He hangarau nui te ERCP mō te tātaritanga me te rongoā i ngā mate ate me te repeure. I tōna putanga mai, he maha ngā whakaaro hou kua puta mai mō te rongoā i ngā mate ate me te repeure. Kāore i te herea ki te "whakaahua hihi-X" anake. Kua huri kē mai i te hangarau tātaritanga taketake ki tētahi momo hou. Ko ngā tikanga rongoā ko te tango i te sphincterotomy, te tango i ngā kōhatu o te awa ate, te tango i te wai ate me ētahi atu tikanga hei rongoā i ngā mate ate me te pūnaha repeure.
Ka taea e te reiti angitu o te whakaurunga ngongo ngongo kōwhiri mō te ERCP te eke ki te neke atu i te 90%, engari kei reira tonu ētahi wā ka kore e taea te whakaurunga ngongo ngongo kōwhiri nā te uaua o te urunga ki te ngongo ngongo. E ai ki te whakaaetanga hou mō te tātaritanga me te maimoatanga o te ERCP, ka taea te tautuhi i te whakaurunga ngongo uaua penei: ko te wā mō te whakaurunga ngongo ngongo kōwhiri o te uma matua o te ERCP tikanga he neke atu i te 10 meneti, ko te maha rānei o ngā nganatanga whakaurunga ngongo he neke atu i te 5 ngā wā. I te wā e mahi ana i te ERCP, mena he uaua te whakaurunga ngongo ngongo i ētahi wā, me whiriwhiri ngā rautaki whai hua i te wā tika hei whakapai ake i te reiti angitu o te whakaurunga ngongo ngongo. Ka whakahaerehia e tēnei tuhinga he arotake pūnaha o ētahi tikanga whakaurunga ngongo āwhina e whakamahia ana hei whakaoti rapanga i te whakaurunga ngongo ngongo uaua, me te whakaaro ki te whakarato i tētahi pūtake ariā mō ngā endoscopists haumanu ki te whiriwhiri i tētahi rautaki urupare ina tūtaki ana ki te whakaurunga ngongo ngongo uaua mō te ERCP.
I. Tikanga Waea Arataki Kotahi, SGT
Ko te tikanga SGT he whakamahi i te kāteta rerekē hei whakamātau tonu ki te whakauru i te awaawa o te ate i muri i te urunga o te waea ārahi ki te awaawa o te repeure. I ngā rā tōmua o te whanaketanga o te hangarau ERCP, he tikanga noa te SGT mō te whakaurunga awaawa uaua. Ko tōna painga he ngāwari ki te whakahaere, ka mau te uma, ā, ka taea te noho i te whakatuwheratanga o te awaawa o te repeure, kia māmā ake ai te kimi i te whakatuwheratanga o te awaawa o te ate.
He pūrongo kei roto i ngā tuhinga e kī ana i muri i te korenga o te whakaurunga ngongo tikanga, mā te kōwhiri i te whakaurunga ngongo āwhina-SGT ka taea te whakaoti angitu i te whakaurunga ngongo awaawa i roto i te 70%-80% o ngā take. I tohu anō te pūrongo i roto i ngā take o te korenga o te SGT, ahakoa te whakatikatika me te tono o te takiruawaea ārahikāore te hangarau i whakapai ake i te reiti angitu o te whakaurunga ngongo ate, kāore hoki i whakaiti i te auau o te pancreatitis (PEP) i muri i te ERCP.
Kua whakaatuhia hoki e ētahi rangahau he iti iho te angitu o te whakaurunga ngongo SGT i te whakaurunga ngongo takirua.waea ārahihangarau me te hangarau transpancreatic papillary sphincterotomy. Ki te whakataurite ki ngā nganatanga maha o te SGT, ko te whakatinanatanga wawe o te takiruawaea ārahiKa taea e te hangarau, te hangarau rānei i mua i te tapahi te whakatutuki i ngā hua pai ake.
Mai i te whanaketanga o te ERCP, he maha ngā hangarau hou kua whakawhanakehia mō te whakaurunga uaua o te ngongo. Ki te whakatauritea ki te whakaurunga takitahiwaea ārahihangarau, he mārama ake ngā painga, ā, he teitei ake te reiti angitu. Nō reira, kotahiwaea ārahiKāore i te tino whakamahia te hangarau i tēnei wā i roto i ngā āhuatanga haumanu.
II.Tuhinga waea arataki-rua,DGT
Ka taea te kī ko te DGT te tikanga noho waea arataki awa pancreatic, arā, me waiho te waea arataki e tomo ana ki te awa pancreatic kia whai me te noho ki roto, kātahi ka taea te tāpiri anō i te waea arataki tuarua ki runga ake i te waea arataki awa pancreatic. Te whakaurunga ngongo awa au whiriwhiri.
Ko ngā painga o tēnei huarahi:
(1) Me te āwhina a tētahiwaea ārahi, he māmā ake te kimi i te whakatuwheratanga o te awaawa au, ā, ka maeneene ake te whakaurunga o te ngongo awaawa au;
(2) Ka taea e te waea ārahi te whakau i te nipple;
(3) I raro i te arataki a te awa pancreaticwaea ārahi, ka taea te karo i te tirohanga anō o te awa pancreatic, ā, ka whakaitihia te whakaohooho o te awa pancreatic i puta mai i te whakaurunga auau o te ngongo.
I kite a Dumonceau me ētahi atu ka taea te whakauru i tētahi waea ārahi me tētahi catheter rerekē ki roto i te kōhao koiora i te wā kotahi, kātahi ka ripoatahia he kēhi angitu o te tikanga noho waea ārahi o te awa pancreatic, ā, ka whakatau ko tewaea ārahiHe angitu te whakamahi i te tikanga o te awa pancreatic mō te whakaurunga o te awa au. He pānga pai tō te tere.
I kitea i roto i tētahi rangahau mō te DGT nā Liu Deren me ētahi atu, i muri i te whakahaerenga o te DGT ki ngā tūroro he uaua te whakaurunga o te ngongo wai ERCP, i eke te angitu o te whakaurunga o te ngongo ki te 95.65%, he nui ake tēnei i te angitu 59.09% o te whakaurunga o te ngongo tikanga.
I roto i tētahi rangahau tirohanga whakamua nā Wang Fuquan me ētahi atu, i te wā i whakamahia ai te DGT ki ngā tūroro he uaua te whakaurunga o te ngongo awa ERCP i roto i te rōpū whakamātautau, ko te angitu o te whakaurunga o te ngongo he teitei ki te 96.0%.
E whakaatu ana ngā rangahau o runga ake nei mā te whakamahi i te DGT ki ngā tūroro he uaua ki te whakauru i te ngongo awaawa o te ERCP ka taea te whakapai ake i te reiti angitu o te whakauru i te ngongo awaawa o te ERCP.
Ko ngā ngoikoretanga o te DGT ko ngā āhuatanga e rua e whai ake nei:
(1) Te repeurewaea ārahitērā pea ka ngaro i te wā e whakauruhia ana te ngongo awaawa, i te tuarua rāneiwaea ārahika taea te hoki anō ki te awa pancreatic;
(2) Kāore tēnei tikanga e pai mō ngā take pēnei i te mate pukupuku o te pane repe taiaki, te piko o ngā awa repe taiaki, me te wehenga o te repe taiaki.
Mai i te tirohanga o te PEP, he iti ake te auau o te PEP o te DGT i tērā o te whakaurunga ngongo wai au. I roto i tētahi rangahau tirohanga whakamua, ko te auau o te PEP i muri i te DGT he 2.38% noa iho i roto i ngā tūroro ERCP he uaua te whakaurunga ngongo wai au. E kī ana ētahi tuhinga ahakoa he nui ake te angitu o te whakaurunga ngongo wai au i te DGT, he teitei ake tonu te auau o te mate pāwera i muri i te DGT ki te whakataurite ki ētahi atu tikanga whakaora, nā te mea ka kino pea te ngongo repeure me tōna whakatuwheratanga i te pokanga DGT. Ahakoa tēnei, e kī tonu ana te whakaaro whānui i te kāinga me tāwāhi i roto i ngā take uaua o te whakaurunga ngongo wai au, ina he uaua te whakaurunga ngongo, ā, ka maha tonu te hē o te whakaurunga o te ngongo repeure, ko te DGT te whiringa tuatahi nā te mea he iti ake te uaua o te whakamahi i te hangarau DGT, ā, he ngāwari hoki te whakahaere. He whānuitia te whakamahinga i roto i ngā whakaurunga ngongo uaua kua tohua.
III. Aratohu waea cannulation-pan-creatic stent, WGC-P5
Ka taea hoki te kī ko te WGC-PS te tikanga whakanoho i te stent o te ngongo pancreatic. Ko tēnei tikanga he whakanoho i te stent o te ngongo pancreatic ki tewaea ārahika tomo hē ki te awa pancreatic, kātahi ka unuhia tewaea ārahiā, ka mahi i te whakapūtanga o te awaawa au i runga ake i te stent.
I whakaatuhia e tētahi rangahau nā Hakuta me ētahi atu, haunga te whakapai ake i te angitu whānui o te whakaurunga ngongo mā te ārahi i te whakaurunga ngongo, ka taea hoki e te WGC-PS te tiaki i te whakatuwheratanga o te awa repeure me te whakaiti nui i te putanga mai o te PEP.
I roto i tētahi rangahau mō te WGC-PS nā Zou Chuanxin me ētahi atu, i kitea ko te angitu o te whakaurunga ngongo uaua mā te whakamahi i te tikanga stent duct pancreatic temporary i eke ki te 97.67%, ā, i tino heke te maha o ngā PEP.
I kitea i roto i tētahi rangahau, ina tika te whakanoho i te stent o te awa pancreatic, ka tino whakaitihia te tūponotanga o te pāngia e te pancreatitis kino i muri i te pokanga i roto i ngā take uaua o te whakaurunga ngongo.
He ngoikoretanga tonu kei tēnei tikanga. Hei tauira, ko te stent o te awa pancreatic i whakaurua i te wā o te mahi ERCP ka nekehia pea; ki te hiahiatia te whakanoho i te stent mō te wā roa i muri i te ERCP, ka nui te tūponotanga o te aukati i te stent me te aukati i te awa. Ko te whara me ētahi atu raruraru ka arahi ki te pikinga o te maha o ngā PEP. Kua tīmata kē ngā whare hauora ki te ako i ngā stent awa pancreatic rangitahi ka taea te neke noa atu i te awa pancreatic. Ko te kaupapa he whakamahi i ngā stent awa pancreatic hei ārai i te PEP. Haunga te whakaiti nui i te maha o ngā aituā PEP, ka taea hoki e ēnei stent te karo i ētahi atu mahi hei tango i te stent me te whakaiti i te taumahatanga ki ngā tūroro. Ahakoa kua whakaatuhia e ngā rangahau he pānga pai ngā stent awa pancreatic rangitahi ki te whakaiti i te PEP, he nui tonu ngā herenga o tā rātou whakamahinga haumanu. Hei tauira, i roto i ngā tūroro he angiangi ngā awa pancreatic me te maha o ngā manga, he uaua ki te whakauru i te stent awa pancreatic. Ka nui ake te uaua, ā, me nui te taumata ngaio o ngā endoscopists mō tēnei mahi. He mea nui hoki kia mōhiotia ko te stent o te awa pancreatic kaua e roa rawa ki roto i te lumen duodenal. Mēnā he roa rawa te stent, ka pakaru pea te awa duodenal. Nō reira, me āta whakaaro tonu ki te whiriwhiri i te tikanga mō te whakauru i te stent o te awa pancreatic.
IV. Te tango i te pūkahukahu whakawhiti-pancreas, TPS
Ko te hangarau TPS te tikanga e whakamahia ana i muri i te urunga hē o te waea ārahi ki te awaawa pancreatic. Ka tapahia te septum i waenganui o te awaawa pancreatic i te ahunga o te waea ārahi awaawa pancreatic mai i te 11 karaka ki te 12 karaka, kātahi ka whakaurua te ngongo ki te ahunga o te awaawa au tae noa ki te urunga o te waea ārahi ki te awaawa au.
I roto i tētahi rangahau nā Dai Xin me ētahi atu, i whakaritea te TPS me ētahi atu hangarau tāpiri ngongo āwhina e rua. Ka kitea te tino teitei o te angitu o te hangarau TPS, e eke ana ki te 96.74%, engari kāore e whakaatu ana i ngā hua tino pai ki te whakatauritea ki ētahi atu hangarau tāpiri ngongo āwhina e rua. Ngā painga.
Kua pūrongohia ko ngā āhuatanga o te hangarau TPS ko ēnei ngā mea e whai ake nei:
(1) He iti te tapahi mō te septum pancreaticobiliary;
(2) He iti te auau o ngā raruraru i muri i te pokanga;
(3) He māmā te whakahaere i te kōwhiringa o te ahunga tapahi;
(4) Ka taea te whakamahi i tēnei tikanga mō ngā tūroro e whakatōkia ana te ngongo o te awa pancreatic, e whakaurua ana rānei ngā nipples ki roto i te diverticulum.
He maha ngā rangahau kua tohu ko te TPS ehara i te mea ka taea anake te whakapai ake i te angitu o te whakaurunga ngongo uaua o te awaawa, engari kāore hoki e whakapiki ake i te maha o ngā raruraru i muri i te ERCP. E kī ana ētahi tohunga mēnā ka puta pinepine te whakaurunga ngongo pancreatic, te papilla duodenal iti rānei, me whakaaro tuatahi ki te TPS. Heoi, i te wā e whakamahia ana te TPS, me aro ki te tūponotanga o te stenosis o te awaawa pancreatic me te hokinga mai o te pancreatitis, he tūponotanga roa pea ēnei o te TPS.
V. Te Whakatakoto i te Sphincterotomy i mua i te tapahi, PST
Ka whakamahia e te tikanga PST te whitiki papillary arcuate hei rohe o runga o te tapahi i mua i te wā, me te ahunga 1-2 karaka hei rohe hei whakatuwhera i te sphincter duodenal papilla kia kitea ai te whakatuwheratanga o te awa au me te awa pancreatic. I konei, e pā ana te PST ki te tikanga tapahi paerewa mō te sphincter nipple ma te whakamahi i te maripi arcuate. Hei rautaki hei whakatau i te uaua o te whakaurunga awa au mō te ERCP, kua whakaarohia whānuitia te hangarau PST hei whiringa tuatahi mō te whakaurunga awa uaua. Ko te tapahi endoscopic mō te sphincter nipple e pā ana ki te tapahi endoscopic o te mucosa mata papilla me te iti o te uaua sphincter mā te maripi tapahi hei kimi i te whakatuwheratanga o te awa au, kātahi ka whakamahia hewaea ārahihe katitere rānei hei whakauru i te awaawa aukume.
I whakaatuhia e tētahi rangahau ā-rohe ko te reiti angitu o te PST he teitei ki te 89.66%, kāore i te tino rerekē i te DGT me te TPS. Heoi, he nui ake te auau o te PEP i roto i te PST i tērā o te DGT me te TPS.
I tēnei wā, ko te whakatau ki te whakamahi i tēnei hangarau e whakawhirinaki ana ki ngā āhuatanga maha. Hei tauira, i kī tētahi pūrongo he pai ake te whakamahi i te PST i ngā wā e rerekē ana, e hē ana rānei te papilla duodenal, pērā i te stenosis duodenal, te mate pukupuku rānei.
Hei tāpiritanga, ki te whakaritea ki ētahi atu rautaki ārai mate, he nui ake te maha o ngā raruraru o te PST pērā i te PEP, ā, he nui hoki ngā whakaritenga pokanga, nō reira ko te mea pai ko ngā tohunga tirotiro puku mātau ki te mahi i tēnei pokanga.
VI. Papillotomy maripi-ngira, NKP
He tikanga wero ngira te NKP, ā, he maripi ngira tōna hei āwhina i te wero ngira. Mēnā he uaua te wero ngira, ka taea te whakamahi i te maripi ngira hei tapahi i tētahi wāhanga o te papilla, o te sphincter rānei mai i te whakatuwheratanga o te papilla duodenal i te ahunga o te 11-12 karaka, kātahi ka whakamahia hewaea ārahite catheter rānei ki te whakaurunga whiriwhiri ki roto i te awaawa ngākau noa. Hei rautaki whakatau i te uaua o te whakaurunga awaawa ngākau, ka taea e te NKP te whakapai ake i te angitu o te whakaurunga awaawa ngākau uaua. I mua, i whakaponohia whānuitia ka piki ake te maha o ngā PEP i ngā tau tata nei e te NKP. I ngā tau tata nei, he maha ngā pūrongo tātari whakamuri kua tohu kāore te NKP e whakanui ake i te mōrearea o ngā raruraru i muri i te pokanga. He mea tika kia mōhiotia mēnā ka mahia te NKP i te wā tōmua o te whakaurunga awaawa uaua, ka nui te āwhina ki te whakapai ake i te angitu o te whakaurunga awaawa ngākau. Heoi, kāore anō kia whakaaetia i tēnei wā te wā e whakamahia ai te NKP hei whakatutuki i ngā hua pai rawa atu. I kōrero tētahi rangahau ko te tere whakaurunga awaawa ngākau o te NKP i whakamahia i te wāERCPhe nui ake te kounga o te whakamahi i raro i te 20 meneti i tērā i te NKP i whakamahia i muri mai i te 20 meneti i muri mai.
Ka tino whai hua tēnei tikanga ki ngā tūroro he uaua te tango i te awaawa o te ate mai i tēnei tikanga mēnā he pupuhi te uma, he whānui rawa rānei te awaawa o te ate. Hei tāpiri, kei reira ngā pūrongo e kī ana, ina tūtaki ki ngā take uaua ki te whakatō ngongo, he nui ake te angitu o te whakamahinga ngātahi o te TPS me te NKP i te whakamahi takitahi. Ko te ngoikoretanga ko te maha o ngā tikanga tapahi e whakamahia ana ki te uma ka nui ake te puta o ngā raruraru. Nō reira, me nui ake ngā rangahau hei whakaatu mēnā me whiriwhiri wawe i mua i te tapahi hei whakaiti i te puta o ngā raruraru, me whakakotahi rānei i ngā mahi whakaora maha hei whakapai ake i te angitu o te whakatō ngongo uaua.
VII.Nira-maripi Fistulotomy,NKE
Ko te tikanga NKF e pā ana ki te whakamahi i te maripi ngira hei wero i te kiriuhi mucous tata ki te 5mm i runga ake i te uma, mā te whakamahi i te au whakaranu hei haehae paparanga i te paparanga i te ahunga o te 11 karaka tae noa ki te kitea te hanganga rite ki te kōhao, te waipuke au rānei, kātahi ka whakamahi i te waea ārahi hei kite i te putanga o te au me te tapahi i te kiko. I mahia te whakaurunga ngongo au i te wāhi i pangia ai te kiri. Ka tapahia e te pokanga NKF te tihi o te whakatuwheratanga o te uma. Nā te noho o te sinus au, ka tino whakaitihia te kino wera me te kino miihini ki te whakatuwheratanga o te awa pancreatic, ka taea te whakaiti i te maha o ngā mate PEP.
I roto i tētahi rangahau nā Jin me ētahi atu, i kīia ko te angitu o te whakaurunga ngongo NK ka eke ki te 96.3%, ā, kāore he PEP i muri i te pokanga. Hei tāpiri, ko te angitu o te NKF i roto i te tango kohatu he teitei ki te 92.7%. Nō reira, e taunaki ana tēnei rangahau ko te NKF te kōwhiringa tuatahi mō te tango kohatu o te awaawa ate noa. Ki te whakatauritea ki te papillomyotomy tikanga, he teitei ake tonu ngā mōrearea o te pokanga NKF, ā, he ngāwari ki te pāngia e ngā raruraru pēnei i te pokanga me te toto, ā, me nui te taumata mahi a ngā endoscopists. Me ako mārire te wāhi whakatuwhera matapihi tika, te hohonu tika, me te tikanga tika.
Ki te whakatauritea ki ētahi atu tikanga i mua i te tapahi, he tikanga watea ake te NKF, he nui ake hoki te angitu. Heoi, me whakaharatau roa tēnei tikanga, me te kohikohi tonu hoki e te kaiwhakahaere kia matatau ai, nō reira kāore tēnei tikanga i te pai mō te hunga tīmata.
VIII. Whakahoki-ERCP
E ai ki te kōrero i runga ake nei, he maha ngā huarahi hei whakatau i ngā uauatanga o te whakaurunga o ngā ngongo. Heoi, kāore he taurangi mō te angitu 100%. Kua tohua e ngā tuhinga e pā ana, ina he uaua te whakaurunga o ngā ngongo ngongo i ētahi wā, ko te whakaurunga roa me te maha o ngā ngongo, ko te pānga wera rānei o te tapahi i mua i te tapahi ka arahi ki te edema duodenal papilla. Mena ka haere tonu te mahi, ehara i te mea ko te whakaurunga o ngā ngongo ngongo anake ka kore e angitu, engari ka piki ake hoki te tūponotanga o ngā raruraru. Mena ka puta te āhuatanga i runga ake nei, ka taea e koe te whakaaro ki te whakamutu i te au.ERCPte mahi tuatahi, ā, ka taea te mahi i tētahi atu ERCP i tētahi wā whiriwhiri. Kia ngaro te papilloedema, ka māmā ake te mahi ERCP ki te whakatutuki i te angitu o te intubation.
I whakahaerehia e Donnellan me ētahi atu tētahi tuaruaERCPi te 51 ngā tūroro i rahua te ERCP i muri i te tapahi i mua i te whakamahi i te maripi ngira, ā, 35 ngā kēhi i angitu, ā, kāore i piki ake te maha o ngā raruraru.
I whakahaerehia e Kim me ētahi atu tētahi pokanga ERCP tuarua ki runga i te 69 tūroro i rahua.ERCPwhai muri i te werohanga ki te maripi ngira i mua i te tapahi, ā, e 53 ngā kēhi i angitu, me te ōwehenga angitu o te 76.8%. Ko ngā kēhi i mahue kāore i angitu i mahia anō hoki he pokanga ERCP tuatoru, me te ōwehenga angitu o te 79.7%. , ā, kāore i piki ake ngā raruraru i ngā pokanga maha.
I whakahaerehia e Yu Li me ētahi atu te kura tuarua whiriwhiriERCPi runga i te 70 tūroro i rahua te ERCP i muri i te tapahi i mua i te werohanga ki te maripi ngira, ā, 50 ngā kēhi i angitu. I piki ake te reiti angitu whānui (te ERCP tuatahi + te ERCP tuarua) ki te 90.6%, ā, kāore i tino piki ake te maha o ngā raruraru. Ahakoa kua whakamāramahia e ngā pūrongo te whai huatanga o te ERCP tuarua, kaua e roa rawa te wā i waenga i ngā pokanga ERCP e rua, ā, i ētahi wā motuhake, ka kino ake pea te āhua i te whakaroa o te tango i te wai mai i te ate.
IX. Te tango wai toto i roto i te biliary e arahina ana e te ultrasound endoscopic, EUS-BD
He tikanga whakaekenga te EUS-BD e whakamahi ana i te ngira poka hei poka i te pūkahukahu mai i te puku, i te lumen duodenum rānei i raro i te arataki a te ultrasound, ka tomo ki te duodenum mā te papilla duodenal, kātahi ka mahi i te intubation biliary. Kei roto i tēnei tikanga ngā huarahi ā-roto me ā-waho.
I roto i tētahi rangahau whakamuri, i kīia ko te angitu o te EUS-BD i eke ki te 82%, ā, ko te auau o ngā raruraru i muri i te pokanga he 13% noa iho. I roto i tētahi rangahau whakatairite, i whakaritea te EUS-BD ki te hangarau i mua i te tapahi, he teitei ake te angitu o te whakaurunga ngongo, tae atu ki te 98.3%, he nui ake tēnei i te 90.3% o mua i te tapahi. Heoi, tae noa ki tēnei wā, ki te whakatauritea ki ētahi atu hangarau, kei te kore tonu he rangahau mō te whakamahinga o te EUS mō ngā mahi uaua.ERCPte whakaurunga o ngā ngongo. Kāore i te rawaka ngā raraunga hei whakamatau i te whai huatanga o te hangarau wero i te awaawa o te ate e arahina ana e te EUS mō ngā uauaERCPte whakaurunga ngongo. Kua whakaatuhia e ētahi rangahau kua whakaitihia te mahi a te PEP i muri i te pokanga.
X. Te whakahekenga wai i roto i te ate, PTCD
Ko te PTCD tētahi atu tikanga whakamātautau whakaeke ka taea te whakamahi tahi meERCPmō ngā uauatanga o te whakaurunga o te awaawa o te ate, inā koa i ngā wā e ārai kino ana te awaawa o te ate. Ka whakamahia e tēnei tikanga he ngira wero hei whakauru mā te kiri ki roto i te awaawa o te ate, ka werohia te awaawa o te ate mā roto i te papilla, kātahi ka werohia te awaawa o te ate ki muri mā roto i tētahi mea kua rāhuitiawaea ārahiI tātarihia e tētahi rangahau te 47 o ngā tūroro he uaua te whakaurunga o te ngongo awaawa o te ate, ā, i whiwhi rātou i te tikanga PTCD, ā, i eke te ōrau angitu ki te 94%.
I roto i tētahi rangahau nā Yang me ētahi atu, i tohuhia he iti noa te whakamahinga o te EUS-BD ina tae mai ki te whakatōtōtanga o te hilar me te hiahia ki te poka i te awaawa aukume o roto i te ate matau, engari ko ngā painga o te PTCD he rite ki te tuaka o te awaawa aukume, ā, he ngāwari ake te ārahi i ngā taputapu. Me whakamahi te whakaurunga o te awaawa aukume ki ēnei tūroro.
He mahi uaua te PTCD e hiahia ana ki te whakangungu pūnaha roa me te whakaoti i te maha o ngā take. He uaua ki te hunga tauhou te whakaoti i tēnei mahi. Ehara i te mea he uaua noa te whakahaere i te PTCD, engari ko tewaea ārahitērā pea ka pakaru te awaawa o te ate i te wā e whanake ana.
Ahakoa ka taea e ngā tikanga o runga ake nei te whakapai ake i te angitu o te whakaurunga ngongo uaua o te awaawa, me whai whakaaro whānui ki te kōwhiringa. I te wā e mahi anaERCP, SGT, DGT, WGC-PS me ētahi atu tikanga ka taea te whakaaro; ki te kore e angitu ngā tikanga o runga ake nei, ka taea e ngā endoscopists matua me ngā tohunga te mahi i ngā tikanga i mua i te tapahi, pēnei i te TPS, NKP, NKF, me ētahi atu; ki te mea kei te mau tonu Mena kāore e taea te whakaoti i te whakaurunga ngongo wai kōwhiriwhiri, me whiriwhiri te tuarua whiriwhiriERCPka taea te whiriwhiri; ki te kore e taea e tētahi o ngā tikanga o runga ake nei te whakaoti i te raruraru uaua o te whakaurunga ngongo, ka taea te whakamātau i ngā mahi pokanga pēnei i te EUS-BD me te PTCD hei whakaoti i te raruraru, ā, ka taea te whiriwhiri i te maimoatanga pokanga mēnā e tika ana.
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Wā tuku: Hanuere-31-2024