Cov khoom siv kho mob ib zaug yog cov cuab yeej kho mob precision kho rau endoscopic retrograde chologanporography (ERCP). Nws yog siv los ua Sphincterotomy (Incision ntawm cov nplais flascter) kom yooj yim pob zeb tshem tawm, stent tso, lossis kho qhov cub. Nws cov kev siv ib-siv txo qis dua cov kev pheej hmoo sib kis thaum txhim kho cov txheej txheem kev ua haujlwm thiab kev nyab xeeb.
Thawj cov ntawv thov
1. CBD ntau dua (CBD) pob zeb extraction: kev txiav txim siab ntawm Oddi Sphincter tso cai rau cov neeg pob zeb lossis tshem tawm.
2. Biliary / Pancreatic Duct nruj dilation dilation: Pab hauv kev kho mob stent lossis zais pa kom nruj rau kev kho nruj.
3. Mob plab bilry pancabe pancreatitis: Sphincterotomy los daws qhov pancreatic kom daws teeb meem.
4. PancreTicBiliation Tterter Plws: palliative txoj kev kho kom txhim kho cov kua ntshav lossis cov kua dej pancrecreic.
Kev Siv Cov Xwm Txheej
- ERCP cov txheej txheem: Siv dav hauv kev phais mob hauv plab lossis phais mob hepatobiliary rau kev cuam tshuam tsawg kawg.
- Kev tiv thaiv thaum muaj xwm txheej ceev: khaus cholungitis, ob leeg ua rau lub ntsej muag daj, los yog pancriceitis yuav tsum muaj kev kho mob ceev.
- So phais kab mob / hnub phais: Qhov zoo tagnrho rau kev saib xyuas luv luv lossis chaw tsheb txiag.
Khoom nta
1. Tsim Tsa
- Adjusted txiav xaim xov: Kho kom tswj tau qhov tob (feem ntau 20-30 mm mm), txo cov kev pheej hmoo zoo tshaj plaws.
- Dual-lumen catheter: enables ua ke rau cov lus qhia kev lom zem thiab kev txhaj tshuaj sib xyaw.
- Cov cim xov tooj cua radiopaque: X-Ray pom cov cim ntawm catheter qhia rau txoj haujlwm tiag tiag.
2. Txhim Kho Kev Nyab Xeeb
- Kev siv ib leeg-siv: Kev tshem tawm cov kev pheej hmoo hla, ua raws nrog cov qauv kev tswj hwm tus kab mob thoob ntiaj teb (CDC, leej twg).
- Ntim khoom tsis muaj zog: Kev ua kom tsis muaj menyuam thiab npaj tau sai.
- Kev Nyab Xeeb Kev Nyab Xeeb Hluav Taws Xob: Txiav Hlau Ua Haujlwm nkaus xwb thaum siv hluav taws xob siv hluav taws xob, tiv thaiv kev raug mob.
3. Cov neeg siv kev ua haujlwm zoo
- Ergonomic Kij: tsim los tuav yooj yim, txo cov neeg tsav tsheb tsis tshua muaj zog.
- Kev nthuav dav: Tau tshaj nrog cov qauv duodenoscopes thiab ua haujlwm raws (ntau dua lossis sib npaug rau 3.2 hli).
4. Cov ntaub ntawv siab heev
- Nitinol txiav hlau: Superelastic Alloy Adapts rau Biliary Anatomical Curves.
- Hydrophilic txheej: txo kev sib txhuam rau kev ua kom du.
Cov ntsiab lus tseem ceeb
1. Txo kev phom sij:
- Cov khoom siv rov qab siv tau muaj kev pheej hmoo ntawm cov tsis muaj menyuam tsis muaj menyuam. Kev siv nkaus xwb-siv tshem tawm cov kev txhawj xeeb no.
- Cov ntaub ntawv hauv tsev kho mob qhia tau 40% txo cov txheej txheem tomqab / txheej txheem, 2022).
2. Tus nqi ua tau zoo:
- tsis muaj kev rov ua dua (kev ntxuav tu, tshuaj tua kab mob, lossis kev txij nkawm) yuav tsum tau ua. Tas nrho tus nqi them ib tus txheej txheem yog 25-30}% qis dua cov khoom siv rov siv tau.
3. Kev ua haujlwm zoo:
- Npaj-siv cov qauv tsim no txo cov kev ua haujlwm ua ntej lub sijhawm, tseem ceeb rau cov xwm txheej kub ntxhov.
Kawm Txog Cov Ntaub Ntawv
Rooj plaub 1: CBD pob zeb nrog mob choladitis
- Tus neeg mob: {{{65- tus txiv neej nrog Jaundice, ua npaws, thiab {mm CBD Pob Zeb ntawm CT.
- Cov txheej txheem:
1. Ercp-coj kev nkag ntawm ib leeg-siv sphincterotome rau distal CBD.
2. Sphincterotomy (25 hli hlau ntev) ua raws li cov zais pa-pab cov pob zeb extraction.
* Qhov tshwm sim: Cov txheej txheem ua tiav hauv 30 feeb; Tsis muaj kab mob tom qab lossis los ntshav.
Rooj plaub 2: Pancreatic Cancer Nrog ob qho tib si Jaigtice
- tus neeg mob: {{{58-} cov poj niam xyoo nrog mob qog nqaij hlav cancer (tag nrho bilirubin: 15 mg / dl).
- Cov txheej txheem:
1. Ua ntej txiav sphincterotomy siv cov khoom siv ib leeg siv.
2. Hlau stent tso rau rau biliary outket, txo bilirubin rau 3 mg / dL.
* Qhov tshwm sim: zam kev pheej hmoo ntawm kev siv tshuab ua kom puas; npliag ua raws li kev xa tawm.
