ERCP ke theknoloji ea bohlokoa bakeng sa tlhahlobo le kalafo ea mafu a biliary le pancreatic.Hang ha e tsoa, e fane ka maikutlo a mangata a macha bakeng sa phekolo ea mafu a biliary le pancreatic.Ha e felle feela ho "radiography".E fetohile ho tloha ho theknoloji ea pele ea ho hlahloba ho ea ho mofuta o mocha.Mekhoa ea kalafo e kenyelletsa sphincterotomy, ho tlosa lejoe la duct ea bile, drainage ea bile le mekhoa e meng ea ho phekola mafu a bile le pancreatic system.
Sekhahla sa katleho ea ho khetha bile duct intubation bakeng sa ERCP e ka fihla ho feta 90%, empa ho ntse ho na le maemo a mang moo phihlello e thata ea biliary e bakang ho se khonehe ho khetha.Ho ea ka tumellano ea morao-rao mabapi le ho hlahlojoa le ho phekoloa ha ERCP, intubation e thata e ka hlalosoa e le: nako ea khetho e khethiloeng ea bile duct intubation ea nipple e kholo ea ERCP e tloaelehileng e feta metsotso ea 10 kapa palo ea boiteko ba ho intubation e feta makhetlo a 5.Ha ho etsoa ERCP, haeba ho thatafala ha bile duct intubation maemong a mang, mekhoa e sebetsang e lokela ho khethoa ka nako ho ntlafatsa sekhahla sa katleho ea bile duct intubation.Sengoliloeng sena se etsa tlhahlobo e hlophisehileng ea mekhoa e 'maloa e thusang ea ho intubation e sebelisetsoang ho rarolla bothata ba bile duct intubation, ka sepheo sa ho fana ka motheo oa theory bakeng sa li-endoscopists tsa kliniki ho khetha leano la ho arabela ha li tobane le bothata ba bile duct intubation bakeng sa ERCP.
I.Singleguidewire Technique,SGT
Mokhoa oa SGT ke ho sebelisa "contrastcatheter" ho tsoela pele ho leka ho kenya duct ea bile kamora hore terata ea tataiso e kene ka har'a pancreatic duct.Matsatsing a pele a nts'etsopele ea theknoloji ea ERCP, SGT e ne e le mokhoa o tloaelehileng oa ho kenya biliary intubation.Monyetla oa eona ke hore ho bonolo ho sebetsa, ho lokisa nipple, 'me ho ka lula ho buloa ha pancreatic duct, ho etsa hore ho be bonolo ho fumana ho buloa ha duct ea bile.
Ho na le litlaleho bukeng ea hore ka mor'a hore intubation e tloaelehileng e hlolehe, ho khetha intubation e thusitsoeng ke SGT e ka phethela ka katleho bile duct intubation hoo e ka bang 70% -80% ea linyeoe.Tlaleho e boetse e bontšitse hore maemong a ho hloleha ha SGT, esita le tokiso le ts'ebeliso ea habeliguidewiretheknoloji ha ea ka ea ntlafatsa sekhahla sa katleho ea bile duct intubation mme ha ea ka ea fokotsa sekhahla sa post-ERCP pancreatitis (PEP).
Lithuto tse ling li bonts'itse hore sekhahla sa katleho ea SGT intubation se tlase ho feta habeliguidewiretheknoloji le thekenoloji ea transpancreatic papillary sphincterotomy.Ha ho bapisoa le liteko tse pheta-phetoang tsa SGT, ts'ebetsong ea pele ea habeliguidewirethekenoloji kapa theknoloji ea pre-incision e ka fumana litholoana tse ntle.
Ho tloha ho nts'etsopele ea ERCP, mefuta e fapaneng ea mahlale a macha a 'nile a ntlafatsoa bakeng sa intubation e thata.Ha ho bapisoa le lesohaguidewirethekenoloji, melemo e hlakile haholoanyane 'me sekhahla sa katleho se phahame.Ka hona, lesohaguidewirethekenoloji ha joale ha e sebelisoe hangata ho tsa bongaka.
II.Mokhoa oa mohala oa tataiso e habeli,DGT
DGT e ka bitsoa "pancreatic duct guide wire occupation method", e leng ho siea terata ea tataiso e kenang ka har'a pancreatic duct ho e ts'oara le ho e lula, ebe terata ea tataiso ea bobeli e ka sebelisoa hape ka holim'a terata ea tataiso ea pancreatic duct.Khetho e khethiloeng ea bile duct intubation.
Melemo ea mokhoa ona ke:
(1) Ka thuso ea aguidewire, ho bonolo ho fumana ho buleha ha duct ea bile, ho etsa hore bile duct intubation e be bonolo;
(2) Mohala o tataisang o ka lokisa nnyo;
(3) Tlas'a tataiso ea pancreatic ductguidewire, pono e pheta-phetoang ea pancreatic duct e ka qojoa, ka hona ho fokotsa ho tsosoa ha pancreatic duct e bakoang ke ho intubation khafetsa.
Dumonceau et al.o hlokometse hore catheter e tataisang le catheter e fapaneng e ka kenngoa ka mokoting oa biopsy ka nako e le 'ngoe, ebe e tlaleha nyeoe e atlehileng ea mokhoa oa ho sebelisa pancreatic duct guidewire, mme a etsa qeto ea horeguidewireho sebelisa mokhoa oa pancreatic duct ho atlehile bakeng sa ho kenella ka har'a bile duct.sekhahla se na le phello e ntle.
Thuto ka DGT ka Liu Deren et al.e fumane hore ka mor'a hore DGT e etsoe ho bakuli ba nang le ERCP bile duct intubation e thata, sekhahla sa katleho ea intubation se fihlile ho 95.65%, e neng e le holimo haholo ho feta tekanyo ea katleho ea 59.09% ea intubation e tloaelehileng.
Boithuto bo lebelletsoeng ka Wang Fuquan et al.e bontšitse hore ha DGT e sebelisoa ho bakuli ba nang le bothata ba ERCP bile duct intubation sehlopheng sa liteko, sekhahla sa katleho ea intubation se ne se le holimo ho 96.0%.
Lithuto tse kaholimo li bonts'a hore ts'ebeliso ea DGT ho bakuli ba nang le bothata ba bile duct intubation bakeng sa ERCP e ka ntlafatsa ka katleho sekhahla sa katleho ea bile duct intubation.
Mefokolo ea DGT haholo-holo e kenyelletsa lintlha tse peli tse latelang:
(1) Pancreatoguidewiremohlomong e lahlehile nakong ea ho kenya bile duct intubation, kapa ea bobeliguidewiree ka boela ea kena ka pancreatic duct;
(2) Mokhoa ona ha oa tšoanela linyeoe tse kang kankere ea hlooho ea pancreatic, pancreatic duct tortuosity, le pancreatic fission.
Ho latela pono ea liketsahalo tsa PEP, ts'oaetso ea PEP ea DGT e tlase ho feta ea tloaelo ea bile duct intubation.Boithuto bo lebelletsoeng bo bontšitse hore ketsahalo ea PEP kamora DGT e ne e le 2.38% feela ho bakuli ba ERCP ba nang le bothata ba bile duct intubation.Lingoliloeng tse ling li bontša hore leha DGT e na le sekhahla se phahameng sa katleho ea bile duct intubation, sekhahla sa post-DGT pancreatitis se ntse se le holimo ha se bapisoa le mehato e meng ea tokiso, hobane ts'ebetso ea DGT e ka baka tšenyo ho pancreatic duct le ho buloa ha eona.Leha ho le joalo, tumellano ea lapeng le kantle ho naha e ntse e supa hore maemong a ho thatafala ha bile duct intubation, ha intubation e le thata, 'me pancreatic duct e buuoa hampe khafetsa, DGT ke khetho ea pele hobane theknoloji ea DGT e na le bothata bo fokolang ba ts'ebetso,' me e batla e le bonolo. ho laola.E sebelisoa haholo ho khetha ho thata ho intubation.
III.Wire guide cannulation-pan-creatic stent,WGC-P5
WGC-PS e ka boela ea bitsoa mokhoa oa ho sebetsa oa pancreatic duct stent.Mokhoa ona ke ho beha pancreatic duct stent leguidewiree kenang ka phoso pancreatic duct, ebe e ntšaguidewirele ho etsa cannulation ea bile ka holim'a stent.
Thuto e entsoeng ke Hakuta et al.e bontšitse hore ntle le ho ntlafatsa tekanyo ea katleho ea kakaretso ea ho intubation ka ho tataisa intubation, WGC-PS e ka boela ea sireletsa ho buloa ha pancreatic duct le ho fokotsa haholo ketsahalo ea PEP.
Thuto ka WGC-PS ka Zou Chuanxin et al.o bontšitse hore sekhahla sa katleho ea ho kenella ka thata ho sebelisa mokhoa oa nakoana oa pancreatic duct stent occupation se fihlile ho 97.67%, mme sekhahla sa PEP se fokotsehile haholo.
Phuputso e 'ngoe e fumane hore ha pancreatic duct stent e behiloe ka nepo, monyetla oa ho ba le pancreatitis e matla ea postoperative maemong a thata a intubation o fokotsehile haholo.
Mokhoa ona o ntse o na le mefokolo e itseng.Ka mohlala, pancreatic duct stent e kentsoeng nakong ea ts'ebetso ea ERCP e ka 'na ea tlosoa;haeba stent e hloka ho behoa nako e telele ka mor'a ERCP, ho tla ba le monyetla o moholo oa ho thijoa ha stent le tšitiso ea duct.Kotsi le mathata a mang li baka keketseho ea sekhahla sa PEP.Hajoale, litsi li se li qalile ho ithuta li-stents tsa nakoana tsa "pancreatic duct" tse ka iphumanang li tsoa ka har'a pancreatic duct.Sepheo ke ho sebelisa pancreatic duct stents ho thibela PEP.Ntle le ho fokotsa haholo liketsahalo tsa likotsi tsa PEP, li-stents tse joalo li ka boela tsa qoba ts'ebetso e meng ea ho tlosa stent le ho fokotsa moroalo ho bakuli.Leha liphuputso li bonts'itse hore pancreatic duct stents e na le phello e ntle phokotsong ea PEP, ts'ebeliso ea bona ea bongaka e ntse e na le mefokolo e meholo.Ka mohlala, ho bakuli ba nang le li-pancreatic ducts tse tšesaane le makala a mangata, ho thata ho kenya stent ea pancreatic duct.Bothata bo tla eketseha haholo, 'me ts'ebetso ena e hloka boemo bo phahameng ba litsebi tsa endoscopists.Hape ke habohlokoa ho hlokomela hore pancreatic duct stent e behiloeng ha ea lokela ho ba telele haholo ka har'a lumen ea duodenal.Stent e telele haholo e ka baka ho phatloha ha duodenal.Ka hona, khetho ea mokhoa oa ho sebetsa ka pancreatic duct stent e ntse e hloka ho tšoaroa ka hloko.
IV.Trans-pancreatocsphincterotomy,TPS
Theknoloji ea TPS hangata e sebelisoa ka mor'a hore terata ea tataiso e kene ka pancreatic duct ka phoso.Septum e bohareng ba pancreatic duct e kenngoa ka lehlakoreng la terata ea tataiso ea pancreatic duct ho tloha ka hora ea 11 ho isa ho 12, ebe tube e kenngoa ka lehlakoreng la duct ea bile ho fihlela terata ea tataiso e kena ka har'a bile. kotopo.
Thuto e entsoeng ke Dai Xin et al.bapisa TPS le mahlale a mang a mabeli a thusang a intubation.Ho ka bonoa hore sekhahla sa katleho ea theknoloji ea TPS e phahame haholo, e fihla ho 96.74%, empa ha e bontše liphetho tse hlahelletseng ha li bapisoa le tse ling tse peli tse thusang tsa theknoloji ea intubation.Melemo.
Ho tlalehiloe hore litšobotsi tsa theknoloji ea TPS li kenyelletsa lintlha tse latelang:
(1) Seso se senyenyane bakeng sa pancreaticobiliary septum;
(2) Ketsahalo ea mathata a morao-rao e tlaase;
(3) Khetho ea tataiso ea ho itšeha e bonolo ho e laola;
(4) Mokhoa ona o ka sebelisoa ho bakuli ba nang le pancreatic duct intubation kapa li-nipples ka har'a diverticulum.
Liphuputso tse ngata li bontšitse hore TPS e ke ke ea ntlafatsa ka katleho sekhahla sa katleho ea bile duct intubation e thata, empa hape ha e eketse liketsahalo tsa mathata ka mor'a ERCP.Litsebi tse ling li fana ka maikutlo a hore haeba pancreatic duct intubation kapa papilla e nyane ea duodenal e etsahala khafetsa, TPS e lokela ho nahanoa pele.Leha ho le joalo, ha ho sebelisoa TPS, ho lokela ho lebisoa tlhokomelo ho monyetla oa pancreatic duct stenosis le ho khutla ha pancreatitis, e leng likotsi tse ka bang teng tsa nako e telele tsa TPS.
V.Precut Sphincterotomy,PST
Mokhoa oa PST o sebelisa sehlopha sa papillary arcuate e le moeli o ka holimo oa ho cheka pele le tataiso ea hora ea 1-2 e le moeli oa ho bula duodenal papilla sphincter ho fumana ho buleha ha bile le pancreatic duct.Mona PST e bua ka mokhoa o tloaelehileng oa nipple sphincter pre-incision o sebelisa thipa ea arcuate.E le leano la ho sebetsana le bothata bo thata ba bile duct intubation bakeng sa ERCP, theknoloji ea PST e 'nile ea nkoa e le khetho ea pele bakeng sa intubation e thata.Endoscopic nipple sphincter pre-incision e bolela ho phunyeha ha endoscopic ea papilla surface mucosa le mesifa e nyenyane ea sphincter ka thipa ea ho phunyeha ho fumana ho buleha ha duct ea bile, ebe o sebelisaguidewirekapa catheter ho kenya lesela la bile.
Phuputso ea malapeng e bontšitse hore tekanyo ea katleho ea PST e phahametse 89.66%, e sa fapaneng haholo le DGT le TPS.Leha ho le joalo, ketsahalo ea PEP ho PST e phahame haholo ho feta ea DGT le TPS.
Hona joale, qeto ea ho sebelisa theknoloji ena e itšetlehile ka lintlha tse sa tšoaneng.Ka mohlala, tlaleho e ’ngoe e ile ea bolela hore PST e sebelisoa hamolemohali maemong ao ho ’ona papilla ea duodenal e sa tloaelehang kapa e sothehileng, e kang ea duodenal stenosis kapa malignancy.
Ho phaella moo, ha ho bapisoa le mekhoa e meng ea ho sebetsana le boemo, PST e na le mathata a mangata a kang PEP, 'me litlhoko tsa ts'ebetso li phahame, kahoo ts'ebetso ena e molemo ka ho fetisisa e etsoang ke li-endoscopists tse nang le phihlelo.
VI. Thipa ea nale Papillotomy,NKP
NKP ke mokhoa oa ho intubation o thusang ka thipa.Ha intubation e le thata, thipa ea nale e ka sebelisoa ho phunya karolo ea papilla kapa sphincter ho tloha ho buloa ha duodenal papilla ho ea ka hora ea 11-12, ebe o sebelisaguidewirekapa catheter ho Kenyelletsoa ka mokhoa o ikhethileng ka har'a moqomo o tloaelehileng oa bile.E le leano la ho sebetsana le bothata ba bile duct intubation e thata, NKP e ka ntlafatsa ka katleho sekhahla sa katleho ea bothata ba bile duct intubation.Nakong e fetileng, ho ne ho lumeloa hore NKP e tla eketsa ts'oaetso ea PEP lilemong tsa morao tjena.Lilemong tsa morao tjena, litlaleho tse ngata tsa tlhahlobo ea morao-rao li bontšitse hore NKP ha e eketse kotsi ea mathata a morao-rao.Ke habohlokoa ho hlokomela hore haeba NKP e etsoa qalong ea intubation e thata, e tla ba thuso e kholo ho ntlafatsa lebelo la katleho ea intubation.Leha ho le joalo, ha joale ha ho na tumellano mabapi le nako ea ho etsa kopo ea NKP ho fumana litholoana tse ntle.Phuputso e 'ngoe e tlalehile hore sekhahla sa intubation sa NKP se sebelisitsoe nakong eaERCPmetsotso e ka tlase ho 20 e ne e phahame haholo ho feta ea NKP e sebelisitsoeng hamorao ho feta metsotso ea 20 hamorao.
Bakuli ba nang le bothata ba ho hlajoa ke li-bile duct cannulation ba tla rua molemo haholo mokhoeng ona haeba ba e-na le maqeba a li-nipple kapa a atolohile haholo.Ho phaella moo, ho na le litlaleho tsa hore ha u kopana le linyeoe tse thata tsa intubation, tšebeliso e kopantsoeng ea TPS le NKP e na le katleho e phahameng ho feta ho sebetsa u le mong.Bothata ke hore mekhoa e mengata ea ho seha e sebelisoang ho nipple e tla eketsa ho hlaha ha mathata.Ka hona, ho hlokahala lipatlisiso tse eketsehileng ho paka hore na u ka khetha ho seha pele ho nako ho fokotsa ho hlaha ha mathata kapa ho kopanya mekhoa e mengata ea ho lokisa ho ntlafatsa lebelo la katleho ea intubation e thata.
VII.Thipa ea nale Fistulotomy,NKE
Mokhoa oa NKF o bolela ho sebelisa thipa ea nale ho phunya mucosa e ka bang 5mm ka holim'a nipple, ho sebelisa motsoako oa hona joale ho senya lera ka lera ka tsela ea hora ea 11 ho fihlela mohaho o kang orifice kapa bile o phalla o fumanoa, ebe o sebelisa. terata e tataisang ho bona ho tsoa ha bile le ho phunya lesela.Khetho e khethiloeng ea bile duct intubation e ile ea etsoa sebakeng sa jaundice.Opereishene ea NKF e seha ka holim'a lesoba la nipple.Ka lebaka la boteng ba bile duct sinus, e fokotsa haholo ts'enyo ea mocheso le tšenyo ea mochini ho buloa ha pancreatic duct, e ka fokotsang sekhahla sa PEP.
Thuto e entsoeng ke Jin et al.e bontšitse hore katleho ea NK tube intubation e ka fihla ho 96.3%, 'me ha ho na PEP ea postoperative.Ho phaella moo, tekanyo ea katleho ea NKF ho tlosoa ha majoe e phahametse 92.7%.Ka hona, boithuto bona bo khothaletsa NKF joalo ka khetho ea pele bakeng sa ho tlosoa ha lejoe le tloaelehileng la bile..Ha ho bapisoa le papillomyotomy e tloaelehileng, likotsi tsa ts'ebetso ea NKF li ntse li phahame, 'me e na le mathata a kang ho phunyeha le ho tsoa mali,' me e hloka boemo bo phahameng ba ts'ebetso ea li-endoscopists.Sebaka se nepahetseng sa fensetere, botebo bo loketseng, le mokhoa o nepahetseng kaofela li hloka ho ithutoa butle-butle.monghali.
Ha ho bapisoa le mekhoa e meng ea pele ho ho seha, NKF ke mokhoa o bonolo haholoanyane o nang le sekhahla se phahameng sa katleho.Leha ho le joalo, mokhoa ona o hloka ho itloaetsa nako e telele le ho bokella ho tsoelang pele ke mosebeletsi hore a be le bokhoni, kahoo mokhoa ona ha o tšoanelehe bakeng sa ba qalang.
VIII.Pheta-ERCP
Joalokaha ho boletsoe ka holimo, ho na le mekhoa e mengata ea ho sebetsana le intubation e thata.Leha ho le joalo, ha ho na tiiso ea katleho ea 100%.Lingoliloeng tse amehang li bontšitse hore ha bile duct intubation e le thata maemong a mang, ho kenella ka nako e telele le nako e telele kapa phello ea mocheso oa mocheso oa pele ho khaola e ka lebisa ho duodenal papilla edema.Haeba ts'ebetso e ntse e tsoela pele, ho ke ke ha e-ba joalo feela hore "bile duct intubation" e ke ke ea atleha, empa monyetla oa mathata o tla eketseha.Haeba boemo bo ka holimo bo etsahala, u ka nahana ka ho felisa hona joaleERCPho sebetsa pele 'me u etse ERCP ea bobeli ka nako ea boikhethelo.Kamora hore papilloedema e nyamele, ts'ebetso ea ERCP e tla ba bonolo ho fihlela intubation e atlehileng.
Donnelan le ba bang.etsa motsotsoanaERCPopereishene ho bakuli ba 51 bao ERCP e ileng ea hloleha ka mor'a ho kenngoa ka thipa ea nale, 'me linyeoe tse 35 li ile tsa atleha,' me liketsahalo tsa mathata ha lia ka tsa eketseha.
Kim le al.e ile ea etsa opereishene ea bobeli ea ERCP ho bakuli ba 69 ba ileng ba hlōlehaERCPka mor’a ho sehoa ka thipa ea nale, ’me linyeoe tse 53 li ile tsa atleha, ka katleho ea 76,8%.Linyeoe tse setseng tse sa atlehang le tsona li kene tšebetsong ea boraro ea ERCP, ka katleho ea 79.7%., 'me ts'ebetso e mengata ha ea ka ea eketsa ketsahalo ea mathata.
Yu Li et al.etsa khetho ea bobeliERCPho bakuli ba 70 ba ileng ba hlōleha ERCP ka mor'a ho sehoa pele ho thipa ea nale, 'me linyeoe tse 50 li atlehile.Kakaretso ea katleho (ERCP ea pele + ERCP ea bobeli) e eketsehile ho 90.6%, 'me liketsahalo tsa mathata ha lia ka tsa eketseha haholo..Le hoja litlaleho li pakile katleho ea ERCP ea bobeli, nako e pakeng tsa ts'ebetso e 'meli ea ERCP ha ea lokela ho ba telele haholo,' me maemong a mang a khethehileng, ho lieha ha biliary drainage ho ka mpefatsa boemo.
IX.Endoscopicultrasound-guided biliary drainage,EUS-BD
EUS-BD ke mokhoa o hlaselang o sebelisang nalete ea ho phunya nyooko ho tsoa mpeng kapa duodenum lumen tlas'a tataiso ea ultrasound, ho kena ka duodenum ka duodenal papilla, ebe o etsa biliary intubation.Mokhoa ona o kenyelletsa mekhoa ea intrahepatic le extrahepatic.
Phuputso ea morao-rao e tlalehile hore tekanyo ea katleho ea EUS-BD e fihlile ho 82%, 'me liketsahalo tsa mathata a morao-rao e ne e le 13% feela.Phuputsong ea papiso, EUS-BD ha e bapisoa le thekenoloji ea pele ho ts'ebetso, sekhahla sa katleho ea eona ea ho intubation e ne e le holimo, ho fihla 98.3%, e neng e le holimo haholo ho feta 90.3% ea pele ho seha.Leha ho le joalo, ho fihlela joale, ha ho bapisoa le mahlale a mang, ho ntse ho e-na le khaello ea lipatlisiso mabapi le ts'ebeliso ea EUS bakeng sa mathata a mangata.ERCPintubation.Ha ho na data e lekaneng ho paka katleho ea tekhenoloji ea ho phunya bile e tataisoang ke EUS bakeng sa boimaERCPintubation.Liphuputso tse ling li bontšitse hore e fokotsehile Karolo ea PEP ea kamora ho buuoa ha e kholise.
X.Percutaneous transhepatic cholangial drainage,PTCD
PTCD ke mokhoa o mong oa tlhahlobo o hlaselang o ka sebelisoang hammoho leERCPbakeng sa ho thatafala ha bile duct intubation, haholo-holo maemong a kotsi a ho thibela biliary.Mokhoa ona o sebelisa nalete ea ho phunya ho kena ka har'a kotopo ea bile, ho phunya lesapo la bile ka har'a papilla, ebe e kenya lesela la bile le khutlela morao ka tsela e bolokiloeng.guidewire.Phuputso e 'ngoe e ile ea hlahloba bakuli ba 47 ba nang le bothata ba bile duct intubation ba ileng ba sebelisa mokhoa oa PTCD, mme sekhahla sa katleho se fihlile ho 94%.
Thuto e entsoeng ke Yang et al.o bontšitse hore ts'ebeliso ea EUS-BD ho hlakile hore e na le moeli ha ho tluoa tabeng ea hilar stenosis le tlhokahalo ea ho phunya lesela le nepahetseng la intrahepatic bile, ha PTCD e na le melemo ea ho lumellana le axis ea bile le ho fetoha habonolo ho lisebelisoa tse tataisang.Bile duct intubation e lokela ho sebelisoa ho bakuli ba joalo.
PTCD ke ts'ebetso e thata e hlokang koetliso e hlophisitsoeng ea nako e telele le ho phethoa ha palo e lekaneng ea linyeoe.Ho thata ho ba qalang ho qeta ts'ebetso ena.PTCD ha e thata feela ho e sebetsa, empa le eonaguidewiree ka boela ea senya duct ea bile nakong ea tsoelo-pele.
Leha mekhoa e kaholimo e ka ntlafatsa haholo sekhahla sa katleho ea ho thatafala ha bile duct intubation, khetho e hloka ho nahanoa ka botlalo.Ha o etsaERCP, SGT, DGT, WGC-PS le mekhoa e meng e ka nahanoa;haeba mekhoa e ka holimo e hlōleha, li-endoscopists tse phahameng le tse nang le phihlelo li ka etsa mekhoa ea pele ea ho khaola, e kang TPS, NKP, NKF, joalo-joalo;Haeba e sa ntsane e sa ntsane e ka khona ho phethoa, khetho ea bobeli e ke ke ea phethoaERCPe ka khethoa;haeba ha ho le e 'ngoe ea mekhoa e ka holimo e ka rarollang bothata ba ho intubation e thata, ts'ebetso e hlaselang e kang EUS-BD le PTCD e ka lekoa ho rarolla bothata,' me phekolo ea ho buuoa e ka khethoa ha ho hlokahala.
Rona, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ke moetsi oa China ea sebetsanang le lisebelisoa tsa endoscopic, joalo ka biopsy forceps, hemoclip, polyp snare, sclerotherapy nale, catheter ea spray, borashe ba cytology,guidewire, seroto sa ho khutlisa lejoe, nasal biliary drainage catheterjoalo-joalo tse sebelisoang haholo ho EMR, ESD,ERCP.Lihlahisoa tsa rona li netefalitsoe ke CE, 'me limela tsa rona li netefalitsoe ke ISO.Thepa ea rona e rometsoe Europe, Amerika Leboea, Bochabela bo Hare le karolo ea Asia, 'me e fumana ho pharaletseng moreki oa kananelo le thoriso!
Nako ea poso: Jan-31-2024