakadai sePEP, uye zvinodiwa zvekushanda zvakakwirira, saka kushanda uku kunonyatsoitwa nevanoziva endoscopists.
VI. Tsono-banga Papillotomy,NKP
NKP inyanzvi yetsono-banga-inobatsirwa intubation. Kana intubation yakaoma, banga retsono rinogona kushandiswa kupinza chikamu chepapilla kana sphincter kubva pakuvhurwa kwe duodenal papilla munzira ye11-12 o'clock, wozoshandisa a.guidewirekana catheter kuSarudzo yekuisa mune yakajairika bile duct. Senzira yekubata nayo yakaoma bile duct intubation, NKP inogona kunyatso kuvandudza mwero wekubudirira kweiyo yakaoma bile duct intubation. Munguva yakapfuura, zvaiwanzotendwa kuti NKP yaizowedzera chiitiko chePEP mumakore achangopfuura. Mumakore achangopfuura, mishumo yakawanda yekuongorora yakadzokororwa yakaratidza kuti NKP haina kuwedzera dambudziko rematambudziko epashure. Zvakakosha kuziva kuti kana NKP ikaitwa mukutanga kwekuoma intubation, ichave inobatsira zvikuru kuvandudza chiyero chekubudirira kweintubation. Nekudaro, pari zvino hapana kubvumirana kuti wonyorera NKP riinhi kuti uwane mibairo yakanaka. Imwe ongororo yakashuma kuti intubation rate yeNKP yakashandiswa panguvaERCPisingasviki maminetsi e20 aive akanyanya kukwirira kupfuura iyo yeNKP yakashandiswa gare gare kupfuura 20 maminetsi gare gare.
Varwere vane yakaoma bile duct cannulation vanozobatsirikana zvakanyanya kubva kune iyi nzira kana vaine mazamu emuzamu kana akakosha bile duct dilation. Pamusoro pezvo, kune mishumo yekuti kana uchisangana neakaoma intubation kesi, iyo yakasanganiswa kushandiswa kweTPS uye NKP ine yakakwira chiyero chekubudirira pane kushandisa chete. Izvo zvisingabatsiri ndezvekuti nzira dzakawanda dzekucheka dzinoshandiswa pazamu dzinowedzera kuitika kwematambudziko. Nokudaro, tsvakurudzo yakawanda inodiwa kuratidza kana kusarudza kutanga kwekutanga-kuchera kuderedza kuitika kwezvinetso kana kubatanidza matanho akawanda ekugadzirisa kuvandudza kubudirira kweiyo intubation yakaoma.
VII.tsono-banga Fistulotomy,NKE
Iyo NKF nzira inoreva kushandisa banga retsono kubaya mucosa inosvika 5mm pamusoro pezamhu, uchishandisa yakasanganiswa ikozvino kuti incise layer ne layer munzira ye11 o'clock kusvika iyo orifice-yakafanana chimiro kana bile mafashama yawanikwa, uyezve kushandisa. waya inotungamira yekuona kubuda kwe bile uye kuchekwa kwetishu. Kusarudza bile duct intubation yakaitwa panzvimbo yejaundice. Kuvhiyiwa kweNKF kunocheka pamusoro pekuvhura zamu. Nekuda kwekuvapo kweiyo bile duct sinus, inoderedza zvakanyanya kukuvadzwa kwekupisa uye kukuvara kwemagetsi pakuvhurwa kwepancreatic duct, izvo zvinogona kuderedza chiitiko chePEP.
Chidzidzo chakaitwa naJin et al. yakaratidza kuti kubudirira kweNK tube intubation kunogona kusvika 96.3%, uye hapana postoperative PEP. Mukuwedzera, chiyero chekubudirira kweNKF mukubviswa kwematombo chakakwira se92.7%. Naizvozvo, chidzidzo ichi chinokurudzira NKF seyekutanga sarudzo yekubviswa kwematombo akajairika bile duct. . Zvichienzaniswa neyakajairwa papillomyotomy, njodzi dzekushanda kweNKF dzichiri dzakakwirira, uye inotarisana nematambudziko akadai sekuboora uye kubuda ropa, uye inoda huwandu hwekushanda hwema endoscopists. Iyo chaiyo yekuvhura hwindo nzvimbo, kudzika kwakakodzera, uye nzira chaiyo zvese zvinoda kudzidzwa zvishoma nezvishoma. master.
Kuenzaniswa nedzimwe nzira dzepre-incision, NKF inzira iri nyore ine budiriro yepamusoro. Zvisinei, iyi nzira inoda kudzidzira kwenguva refu uye kuenderera mberi kuunganidza nemuiti kuti ave akakodzera, saka iyi nzira haina kukodzera kune vanotanga.
VIII.Repeat-ERCP
Sezvambotaurwa pamusoro apa, kune nzira dzakawanda dzekutarisana nekuoma intubation. Zvisinei, hapana vimbiso ye100% kubudirira. Zvinyorwa zvakakodzera zvakaratidza kuti kana bile duct intubation yakaoma mune dzimwe nguva, nguva yakareba uye yakawanda intubation kana kupisa kwemukati kwekutanga kwekucheka kunogona kutungamirira ku duodenal papilla edema. Kana kuvhiyiwa kuchienderera mberi, kwete chete iyo bile duct intubation haizobudiriri, asi mukana wezvinetso uchawedzerawo. Kana mamiriro ari pamusoro akaitika, unogona kufunga kumisa ikozvinoERCPkuvhiya kutanga uye kuita yechipiri ERCP panguva yekuzvisarudzira. Mushure mokunge papilloedema inonyangarika, kushanda kweERCP kuchava nyore kuwana kubudirira intubation.
Donnelan et al. akaita chechipiriERCPoparesheni pavarwere ve51 vane ERCP yakundikana mushure mekusarukwa kwetsono-banga, uye 35 nyaya dzakabudirira, uye chiitiko chezvinetso hazvina kuwedzera.
Kim et al. akaita chechipiri ERCP oparesheni pavarwere ve69 vakakundikanaERCPmushure metsono-banga pre-yakacheka, uye 53 nyaya dzakabudirira, nekubudirira kwe76,8%. Mhosva dzakasara dzisina kubudirira dzakaitwawo ERCP yechitatu, nekubudirira kwe79.7%. , uye maitiro akawanda haana kuwedzera kuitika kwematambudziko.
Yu Li et al. akaita sarudzo yechipiriERCPpavarwere makumi manomwe vakakundikana ERCP mushure mekuchekwa kwetsono-banga, uye 50 kesi dzakabudirira. Iyo yose yekubudirira kwehuwandu (yekutanga ERCP + yechipiri ERCP) yakawedzera kusvika ku90.6%, uye chiitiko chezvinetso hazvina kuwedzera zvakanyanya. . Kunyange hazvo mishumo yakaratidza kushanda kwesekondari ERCP, nguva iri pakati pemaoparesheni maviri eERCP haifanire kunge yakarebesa, uye mune zvimwe zviitiko zvakakosha, kunonoka kwe biliary drainage kunogona kuwedzera mamiriro acho.
IX.Endoscopicultrasound-inotungamirirwa nebiliary drainage,EUS-BD
EUS-BD invasive maitiro anoshandisa tsono kubaya gallbladder kubva mudumbu kana duodenum lumen pasi pekutungamirirwa neultrasound, kupinda muduodenum kuburikidza neduodenal papilla, uyezve kuita biliary intubation. Iyi nzira inosanganisira zvose intrahepatic uye extrahepatic nzira.
Ongororo yakadzokororwa yakashuma kuti kubudirira kweEUS-BD kwakasvika 82%, uye chiitiko chematambudziko epashure chaingova 13%. Muchidzidzo chekuenzanisa, EUS-BD kana ichienzaniswa nepre-incision tekinoroji, mwero wekubudirira kwayo intubation yaive yakakwira, ichisvika 98.3%, yaive yakakwira zvakanyanya kupfuura 90.3% yepre-incision. Nekudaro, kusvika pari zvino, zvichienzaniswa nemamwe matekinoroji, pachine kushomeka kwekutsvagisa pamusoro pekushandiswa kweEUS kune yakaoma.ERCPintubation. Iko hakuna data rakakwana kuratidza kushanda kweEUS-inotungamirwa bile duct puncture tekinoroji yakaomaERCPintubation. Zvimwe zvidzidzo zvakaratidza kuti zvakaderedza Basa rePEP mushure mekuvhiyiwa harisi kugutsikana.
X.Percutaneous transhepatic cholangial drainage,PTCD
PTCD imwe nzira yekuongorora inopindira inogona kushandiswa pamwe cheteERCPkune yakaoma bile duct intubation, kunyanya mumamiriro ezvinhu ehutachiona husina kunaka. Iyi nzira inoshandisa tsono yekubaya kuti ipinde mubile duct, kubaya bile duct kuburikidza nepapilla, uyezve intubate bile duct retrogradely kuburikidza neyakachengetwa.guidewire. Imwe ongororo yakaongorora varwere makumi mana nevanomwe vane yakaoma bile duct intubation vakaita PTCD tekinoroji, uye kubudirira kwakasvika 94%.
Chidzidzo chakaitwa naYang et al. yakaratidza kuti kushandiswa kweEUS-BD kuri pachena kunogumira kana zvasvika kune hilar stenosis uye kukosha kwekubaya iyo chaiyo intrahepatic bile duct, nepo PTCD iine zvakanakira kuenderana neiyo bile duct axis uye kuve nyore kuchinjika mukutungamira zvishandiso. Bile duct intubation inofanira kushandiswa kune varwere vakadaro.
PTCD ibasa rakaoma rinoda kudzidziswa kwakarongeka kwenguva refu uye kupedzwa kwenhamba yakakwana yenyaya. Zvakaoma kuti vatsvaki vapedze basa iri. PTCD haina kuoma chete kushanda, asi iyoguidewireinogona zvakare kukuvadza bile duct panguva yekufambira mberi.
Kunyangwe nzira dziri pamusoro dzichigona kuvandudza zvakanyanya mwero wekubudirira kwekuoma bile duct intubation, sarudzo inoda kutariswa zvizere. PakuitaERCP, SGT, DGT, WGC-PS uye mamwe matekiniki anogona kutariswa; kana maitiro ari pamusoro akatadza, vakuru uye vane ruzivo endoscopist vanogona kuita pre-incision matekiniki, akadai TPS, NKP, NKF, nezvimwewo; kana zvakadaro Kana yakasarudzika bile duct intubation isingagone kupedzwa, sarudzo yechipiriERCPinogona kusarudzwa; kana pasina imwe yemaitiro ari pamusoro apa inogona kugadzirisa dambudziko rekuomerwa intubation, mashandiro anoita seEUS-BD uye PTCD anogona kuyedzwa kugadzirisa dambudziko, uye kurapwa kwekuvhiya kunogona kusarudzwa kana zvichidikanwa.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., inogadzira muChina inyanzvi mune endoscopic consumables, senge biopsy forceps, hemoclip, polyp snare, sclerotherapy tsono, pfapfaidzo catheter, cytology mabhurashi,guidewire, dombo rekudzosa tswanda, nasal biliary drainage catheternezvimwewo izvo zvinonyanya kushandiswa muEMR, ESD,ERCP. Zvigadzirwa zvedu ndezveEC Certified, uye zvidyarwa zvedu ISO certified. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East uye chikamu cheAsia, uye zvakanyanya kuwana mutengi wekuzivikanwa nekurumbidzwa!
Nguva yekutumira: Jan-31-2024