Endogopika retograde cholangiopancreatography

ʻO Endoscopic retrograde cholangiopancreatography (ERCP) kekahi o nā hana hou a me ka pono o ka maʻi lapaʻau, kahi e hiki ai iā ʻoe ke hana i kahi maʻi kūpono a kuhikuhi i nā lāʻau lapaʻau kūpono a me nā kaʻina hana no ka mea maʻi. Ma lalo iho mākou e noʻonoʻo ai i nā hiʻohiʻona nui o kēia ʻano diagnostic, nā hōʻailona no ka hoʻokō ʻana a me nā hiʻohiʻona ʻē aʻe i ʻike ʻia e nā kauka a me nā maʻi.

He aha ia a he aha ke kumu o ka hana?

ʻO ERCP kahi ʻano loiloi kūikawā i hoʻohana ʻia no nā maʻi o ka dile cile a me nā pancreas. Aia pū me ka hoʻohana ʻana o nā mea kani X-ray a me nā mea endoskopika, kahi hui e hiki ai iā ʻoe ke hoʻomaopopo pololei i ke ʻano o kēia manawa o nā ʻenemi i ʻike ʻia. Ua noi ʻia kēia ʻano noiʻi ma 1968. I kēia lā, i ka noʻonoʻo ʻana i ka hoʻolālā o ka lāʻau lapaʻau, ua hoʻomaikaʻi nui ʻia. Hiki iā ERCP ke hōʻoia i kahi maʻi me ka hilinaʻi kiʻekiʻe, hoʻomaopopo i ke kiʻi o ka maʻi a hoʻokō i nā hana therapeutic.

Hoʻololi ʻia ka Endoscopic retrograde cholangiopancreatography ma ka hoʻolauna ʻana i kahi endoskopopono i loko o ka duodenum, kahi i hoʻopili ʻia ai i ka pū o nā papilla duodenal nui, kahi hōʻaiʻe me ke alahula kūikawā no ka hāʻawi ʻana i kahi ʻaoʻao kuʻikahi e huki ʻia ma nā kahope endoscope. Ma hope o kēia mea e komo i ke kino ma o ke kahawai, lawe ka ʻenehana i nā kiʻi o ka wahi i hoʻopaʻa ʻia e hoʻohana ana i nā lako x-ray. Hoʻokumu i nā kiʻi i loaʻa, ua hōʻike ʻia kahi maʻi. Ke hana nei i ka ERCP hiki ke hoʻokaʻawale i nā pae aʻe:

Ke nānā ʻana i ka duodenum a me ka papalā duodenal
NO ka paila o ka papila a me ka ho theokomo ofana o ka p mediumle like me n x x-ray e iho ana,
Hoʻopiha i nā kaupalena o nā ʻōnaehana i aʻo ʻia,
X-ray pana,
ʻO ka hoʻokaʻawale ʻana ʻē aʻe mai nā kiko,
Ke kāohi ʻana i ka hopena makemake ʻole.

No ka hana ʻana i kahi ERCP, pono kahi polokalamu me ka hoʻonoho i nā optics hou - pono ia i kēia hoʻoponopono ke nānā i nā kino o loko i ke ʻano maʻalahi. ʻO ka huakaʻi, ka mea i hoʻoneʻe ʻia ma ka endoscope, he cannula kūikawā i hana ʻia me ka waiwai lepo, ka mea e huli ai i kekahi ala no ka hoʻopiha piha ʻana o nā papa me nā mea radiopaque. E like me ke kānāwai, ua hana ʻia ka cholangiopancreatograpuri endoscopic i loko o kahi lumi X-ray i loko o kahi haukapila.

Nā hiʻohiʻona o ka hoʻomākaukau no ke kaʻina hana

E like me ka mea i ʻōlelo ai ma luna aʻe, hiki i kahi ERCP ke hiki i kahi o ke haukapila. Ma mua o ka hoʻokō ʻana i kahi hoʻouluʻana o ka endoscopic, pono ke hana ʻia kahi mea hoʻonāukiuki, e hōʻoluʻolu i ka luhi a me ka pupule o ka mea maʻi. Mai ka paʻakikī loa o ke kaʻina hana a hōʻehaʻeha kekahi manawa, hiki i kēia maʻi ke koi i mea pono e hoʻomākaukau ai no ka ERCP. I kekahi mau manawa, hiki ke hoʻolilo ʻia ka ulu ʻana o nā mea huki ʻole wale i ka lā o ke kaʻina hana, akā i ka pōʻaleʻa hoʻi, inā he nui ka huhū o ka huhū o ka mea maʻi.

Ma mua o ke kaʻina hana, ʻaʻole pono ka mea maʻi e ʻai i ka meaʻai a inu i ka wai - ua lawe wale ʻia ʻo ERCP ma kahi ʻōpū ʻole. ʻO ka hapalua hola ma mua o ka hoʻomaka ʻana o ke kaʻina hana i kūmākia i ka retrograde cholangiopancreatography, intramuscularly injected solution o ka atropine sulfate, platifillin a metacin i hui pū me nā hopena o ka diphenhydramine a me ka promedol. E kōkua kēia i ka hoʻokō ʻana i ka hoʻomaha hoʻomaha o ka duodenum a waiho i ke kaʻina hana ERCP kuʻi ʻole. Eia nō naʻe, i ka manawa like, ʻaʻole kūpono nā ʻano aʻoaʻo a me ka morphine i hoʻomākaukau ʻia mai nā mea hōʻehaʻeha, ʻoiai hiki iā lākou ke hōʻemi i ka hāmeʻe o ka Oddi sphincter. Inā, ma o ka hoʻolaha ʻana o nā hoʻonā i luna, e hoʻomau ka hoʻowalewale o ka ʻōpū, a laila ma mua o ka kolokalaopancreatografia retrograde. ʻO nā mea maʻamau maʻamau o buscopan a me benzohexonium.

ʻO nā mea nui no ka kaʻina hana

ʻO ERCP kahi hana hoʻoweliweli i paʻakikī, i kuhikuhi ʻia e like me nā hōʻike. Ma ke kānāwai, nā hōʻailona koʻikoʻi e hōʻike ana i ka pono o kēlā maʻi like me ka hele ʻana o ka ʻeha o ka ʻōpū ma muli o nā mea maʻi o ka bile duct patency ma muli o nā pōhaku, nā kuʻi, a me nā ʻano hou aʻe. I kēia hihia, pono nā hoʻopiʻi pono e hōʻoia ʻia e pale aku i nā hewa ma ke ʻano maʻi a ma ka mālama ʻana ma hope.

Inā mākou e noho i kēia ma luna o ka kikoʻī, a laila ʻo nā kumu maʻamau loa ke alakaʻi o ka ERCP i nā ʻano maʻi like ʻole:

ʻO ka jaundice ahuwale ma muli o ka hoʻokumu ʻana i kahi kūpono (kaohiʻana) o ka dile bile maʻamau, stenosis o ka papilla duodenal a choledocholithiasis. ʻO ka mea hope loa, hōʻike ʻia ʻo ia iho kahi hoʻopiʻi ma hope o ka maʻi o ka gallstone, i ka wā i pohā ai nā pōhaku i nā papa umauma nui a hoʻonāukiuki i kā lākou make. Kahi ʻia nā maʻi e like me ka hypochondrium kūpono a hiki ke hāʻawi ʻia ma ka ʻaoʻao ʻākau, lumbar, scapular a me nā ʻāpana ʻāina.
ʻO ka ikehu o ka maʻi ʻaʻai o ka pancreas. Basically, ka hoʻokae ʻia ʻana o kahi ʻano maʻi manuahi me ka hoʻohana ʻana i ka ultrasound a i ʻike ʻia i ka tomography computed, akā i kekahi manawa, ʻaʻole i hiki i nā mea maʻi ke ʻano. Mahalo i ia mau kūlana, hiki iā ia ke hoʻohana iā ERCP ma ke ʻano he ʻano loiloi.
Nā maʻi pancreatitis me nā exacerbations maʻamau.
ʻO ka heleʻana o nā fistula pancreatic a me ka hōʻike ʻana i nā ʻano hana no kā lākou hoʻomaʻamaʻi maikaʻi ʻana.
Ka ʻike ʻana i nā hōʻailona no nā ʻano lāʻau lapaʻau hou.

Hoʻokahi ala a i ʻole kekahi, ma mua o ka hana ʻana i kēia kaʻina hana, pono ʻoe e nānā pono no ka hele ʻana o nā hōʻailona kūpono. ʻO ia ke kumu e hoʻoholo mua ai i ka mea maʻi i ka haukapila a hāʻawi i ka mālama o kona kūlana.

ʻO nā contraindications a me nā hopena

Mai ka pili pū ʻana o ke ala ERCP me ka hoʻopuka komo ʻana i ka nui o nā palena a me nā hiʻohiʻona o kāna palapala noi. I kēia hihia, hiki ke noʻonoʻo ʻia ka contraindication nui i kekahi ʻano o ke kino i ʻae ʻia i ka ʻae ʻana o ka endoscopic.

Eia kekahi, inā i ka mea maʻi me ka intolerance i nā lāʻau lapaʻau i hoʻokomo ʻia i loko o ke kino i ka wā o ka hoʻomākaukau a me ka hoʻokele ʻana o ka ERCP, a laila hiki i ka maʻi ma kēia ala ke hiki ʻole.

ʻO kekahi o nā contraindications he maʻi pancreatitis a exacerbation o ka maʻi pancreatitis maoli.

Inā hiki ke hoʻopili ʻia nā maʻi i luna aʻe e pili ana i nā contraindications paʻa, ke kau nei nā kūlana ma hope o ke kino i ke kau ʻana i kekahi mau palena, akā ʻaʻole e kāpae i ka hiki ʻana o nā maʻi maʻi.

Kahawai
ʻO nā maʻi o ka ʻōnaehana cardiovascular,
ʻO ka maʻi maʻi a me ka insulin
ʻO ka ʻae ʻana o nā anticoagulants (ʻo nā mea maʻamau ka nui o ka aspirin).

I nā kūlana ʻelua i hala hope loa, ʻōlelo aku nā kauka i ka hoʻoponopono ʻana i ka nui o ka lāʻau o ka lāʻau a i ʻole ke hoʻololi ʻana iā ia me nā lāʻau lapaʻau like like ʻole i pili ʻole i ka ERCP.

Ma ka laulā, ʻaʻole i komo nā kaʻina ERCP i nā hoʻokolohua olakino hoʻowalewale ʻia, akā naʻe, ʻo ka hoʻopiʻi o nā ʻano genesis like ʻole ma hope o ia. ʻO nā ʻōnaehana maʻamau loa e ʻike ʻia i loko o ka ʻōpū, ka hoʻonaninua o ka ʻōpū, a me ka koko.

Eia naʻe, ke kūpaʻa nei nā limahana loea e hiki ke hōʻemi i nā mea hoʻopiʻi inā hiki ke lawe ʻia nā hana pale. ʻO ka mea mua, ma hope o ka pau ʻana o ke ʻano maʻi, pono e noho ka mea maʻi i nā hola i loko o ka haukapila ma lalo o ka mākaʻikaʻi koʻikoʻi o nā kauka. ʻO nā manaʻo lohi i ka larynx ma hope o ka hoʻokomo o ka uaea hiki ke hōʻemi ʻia e ka lozenges i kona ʻāʻī. Pono ke noho o ka mea maʻi no 24 mau hola ma hope o ka hopena o ke ʻano o ka maʻi. Inā mālama ʻia nā hōʻailona e like me ka wīwī, ka umau, ka maʻi a me ka luaʻi ʻana, ʻeha nui ka ʻōpū ma ka ʻōpū a me ka umauma, a laila e hoʻoikaika ʻia e hōʻike i ke kauka e pili ana iā lākou. ʻO ka heleʻana o ia mau hōʻailona, ma ke ʻano he kānāwai, e hōʻike i nā hala i hala i ka wā o ka maʻi maʻi.

No laila, ʻo ka mea hoʻokūkū a me ka mākaukau o ka ERCP e hiki iā ʻoe ke kiʻi i ka ʻike e pili ana i ke ʻano o ka mea maʻi me ka maikaʻi ʻole i ka olakino a me nā hopena ʻē aʻe.

ERCP (ʻo ka pancreatocholangiography ʻo endoscopic retrograde)

ʻO ERCP kahi hōʻike X-ray endoskopikika o nā kino o ke kano pancreatobiliary (duodenum, duodenal papilla, bile ducts, pancreatic duct).

ʻO ka mea nui o ke ala ke nānā aku i ka lumen o ka duodenum, duodenal papilla, inā pono, lawe ʻia nā tauira micro o ka membrane ka mucous (biopsy) no ka hoʻokolokolo papalua, me ka loaʻa ʻana o nā kiʻi x-ray o ke ʻano o ke kaila o ka papa pancreatobiliary. Loaʻa ia i ka hoʻolaha ʻana i ka esophagogastroduodenodenoscope i loko o ka duodenum, ma o ke kahawai hana hana kahi i kau ʻia ka cannula i loko o ka lumen o ka bile a me / a me nā papa pancreatic ma o ka papila duodenal, hoʻopiha ʻia iā lākou me kahi mea hoʻohālikelike X-hihi, a ʻimi ʻia e ka radiography X-ray. ʻO kēia kahi ʻōnaehana hulina endoscopic a me radiological. ʻO Esophagastroduodenoscopy kahi mea kūikawā, ʻo ia ka mea e leʻaleʻa a me ka nani, ka lōʻihi lōʻihi me ka mīkini Optical fiber optic a i ʻole chip wikiō, e hiki ai iā ʻoe ke hoʻihoʻi i ke kiʻi mai loko o kou kino i ka monitor.

Hoʻohana ʻia nā mea hana kūikawā ma ka kahawai hana o ka esophagogastroduodenoscope (nā cannulas no ka hoʻopuka ʻana i nā hopena, forceps, kipi no ka lawe ʻana i nā pōhaku, nā puʻu papillotomy no ka hoʻowalewale ʻana i nā ʻāpana a me nā constriction, a me nā mea a pau).

ʻO ka ʻike e pili ana i ke ʻano o kou olakino, loaʻa me ke kōkua o esophagogastroduodenoscopy, he mea kūʻokoʻa ia e hiki ai iā ia ke hana i ke ʻano kūpono, no ke koho ʻana i kahi ʻano kūpono o ka mālama ʻana.

Hoʻopili ʻia he esophagogastroduodenoscopy i loko o ka esophagus, ʻōpū a me ka duodenum, e hoʻihoʻi hou i kā lākou kuala. He maʻi ʻeha ʻole kēia, akā hiki iā ʻoe ke hōʻemi a loaʻa paha ʻoe i ke ʻano hōʻino.

Ma muli o ke ʻano i koho ʻia, nā ʻano ʻē aʻe a i hui pū ai me lākou o nā mea pili o ke kano pancreatobiliary:

ERPHG (retrograde cholangiopancreatography) - ka hoʻokomo ʻana i ka hoʻohālikelike o ka X-ray i ka ʻōnaehana wai a me ka hoʻoili,
EPT (ʻo ka papillosphincterotomy endoskopiko) - ka haʻalele ʻana i ka papilla duodenal a me nā kumu hoʻokō,
EPD (ʻo ka papillosphincterodilation endoskopiko) - ka uhiʻana o ka papilla duodenal a me nā kumu hoʻokūkū,
LAHUI A ME KA LAHOLAHA - luku a me ke kāohi ʻana i nā pōhaku mai nā papahele,
Ka hoʻolima a me nā prosthetics o nā papa - ka hoʻokomo ʻana i nā pā wai kūikawā (stents, prostheses) e hōʻoia i ka nui o ka puka o ka bile a me / ai wai pancreatic i loko o ka lumen o ka duodenum.

ʻO ke ʻano o kēia ʻano hopohopo hope a me ke ʻano loiloi X-ray i hana ʻia i mau makahiki he nui, ua ʻike ʻia ke ʻano a me ke ʻano loiloi, ua loaʻa i nā kauka ke ʻike o ka hana kūleʻa, akā naʻe, i loko o kahi helu liʻiliʻi, hiki ke hana ʻia ke kikowaena a i ʻole nā hoʻopiʻi kō. Aia ka mea i hilinaʻi nui ʻia i nā ʻano anatomical o kāu mau kino, ka hele ʻana o nā diverticulum, nā maʻi o mua, nā ʻalā, nā loli i nā ʻōpū pili, nui ke kani o ka paia ʻōpū, a me ke kiʻekiʻe o kou ʻeha a me kou naʻau. I kekahi manawa lilo kēia mau hoʻololi i ka uku ʻole no ka hana ʻana i ka interoscopical intervention a hiki ke ʻike wale ʻia ia mau mea wale nō i ka wā hoʻokuʻi wale ʻia. ʻO kahi hoʻonāukiuki o kēia kāpili (i hōʻike ʻia ma ka papa ma lalo) kahi exacerbation o ka pancreatitis. Me ka nele ʻole, hana mākou i nā hana i kuhikuhi i ka pale ʻana i nā ʻōhua. Loaʻa iā mākou nā mea āpau (ʻike, mākaukau, ʻike, nā pono, nā lāʻau lapaʻau, kahi hui paʻa o nā loea loea a me nā anesthetist) e hoʻoponopono a hōʻemi i nā hopena o nā hoʻopiʻi.

ʻO ka hopena noiʻi huluhulu ʻ -lelo X-ray ke ʻano kūpono a paʻa i ka maʻi a me kahi ʻano hōʻemi minimally invasive no nā maʻi he nui o ka maʻi pancreatobiliary, e hōʻalo ana i nā hōʻeha ʻeha. No laila, ʻoi aku ka liʻiliʻi o ka hoʻopiʻi o nā hoʻopiʻi ma kēia hana, a ʻoi aku ka maʻalahi o ke ahonui me ka wikiwiki hou.

Ke kaʻina hana o ERCP

Ma hope o ka hoʻokomo ʻana i kahi mea kūikawā i loko o ka ʻāʻī, hoʻōla pono ʻia ke kauka ma ka esophagus, ʻōpū a me ka duodenum. Hiki i ka hāmeʻa ke hōʻea i kahi o ka pilina a me ka umauma pancreatic. Ma kēia wahi, hana ʻia kekahi nui o ka papilla duodenal nui, a aia ma kona waha aia he lumen o ka duodenum.

Ma hope o ka hāmeʻa ma ka hoʻomaka ʻana o kēia ʻano, hana ka gastroenterologist i kēia mau lalo.

Hoʻokomo ʻia kahi mea radiopaque kūikawā i loko o ka pancreas a me nā kahawai bile.
ʻO nā lako X-ray hiki iā ʻoe ke kiʻi i kahi kiʻi o nā ʻōnaehana wai.
Inā ʻike nā pōhaku i ka nānā ʻana, e hana koke ʻia ka hana endoskopika, ma muli o ia mea ke hoʻomau ʻia e hoʻihoʻi ʻia a hoʻopau ʻia nā kumu.

ʻO ke kaʻina hana

Ma hope o ERCP, pono ka mea maʻi i ka haukapila lā no ka manawa i hōʻike ʻia e ke kauka komo. Hoʻoholo kēia manaʻo i ke kumu o ke kūlana maʻamau o ke kino o ka mea maʻi a me nā hopena i loaʻa ma hope o ke kūʻana. Ma ke ʻano he kānāwai, e pono e lilo i ke ʻano i ka wā o ka lā. E kōkua a lilo iā Cough lozenges i nā hōʻea i ka ʻāʻī.

Nā hōʻailona a me nā contraindications

Hoʻopau ʻia kēia maʻi ma ka hihia o nā hōʻike aʻe:

maʻi mumū o nā kōkō pancreatic,
ka maʻi pancitisitis
jaundice kaahope
hopohopo i ke kūpaʻa ʻana i ka pancreas a i ʻole ka palaka a i ʻole ka maʻi gallstone,
nā ʻōpū o ka pā o ka lālau,
ka ʻike ʻana i nā hōʻailona no ka papillosphincterotomy endoscopic.

Nā Hoʻohui

Ua hoʻohālikelike ʻia ke kaʻina hana i kēlā mau maʻi:

maʻiʻo pancreatitis
maʻiʻo pancreatic
ka stenosis o ka papilla duodenal nui,
maʻa maʻi nui,
kaomi hepatitis
nā kakaho i paʻakikī ma o ke kahe.

I kekahi mau maʻi hoʻomanawanui, ʻae ʻia ke ʻano, akā he mea pono ʻole:

hapai
nā maʻi o ka ʻōnaehana cardiovascular,
lawe ana i nā anticoagulants
maʻi mellitus maʻiʻi.

Nā hopena

Ua ʻōlelo kekahi ʻo nā loiloi he palekana palekana loa ia. Eia nō naʻe, ma nā hihia līkō, hiki i nā hoʻopiʻi hou ʻana:

palaualelo
kahe koko
maʻi ʻōpū.

Hōʻike kekahi mau hōʻailona i nā hewa i hana i ka wā o ke kaʻina hana. Ma waena o kēia mau hoʻopiʻi e hiki ke hoʻomaopopo ʻia:

ninini
mea ʻalaʻawa
utuka
ʻeha i ka ʻōpū a i ʻole ʻōpū paha.

ʻO ka maʻi Mirizzy

ʻO nā lako hana ʻenehana. He paʻakikī nā ala ERPC, ka nānā ʻana o ka hoʻokau endoskopika o nā māhele haʻahaʻa o ka esophagus, ka ʻōpū, ka duodenum a me BSC a me ka hōʻike X-ray o nā kumu pancreatic a me kahi biliary tract.

E hoʻokō ʻo ERCP nā ʻeleʻele ʻokoʻa ka ʻokoʻa e ka poʻe ʻē aʻe e ka hoʻonohonoho hope ʻana o nā optika a me ka hiki ʻana o kahi kanaluna mea hana pono ʻia me kahi hāpai ʻana, me ka ʻae ʻana o nā hoʻomaʻamaʻa e hana ʻia ma ka nodle duodenal.

ʻO nā Gastroduodenoscope e hana ʻia e nā ʻoihana ʻē aʻe. Aia ma kahi o 5 mau hiʻohiʻona o kēia polokalamu. ʻO kā lākou ʻano kikoʻī koʻikoʻi nui loa, ka mea e hoʻoholo ai i ka laulā o ke noi, ʻo ke anawaena o ke ala pahu kikoʻī (mai 2.2 a 5.5 mm).

ʻO ke kahe mea kikoo o ka liʻiliʻi liʻiliʻi e hiki ai iā ʻoe ke hana: 1) ke nānā i ka nipple duodenal me ka catheter no ka hoʻōla ʻana i ka hopena o ka hopena ʻokoʻa, 2) ka hakahaka endoskopika o ka nipple duodenal, 3) ka wehe ʻana i ka calculi e loaʻa ana i ka hepatico-choledochus, kīʻī Dormia, 4) ka waipuna nasobiliary me nā ʻāpana o ka ʻona.

ʻO ka nui o ke noi ʻana o nā hāmeʻa me kahi papa hāmeʻa o ke kikowaena waena (3.2-3.7 mm) he mea nui aku, no ka mea, ʻoi aku ka hoʻohui i nā mea i luna aʻe, hiki i kēia mau mea ke hana i mea e hoʻopau i nā pōhaku i loko o ka papa bile nui me ka hoʻoneʻe ʻia o nā kaʻina. Kuhi ʻia kēia mau hiʻohiʻona no ka stenting, endoprosthetics a me ka pāhaʻi wai nasobiliary.

ʻO nā Endoscope me kahi pālahalaha hāmeʻa me ke anawaena o 4.2 a i 5.5 mm ʻaʻole i like ʻole.

Hoʻohana ʻia ka hoʻohana ʻana o kēia mau hiʻohiʻona o ka hoʻokele ERPC a i ʻole EPST e ka palena manuahi o ka palena mamao o ka gastroduodenoscope a me kahi ʻike nui ma waena o ke kahuli kahawai a me nā māka o ka catheter a me diathermosond i hoʻohana no kēia kumu.
I ka manawa like, nā endoscope o kēia hoʻolālā hana nui i ka nui o ka luku ʻana i ka caluli o ka lōʻihi. Eia kekahi, ua hoʻolālā ʻia kahi waikā ākea ākea no ka hoʻohana ʻana i nā kahawai o ka diameter nui, bougienage a me nā maka o nā ʻāpana stenosed o ka dile extrahepatic bile.
Hoʻokumu ʻia e pili ana i kēia mau mea hana, ua hoʻolālā ʻia ka pakanā mather-baby, i manaʻo mua ʻia no ka transduodenal choledochoscopy, a ua hoʻohana hou nei no ka luku intraductal i ka calculi me ka ʻenehana laser.
I ka hoʻohui i nā endoscope, koi nui nā mea hana no ka hana ʻana i ka leo endoskopika X-ray e hōʻike nui ʻia i nā kiko o Olympas, Pentax, Cook, a me Fujinon.

ʻAʻole hiki i ke kau i nā mea kikoʻī i kēlā me kēia me kēia kaila no ka nui o kā lākou ʻokoʻa hoʻolālā, no laila mākou e noho ma luna o nā hiʻohiʻona o ka pono o ka pono.

Nui nā ʻili manaʻo no ka ERPC, hiki ke hoʻokaʻawale i 3 mau pūʻulu nui: 1) me kahi cylindrical a i ʻole ka palena spherical, 2) me kahi hopena kolo conical, 3) me kahi mea lawe.

ʻO ka ʻano o ke ʻano o ka hopena mamao, i kēlā me kēia hui i hōʻike ʻia he mau x-ray positive catheters, e ʻae loa i ka mana x-ray e kāʻei i ke kuhikuhi o ko lākou ulu ʻana a ʻae i ka catheterization koho a me ka hoʻohālikelike ʻana o ka ʻōnaehana kumu.

Hoʻohana ʻia ka hana like e nā mea lawe e holo i loko o ka catheter, a me nā hiʻohiʻona hana o ka hopena mamao. No laila, ʻo nā catheters i hōʻike ʻia ma ka hui mua ʻaʻole i kūpono no ka hoʻokolokolo koho.

ʻOihana kūmaha, kupono no ka wehe ʻana i ka nipple duodenal, hiki ke hoʻokaʻawale i 3 mau pūʻulu: 1) kahi māla ʻenehana huila, kahi i kū ai ka "bowstring" ʻo ia ka hana o ka hāmeʻa, e hele ana ma ka ʻaoʻao o ka ʻaoʻao mamao o ka wahī vinyl, kahi e huki ʻia ana i ka wā ke pale ʻana i ka BSS, 2) Soma papillotus ", Aia i ka hoʻokalakupua o ka mea hao, akā e hoʻokō i ka hana, pono ia e hoʻopuʻi ʻia mai ka lumen o ka catheter, ka hana ʻana i kahi hemispherical loop, 3) ka papleotome puliki, kahi e hana ai ka mea metala ma ke ʻano he hana hana. eskaya kui exiting ma ka hoʻoneʻe mamao mai ka puka mai o ka pau ana o ka catheter. ʻO nā papillotomas o nā hoʻolālā mua ʻelua he ʻokoʻa like ia o ka palena mamao, ʻokoʻa i ka pae a me ke ʻano o ke hoʻoponopono ʻana i ka ʻoki ʻoki, ʻo ka lōʻihi o 15 ka 35 mm. ʻO ke ʻano conical o ka catheter, aia ma luna o ka ʻoki ʻoki o ka diathermosond, hoʻomaʻamaʻa ka selectivity inā hoʻokomo ʻia ʻo ia i loko o ka pahu wahi o ke au o ka maile o ka maʻamau, ʻoiai ʻo ka papillotomas kahi o kēia e manaʻo e hana "pre-dissection" ma lalo o nā kūlana ke hoʻāʻo nei e hoʻolauna i ka mea hana i ka hohonu hohonu. Pono ke ʻano nui o ka diathermic no ka wehe ʻana i ka lumen o ka ampou BSDK mai ka duodenum, a laila he like ʻokoʻa nā hana endoskopika ʻokoʻa ma ka ʻaoʻao ma luna a ua kapa ʻia ʻole non-cannulation papillotomy.

Nā Hoʻolaha ʻO nā hīnaʻi Dormia, hoʻolālā ʻia e kāohi i ka calculi mai ka lumen o ka hepaticoholedoch, ua like like me nā mea hana i hōʻike ʻia ma luna. Akahi, ua ʻokoʻa lākou i ka helu o nā kelepona metala e hana ai i ka hana o ka hāmeʻa, ko lākou ʻae, a me ke ʻano o ka hīnaʻi, ka ʻili a lākou i hana ai, a me nā ʻāpana waho.

ʻOi aku ka nui o nā lālā o ka hinai, ʻo ka liʻiliʻi o ka diameter o ka pōhaku i hiki ke hopu ʻia i kona lumen a hoʻoili ʻia i loko o ka duodenum. Hiki ke loaʻa ka hopena like ma ka hopu ʻana i nā calula liʻiliʻi a ʻoi aku ka nui o ka olonā ma o ka hana ʻana me kahi hāmeʻa e like me ka piston, i.e.

ʻaʻole e loaʻa nā pōhaku i loko o ka hīnaʻi. ʻO ka liʻiliʻi o ka nui o nā kelela metala e hana ai i ka mahele o ka hāmeʻa, ʻoi ka nui o ka pōhaku ke hoʻokomo i loko.

No ka mea, i loko o ka hīnaʻi nona ka 3 mauʻaina, hiki ke hopu ʻia i kahi helu 2 cm ke anā o ka lapalapa, akā naʻe, e hoʻāʻo ai e hana i kahi kuʻikahi me ke anawaena o ka hapa i lalo o 1 cm i loko o ia mau mea ʻaʻole i hoʻokō.

ʻO ke kuhikuhi a nā mīkini metala e hana ai i ka hīnaʻi i hoʻoholo nui ʻia i kona maneuverability.

Pēlā, ʻo nā hīnaʻi me kahi papa kuhikuhi o nā kelepona, ʻo ka hoʻohui ʻana i ke ʻano he unuhi i nā ʻano hana āpau ke pani ʻia, i ka manawa wehe a i ʻole ka wehe ʻana, ʻae ʻia ka pīhoihoi e pili ana i nā koina lōʻihi, e kōkua ana i ka mea e kau ʻia ma luna aʻe o ka helu i ka wā e hele ai nā kihi i ka pili ka paia o loko o ka papa nui. Hoʻohana ʻia kēia hopena e hana i ka paʻakikī o ka choledochus proximal. Eia kekahi, ʻoi aku ka maikaʻi o ka hoʻohana ʻana i kahi hina o kēia hoʻolālā i ka wā e wehe ai i nā pōhaku o ke anawaena liʻiliʻi e hoʻohālikelike i nā mea ʻē aʻe me kahi kuhikuhi kūpaʻa o nā kelepona.

Aia he 3 mau hiʻohiʻona nui o ka hīnaʻi Dormia, i hoʻolālā ʻia e wehe i ka calculi mai ka pahu biliary: spherical, polygonal a parachute. Hiki ke hoʻoholo ʻia ke ʻano o ka hīnaʻu ma hope o kona wehe ʻana, kahi e hiki ai iā ʻoe ke loaʻa kahi manaʻo e pili ana i ka hiki o ka hāmeʻa.

Pono e hoʻomaopopo ʻia, ʻoiai he mea nui o nā hiʻohiʻona hoʻolālā o nā mea pono, he mea koʻikoʻi a me ka ʻike hoʻokō endoscopic a me ka hoʻokūkū kūleʻa o ka choledocholithiasis.

Eia kekahi, ʻaʻole wale ka pathogenesis, ka nui, ka nui, ke ʻano, ka wahi o ka calculi i ka puke pai, akā, ʻo nā kūlana anatomical hoʻi ka mea nui loa o ka hopena.
E kūkākūkā hou ʻia nā mea e pili ana i ka hana o kēlā me kēia ʻano, a ma kēia ʻāpana e noho ai mākou i nā hiʻohiʻona o nā mea hana no ka luku intra-stream.
Nā mea hana hana lithotriptors He mau ʻokoʻa koʻikoʻi, he mea i hilinaʻi ʻia ka mea hana, aʻo kekahi ʻē aʻe i hōʻike mua ʻia e ka therapeutic efficacy.
Aia nā ʻōnaehana ikaika loa i ka pale keleawe, ʻo ka waho o ke aniani mai kahi 2.2 a 3 mm, e hoʻoponopono ʻia ana i ke koho o endoscope. I kēia manawa, hiki i nā hiʻohiʻona ʻelua o nā endoscope ke hoʻohana no nā mea hana o ke anawaena liʻiliʻi, aʻo kahi lithotripter me ka lōʻihi o 3 mm, hiki wale ke hoʻohana ʻia TJF mai Olimpus.
Me ka mana iki o ka like, ʻoi aku ka nui o nā mea hana o ke aniani liʻiliʻi, akā ʻoi aku ka nui o ka hīnaʻu kīʻaha o ka ʻaoʻao o ka lua.
No ka luku ʻana i ka calculi i loko o ka puke bile, ua hoʻomohala ʻelua mau hoʻolālā kiaʻi: ʻo kekahi o lākou he pahu a no laila ke ʻoi aku ka ikaika o ka mea ʻoi aku ka nui o ka mea i hoʻohālikelike ʻia i hana ʻia.

Hoʻomaʻamaʻa ka wā e hoʻohana ai i ka paʻa o ke ʻano mua, ʻo ka hana o ka hāmeʻa, me ka manaʻo ʻole o ka buke, ka hoʻomohala i nā hoʻololi hou ʻole ma hope o ka hoʻohana ʻana a hiki ʻole ke hoʻihoʻi ʻia. I kekahi laʻana, hiki ke hoʻohana hou i ka hāmeʻa, ʻoiai ke ʻano o ka hoʻololi hou ʻana o ka hīnaʻi.

Nā Catheters i hoʻolālā e hana hoʻoheheʻe wai ʻokoʻa ka ʻokoʻa ma waho, kahi mai ka 2 a 2.8 mm, a me ke ʻano o ka palena ākea.

ʻO ke ʻano loea o ka pahu o ka hopena mamao, a ʻo ia ʻāpana o ka mea i loko o ka duodenum, e hāʻawi ana i ka hoʻomohala ʻē aʻe i ka kahawai i ka lumen o ka hepatic choledochus.

Hiki iā ʻoe ke loaʻa i kahi manaʻo o ke ʻano o ka pipī waiona ma hope wale o ka lawe ʻana i kahi mea lawe metala mai ia.

ʻO ka pololei o ka maʻi maʻi, a me nā hopena o ka inter-mole endoskopona x-nui, i hilinaʻi nui ʻia i ka mea i hoʻohana ʻia X-ray hana i ka manawa like, ʻo nā loina no ia ʻaʻole kūikawā.

ʻO nā mea pono e loaʻa ai ka mea hoʻokahikona electron-optical (EOP), hiki ke hana i kahi noi polypositional, kiʻi i nā kiʻi paʻi, e pili ana i ka nānā, me ka mālama pono o ka mea maʻi a me nā limahana mai ka radiation ionizing.

I kēia manawa, hālāwai ka hapanui o nā mīkini x-ray i kēia mau koi.

Pono e hoʻokō pono ʻia ka hoʻokō o ka hōʻike x-ray endoscopic a me ke ʻano, i hāʻawi ʻia i ka hiki ke hoʻonā i nā hana nui:

1) hoʻonohonoho o kahi lumi hoʻokele me nā lako x-ray,
2) hāʻawi i nā hoʻonohonoho pono e pono ai,
3) ke loaʻa o nā limahana kūpono - he endoscopist X-ray, kahi radiologist a me nā kahu hānai.
4) ma mua o ka hoʻomaka ʻana i ka hana, pono i ke kauka ke hoʻomaʻamaʻa i ke kikowaena kūikawā.

Ka hoʻomākaukau ʻana i nā maʻi no REV. Ke hoʻomākaukau nei i nā mea maʻi no REV, pono e noʻonoʻo i ka hoʻokaʻawale ʻana i ka manawa o ke kaʻina diagnostic (ERCP) a me ka hoʻomaʻamaʻa endoskopika (EPST) ʻaʻole wale ia he mea kūpono ʻole, akā pū kekahi me ka hoʻomohala a i ʻole ka hoʻomohala ʻana i ka papa o nā hōʻeha e like me ke kolangitis aikoʻi a me ka pancreatitis.

Hōʻike ʻia kēia kumu ma ka hapa nui o nā hihia, hana ʻia ka hoʻoneʻe endoskopika X-ray e hoʻokaʻawale i ka latent hypertension mua a ʻokiʻoki paha i kona kumu i nā hihia i hōʻike ʻia e ka jaundice obstructive.

ʻO kaʻoiaʻiʻo, ʻo ka hoʻomaka ʻana o ka hoʻohālikelike i nā medium miliary, ʻoiai ma ka liʻiliʻi, e hoʻonāukiuki i ka hypertension inā ʻaʻole i lawe ʻia nā hana e hoʻoholo ai.

No laila, ʻo ka mākaukau o ka poʻe maʻi, i ka premedication kūikawā, pono e hoʻokō me ka manaʻolana e hana ʻaʻole wale ʻo ERCP a me EPST, akā e noʻonoʻo pū ana i ka hopena o ka hoʻohana ʻana i ka lithotripsy mekanika a me kahi pāhaʻi nasobiliary.

Mālama i nā mea maʻi no REV a maʻalahi loa a hoʻokau i ka hoʻokuʻu ʻana i nā ʻaoʻao o ka papa o ka gastrointestinal mai nā ʻike i loko o ka ʻimi loiloi a i ʻole he mea maʻamau loa, i ka hōʻole ʻana i ka pāʻina kakahiaka i ka lā o ka hoʻopaʻa ʻana, i.e. ma kahi ʻōpū.

Premedication i loko o ke kuhikuhi ʻana i nā lāʻau lapaʻau ka hopena i ka hopena sedative a, ma ke ʻano he kumu hoʻomohala pōkole o peristalsis o ka duodenum. ʻO ka mea hope loa ka mea nui loa no ka hoʻowahāwahā ʻana o ka endoskopika o ka nipple duodenal.

Wahi a kā mākou ʻike, ganglio-blockers (benzohexonium, pentamine) e kōkua ana i ka hoʻokō nui ʻana - 0.5-1 ml 10-15 mau minuke ma mua o ka hōʻike o ka endoscopic. ʻO ka hoʻohana ʻana i kēia mau lāʻau lapaʻau no 19 mau makahiki ʻaʻole i ukali ʻia e kekahi hoʻopiʻi i ʻike ʻia, me ka hoʻoluhi nui ʻana o ke kahe koko.

I ka manawa like, ʻo ka hoʻohana ʻana i nā lāʻau lapaʻau e like me ka buscopan a me ka metacin e hāʻawi ana i ka hopena hou ʻole a ʻōlelo i ka wā e loaʻa ai ka paresis o ka duodenum.

Ma ka hana lāʻau lapaʻau o kahi haukapila hōʻea, nā hihia o kahi kūlana koʻikoʻi o nā maʻi, no ka mea, ʻaʻole wale nō e nā mea koʻikoʻi o ke papa papa, akā na nā maʻi hui koa, ʻo ia hoʻi ʻo ka ʻōnaehana cardiovascular, he ʻano ʻole.

Ma lalo o kēia mau kūlana, ʻaʻole i ʻokoʻa ka mākaukau a me ka hana ʻana o nā REV i nā poʻe preoperative, i.e. hoʻohui i nā lāʻau lapaʻau e kōkua i ka hoʻoliʻiliʻi ʻana i nā kumuwaiwai a me nā ʻōnaehana.

Ma muli o ke kūlana kūikawā, hiki ke hoʻohana ʻia kēia mau lāʻau i mua, i ka wā a ma hope o ka wawaʻi, e like me ka mea i hoʻoholo ʻia e ka anesthetist i komo i ka hoʻopaʻa ʻana.

Nui loa ka pono no ka huli ʻana no ka REV a, e like me kā mākou ʻikepili, aia wale nō i ka poʻe me nā maʻi noʻonoʻo mau loa. ʻO ka hoʻohana ʻana i kēia ʻano hana i ka wā o nā hōʻiliʻili o nā ʻōpū o ka ʻōpū, ʻoiai hiki, i ko mākou manaʻo, i ka mea kūpono ʻole ma muli o ka hiki ʻole o ka hopena piha piha piha-palekana x-ray.

Ke hoʻopau nei i kēia ʻāpana, ʻike mākou aia i ka hoʻomākaukau ʻana o nā mea maʻi no REV, ʻaʻohe pono o ka hoʻohana ʻana i nā lāʻau lapaʻau.

ʻEtrlelo i loko o ka makaʻolika (RCHP)

ʻEtrlelo i loko o ka makaʻolika (RCHP) He ʻano e hoʻohui pū ana i ka endoscopy me kahi hoʻokolohua fluoroscopic manawa. Hoʻohana ʻia kēia ʻano ʻano no ka choledocholithiasis hiki iā ia, e hoʻoholo i ke ʻano o ka jaundice o ka obstructive a me ka noiʻi ʻana i ke anatomy o nā kumu ma mua o ka hoʻomaʻemaʻe.

ʻOiai ʻo RCHP kahi hana e hōʻoki ʻia ai, hōʻike ʻia ke ʻano no ka hoʻopiʻi ʻia ʻana. ʻO Retrograde cholangiopancreatography i hana mua ʻia ma 1968. I kēia manawa, ke lawe ʻia nei nā ʻano ʻano like ʻole o ka RCP therapeutic i loko o nā wahi he nui.

Eia nō naʻe, e like me ka mea i ʻōlelo ʻia ma mua, ʻaʻole pono e hoʻopaʻapaʻa ʻia nā hōʻike, no ka mea, pili paha i ka hana ʻana o kēia kuhihewa me ka hoʻomohala ʻana i nā hōʻeha hōʻeha a hiki i ka make (ʻo ka hapa helu o nā hoʻopiʻi e like ʻole mai ka 4,0% a i 4.95% i ka hui o ka endoskopika papillosphincterotomy ( PST) hiki i ka 9.8%).

Ua hōʻike ʻia nā ʻano aʻoaʻo e hōʻemi i ka ulu ʻana o nā ʻōpiopio, e like me ka pancreatitis, ma hope o RCP.

ʻO ka kumu, ʻo ia nā mea ʻenehana neʻe: e pale i ka hoʻoneʻemu pinepine ʻana o ka papa pancreatic me a ʻole kūlike ʻole, e hoʻohana i kahi ʻano i hui ʻia me ka mea nui o ka ʻoki ʻana i ka wā e hoʻokō ana i ka PST, i ka wā e hana ai i ka PST mua, ʻaʻole i kū ka manaʻo mai ka waha o ka BDS a me pharmacotherapy.

ʻO Endoscopic retrograde cholangiopancreatography (ERCP) kahi mea hana pono no ka hoʻomaʻamaʻa ʻana i ka papa momona a me ka papa pancreatic me ka hoʻohana ʻana i nā hou hou loa o nā hana endoscopic a me x-ray.

Hāʻawi kēia ala iā ʻoe e ʻike i nā maʻi like ʻole o ka pancreas (keaka a i ʻole kaomi ʻana o ke ʻano aʻokiʻoki, kahi keaka, kahi cyst), a me nā loli i ka palaki bile a me nā mea ʻaihue (nā pōhaku, ka hōʻiliʻili o nā kohu, nā mea kīkī).

ʻOkoʻa kēia haʻawina ma o nā hana noiʻi ʻē aʻe āpau ma o kāna ʻike kikoʻī kiʻekiʻe a me ka hilinaʻi ʻana, me ka hiki ke hoʻokō i nā helu lapaʻau hou. Ma mua o kahi aʻo ʻia, ʻike ʻia kahi ʻōpiopio ʻokoʻa.

Ma hope o ka anesthesia kūloko o ka waha a me ka pharynx, ua hui pū ʻia kahi ʻano optical kūikawā (duodenofibroscope) ma ka waha, esophagus a me ka ʻōpū i loko o ka duodenum i kahi i kau ai ka bile maʻamau a me ka umauma pancreatic e hui pū ai (ka duodenal papilla), e hāmama ana kona waha i ka lumen o ka duodenum . ^ E Ha yM. Me ke kōkua o kahi wai kū wai kūikawā, i hoʻoili ʻia ma loko o ka waahana o ka endoscope, ua hoʻokomo ʻia ka waha o ka papila i nā kohu bile a me ka pancreatic duct me nā mea radiopaque. A laila, e hoʻohana ana i nā lako hana X-ray, loaʻa ka ʻenehana i kahi kiʻi o ka ʻōnaehana wai. Inā ʻike ʻia nā ala āpau, hoʻopili ʻia o ka papaʻi a i nā pōhaku paha, e hana ʻia ana ka hana endoscopic i loko o ia mea, kahi e hoʻokaʻawale ana i ke kāʻei a me ka hoʻomāno maʻamau o nā kumu o ka ʻoile. No kēia hopena, me ka hoʻohana ʻana i nā pono hana kūikawā i hoʻokele ʻia ma ke kahawai o ka endoscope, hana ʻia kahi incision mai ka puka o waho o ka papa kahi e lawe ʻia ai nā pōhaku.

ʻO ka Endoscopic retrograde cholangiopancreatography kekahi o nā ʻano hana koʻikoʻi o kēia kaila no ka hoʻomohala ʻana i nā maʻi o ka pae pancreatobiliary.

Endrosopika retrograde cholangiopancreatography ma Novorossiysk

Endogopika retograde cholangiopancreatography (RCHP) kekahi o nā lāʻau o ka diagnostics instrumental, ma ʻIseraʻela ka mea e hoʻohana pinepine e nānā i nā maʻi o ka ʻalā o ka gastrointestinal.

Ma ke kikoʻī o RCHP, hiki ke ʻike i nā maʻi patency (ka ʻāpana a me ka ʻōpiopio paʻa loa) o nā kumu o ka bile a me ka pancreatic, ka hele ʻana o nā pōhaku, nā tumors a me nā kūlana pathological ʻē aʻe. Ma ke kikowaena Meir Medical Center, hoʻomaʻamaʻa ʻia nā RCP ʻaʻole wale no nā maʻi diagnostic, akā no nā kumu therapeutic wale nō.

I ka wā o ke kaʻina hana, hiki iā ʻoe ke hoʻihoʻi i ke ʻano o nā papa o nā papa, no ka laʻana, e hoʻowalewale i nā pōhaku a hoʻokomo i ke kākoʻo kākoʻo.

Nā hōʻailona no ka cholangiopancreatography

Jaundice a i ʻole ʻehaʻeha o ka ʻōpū e ʻike ʻole i ka etiology
Nā ʻōpala i hoʻopaʻa ʻia a i ʻole nā pōhaku bile duct
ʻO nā maʻi o ka ate, pancreas, tractary tract
Hoʻokomo a hoʻoweliweli wale ia i nā dile bile ma muli o ka cholelithiasis
ʻO ka pancreatitis
Biopsy a i ʻole kūlike
ʻO ka manometry - e ana i ke kaomi i loko o ke kumuiki o ka gallbladder a ma ka maʻamau cile dile

ʻO ka hoʻomākaukau no ka cholangiopancreatography endoscopic

Inā loaʻa iā ʻoe kahi kaʻina HRCG, e ʻimi ʻoe i nā ʻōkuhi ma lalo:

ʻO ka papa ʻai hope e ʻae ʻia 8 mau hola ma mua o ke kaʻina hana. Ma hope o kēia, e pale i ka ʻai ʻana a, inā hiki, mai ka inu ʻana. Inā ʻoe i kuhikuhi i nā lāʻau lapaʻau no ka hypertension a i ʻole nā maʻi cardiovascular ma ka maʻamau maʻamau, ʻaʻohe mau manawa ma mua o ʻekolu mau hola ma mua o RCP, hiki iā ʻoe ke lawe i ka lāʻau lapaʻau e pono ai a inu iā ia me ka inu wai. Ma hope o kēia, pāpā paʻa ka wai wai.
ʻO ka hoʻohana ʻana i nā lāʻau lapaʻau e hōʻemi i ka coagulation koko (coumadin, synthroma) pono e hooki ʻia ma ka hebedoma ma mua o ka lā o RCP. Hiki ke hoʻomau i ka aspirin me ka palena ʻole. E kūkākūkā i kēia pilikia me kāu mea mālama ola olakino.
Hoʻopili ʻia ke kaʻina hana me ka hoʻohana ʻana i nā hana sedatives, e hoʻolilo i ka puʻupuʻu pōkole ʻoi pōkole. No laila, kauoha ʻia e hōʻea i ke kikowaena lapaʻau me kahi escort a i ʻole e hoʻokele i kahi kaʻa i kēlā lā.
ʻAe ʻia ka poʻe maʻi e loaʻa i ka insulin e loaʻa i kahi maʻi i ka wana i kakahiaka. Pono e lawe ʻia ka syringe insulin.
Hele mai i ke kaʻina hana i nā lole hoʻonaninani a me nā mea ʻole.
Ma mua o ke kaʻina hana, pono e huki i ka pahi, hoʻoneʻe i nā niho a me nā lente e hoʻopili.

Ke kaʻina hana RCHP

Hoʻololi ʻo ECHO i ka hana ʻana i ka diagnangiic a me ka cholangiopancreatography therapeutic e hoʻohana ana i nā lako o kēia wā - nā ʻāpana haʻalulu palupalu i loaʻa ka optical fiber.

Hoʻopili ʻia ka endoscope me kahi kāmele wikiō liʻiliʻi e hoʻouna ana i nā kiʻi kiʻekiʻe ma kahi kāʻei loiloi i hoʻonohonoho ʻia i loko o ka lumi mālama.

Eia pū kekahi, me ke kōkua o ka endoscope, hiki ke hoʻopili ʻia nā mea hana kūikawā i ka pānaʻi ʻana o ka mea maʻi e hana pono i ka hoʻomaʻamaʻa pono ʻia.

ʻO ka lōʻihi o ke kaʻina hana mai 30 a 60 mau minuke. Ma hope o ka hoʻopau ʻana, pono ka mea maʻi i nā kiaʻi o nā limahana lapaʻau no 1-2 mau hola. Inā hoʻomaʻamaʻa ʻia nā hoʻomaʻamaʻa olakino i ka wā RCHP, hiki i ka mea maʻi ke noi ʻia e noho i loko o ka haukapila a kakahiaka aʻe.

I mea e hoʻomaʻamaʻa ʻia ai ke kahe o ka endoscope ma o ka waha a me ka pharynx, hoʻohana ʻia kahi mea hoʻohana kūloko. Ma mua o ka hoʻomaka ʻana i ke kaʻina, e mālama ʻia nā mea hoʻohālike a me nā mea hōʻeha i ka mea maʻi. I ka laulā, ʻaʻole ʻeha a ke kaʻina me ka ʻoluʻolu ʻole. He liʻiliʻi ka loa o ka endoscope a ʻaʻole iʻoi aku ka nui o ka ʻāpana meaʻai i hoʻomāʻino ʻia e kekahi kanaka me ka meaʻai.

Hōʻalo ke kauka i ka endoscope ma o ka esophagus a me ka ʻōpū, e nānā ana i ko lākou ʻaoʻao o loko, a hōʻea i ka duodenum, kahi i hāwili ʻia ai ka limahana a me ka pankowatic.

Hoʻokomo ʻia kahi hau liʻiliʻi i loko o ka lua duodenal, a hoʻokomo ʻia ka mea hoʻonanea i nā ʻāpana o ka puhaka a me ka pancreas. A laila e hana i kahi kuʻina o nā x-ray. I ka wā o ke kaʻina hana, hiki ke loli i ke kūlana o ka mea maʻi: e hoʻohuli iā ia ma kona ʻaoʻao a i ʻole kona ʻōpū.

Pono kēia no ka ʻikeʻana o nā hana anatomical i ka wā radiography.

Ma o ke kahawai ma ka endoscope, hiki iā ʻoe ke kahakaha nā mea hana kūikawā liʻiliʻi e hana i kahi biopsy - lawe i kahi santena mai ka wahi kānalua no ka nānā ʻana. Me ke kōkua o lākou, i kekahi mau manawa, hiki iā ʻoe ke wehe i ka pōhaku e pale ai i ka kahe mai o ka bile, a i ʻole e hoʻokae i kahi stent.

ʻO ka stent he pahu a pala paha paha. Kākoʻo ia i nā paia o ka papa o ka bile a i ʻole ka papa pancreatic i mea e pale ai i kona mau ala (ʻōpiopio).

ʻO kekahi o nā hōʻailona no ka stenting ka hele ʻana o kahi ʻōpala e pāpā ai i ka lumen o ka loko a i ʻole ka māhele o ka nipple o Vater - kahi i komo ai nā kumu i ka duodenum.

Ma hope o ka hoʻopili ʻana i ke kaʻina hana, lawe pono ʻia nā endoscope.

ʻO ke kaʻina hoʻolaʻa

Ma kahi o kahi hola ma hope o RCP, hiki iā ʻoe ke hoʻomaka e inu. I ka lā mua ua ʻōlelo ʻia e hoʻohana i nā mea inu wale nō a me ka meaʻai ʻaʻai-ʻo e like me ka meaʻai.

E kāhea i ka lumi ākea o ka haukapila inā loaʻa kekahi o kēia mau ʻano hōʻailona:

ʻOi aku ma luna o 38 mau degere
ʻEha ka ʻōpū
Hoʻohuʻi me nā ʻāpana o ke koko
ʻO ka huhū lae, ʻōpala ʻeleʻele

Ligation ka varicose veins o ka esophagus

ʻO kahi ala endoscopic no ka mālamaʻana a me ka pale ʻana i ke kahe koko mai nā veins o ka esophagus a me ka ʻōpū.

Ma hope o kahi gastroscope me kahi nozzle kūikawā, hoʻomaka ka līpoki endoscopic me ka māhele o ka neʻe esophagocardial, ma luna aʻe o ka laina dentate. Hoʻokomo ʻia nā apo i loko o kahi kikoʻī, a hoʻokuʻu ʻia ma hope o ka node venous i koho ʻia i loko o kahi cylinder ma ka liʻiliʻi o ka hapalua o ke kiʻekiʻe.

No ka hālāwai (ma muli o ka nui o nā veins varicose) e kau i kahi 6-10 ligature.

E like me ke kānāwai, hana ʻia nā ligation ma nā apo loloa. Hiki ke hoʻokō ʻia ka hana o ke kahe elastic ma ka hīnaʻi nylon me ka diameter o 11 a 13 mm, e like me ka nui o ka cap distal.

Hoʻokahi pule ma hope o ke kaʻina hana, hana ʻia kahi endoscopy mana e loiloi i nā hopena o ka hōʻemi hōʻemi.

I ka hihia o ka hoʻoheheʻe ʻana i ke kahe, pono e hoʻihoʻi ʻia ka lōkomo endoscopic.

ʻO ka lōkōkōlani hope o nā lula esophageal

I kēia manawa, loaʻa kahi mākaʻi o ka nui o nā maʻi o ka puʻukū, inā paha, ka hōʻeha ʻana o ka ate ma ka hepatitis viral maʻi a me ka hōʻino ʻana i ka waiʻona a me nā lāʻau hepatotoxic, e hala ana i ka manawa e alakaʻi i ka cirrhosis.

ʻO kekahi nā mea hoʻopiʻi loa a me nā mana koʻikoʻi o ka maʻi hepatitis a me ka cirrhosis ʻo ka hoʻokumu ʻana o nā veic varicose o ka esophagus a me ka ʻōpū, ma muli o ke kahe mai o ke koko ma o ke ake, kahi ma 50% o nā hihia i hele pū me ka hoʻōho nui ʻana. ʻO ka make me ke kōkua ʻole, me ke kōkua mua o ke kahe koko he 30-40%, a me ka hoʻoiho pinepine ʻana he 70%.

Pono ka Fibrogastroscopy no nā maʻi āpau me ka cirrhosis o ke ake o nā ʻano kumu, me ka mea maʻi me ka hepatitis maʻi maʻi, no ka mea ʻO ka pinepine o ka hoʻomohala ʻana o nā maʻi varicose i mua o ka hoʻomohala ʻana o ka manawa cirrhotic o ka hepatitis maʻi.

He nui nā hana o ka hana ʻulepule i manaʻo ʻia e hoʻopau i nā varicose veins, i ʻae ʻia i ka maʻi maʻi e hōʻemi ʻia o ka puʻuwai, a he traumatic a hoʻopili ʻia me ka make nui.

No laila, ua ʻae ʻo endoscopy i kahi koʻikoʻi ma ka maʻi a me ka mālama ʻana i nā maʻi varicose o ka esophagus a me ka ʻōpū.

ʻO ka lōkōkōlani hope o nā lula esophageal

ʻO ka līpoti endoskopika o nā veins dilated o ka esophagus i loko o ka ligation o nā nū varicose me ke kōkua o nā kaula elastic liʻiliʻi. Kuhi ʻia kahi gastroscope maʻamau me ka nānā i ka hopena o ka hopena i loko o ka lalo haʻahaʻa o ka esophagus a me kahi mea hou aku e hana ʻia ma lalo o kāna kaohi. A laila e hoʻokaʻawale i ka gastroscope a hoʻopaʻa ʻia ka polokalamu ligation a hiki i kona hopena.

Ma hope o kēlā, ua hoʻopili ʻia ka gastroscope i ka esophagus mamao, ua hōʻike ʻia ka maʻi varicose a ua kuhi ʻia i loko o ka lumen o ka polokalamu ligation. A laila, ke kaomi ʻana i nā leve kawele i hoʻopili ʻia iā ia, kau ʻia kahi apo elastic ma luna o ka vein. Hoʻomaʻamaʻa ʻia ke kaʻina a hiki ke hoʻōla ʻia nā varicose veins.

Ma kēlā me kēia pākuʻi ʻia mai 1 a 3 mau apo.

ʻO ka līpoti Endoskopika o nā veins dilated o ka esophagus e hāʻawi iki i nā hoʻopiʻi hou aʻe ma mua o ka sclerotherapy, ʻoi aku ka nui o nā ʻoi aʻe e koi i nā varicose veins. ʻO ka hoʻopiʻi pinepine loa ʻana ʻo ia ka transsp dyagia, ʻo ka hoʻomohala ʻana o ka maʻi bacteria.

Hiki i kahi hoʻokūkū keu hiki ke hoʻowalewale i ka esophagus. Ma nā wahi e kau ai i nā apo, e hiki i nā ulia ke ulu. Hōʻalo ʻia nā apo, e hoʻoheheʻe nui ai.

No laila, ʻāpono mākou i nā ligation o nā dilated veins o ka esophagus wale nō i nā keʻena lapaʻau kūikawā.

ʻO ka hoʻonāukiuki o nā vein varicose e hoʻohana ana i nā apo i hoʻohana ʻia i ka hana hōʻeha e hoʻopau i ke kahe mai nā nū ʻana o nā veʻa varicose o ka esophagus. Eia nō naʻe, ʻo ka hana ʻana i ka hana ma nā kūlana o ke koko e holo paʻakikī ana, ʻoi aku ka paʻakikī, a me ka loaʻa ʻole o ka radicalism kiʻekiʻe.

No laila, ke noi aku nei mākou e loaʻa i nā maʻi āpau me ka cirrhosis o ka ate a me ka maʻi hepatitis viral e hoʻomaʻemaʻe i ka gastroscopy i ka manawa kūpono, inā pono, hana i ka ligation a pale i ke koko.

Endoscopic retrograde pancreatocholangiography a me ka papillosphincterotomy no ka lae pāpaʻi

ʻO Bregel A. I. (ke poʻo o ka keʻena ʻo ka endoskopika, luna ʻohana o ke keʻena o ka hana kūpono i ka loina)
Andreev V.V. (endoscopist), Yevtushenko V.V. (endoscopist), Borkhonova O. R. (radiologist) MAUZ Clinical Hospital No 1 o Irkutsk,
Ke Kulanui Kauʻāina ʻo Irkutsk State

ʻO ka Endretopic retrograde pancreatocholangiography (ERCP) kahi ala hilinaʻi loa loa no ka nānā ʻana i ke kumu o ka jaundice, a me ka papillosphincterotomy (EPST) ʻo ia ke kōkua maikaʻi a minimally invasive no ka pale hewa ʻana i ka pōpoki i loko o ka duodenum (duodenum). Hana ʻia ka noʻonoʻo e like me nā hōʻike koʻikoʻi i nā lā 1-3 mua o ka noho ʻana o nā mea maʻi i ka haukapila.

Ua hōʻike ʻia nā hopena o ERCP a me EPST no 5 mau makahiki ma 312 i nā maʻi maʻi.

Ma 240 nā mea maʻi, ua lawe ʻia kahi loiloi o nā moʻolelo mōʻaukala, a ma ka 72 - wale nō nā protocols o nā haʻawina endoscopic wale nō. Ua lawe ʻia nā haʻawina i nā hihia paʻakikī no ka hōʻike o ka lāʻau ma ka maʻi a, inā pono, i ka hoʻokō ʻana i ka EPST. Inā loaʻa nā hōʻailona i nā maʻi 265, ua hoʻokau ʻia ʻo EPST. He 86 kāne (27.56%), 226 wahine (72.44%).

Ua helu ʻia nā maʻi e nā makahiki e like me kēia: 14 (4.49%) mau mea maʻi ma lalo iho o 30 mau makahiki he 6, 6 (1.92%) mau makahiki 31-40 mau makahiki, 24 (7.69%) mau maʻi he 41-50 mau makahiki, 58 (18.59%) nā mea maʻi - 51-60 mau makahiki, 76 (24.36%) nā mea maʻi - 61-70 mau makahiki ʻokoʻa, 89 (28.53%) mau mea maʻi - 71-80 mau makahiki a 45 (14.42%) mau mea maʻi ma mua o 80 mau makahiki.

I nā makahiki 3 i hala iho nei, ua hoʻonui ka nui o nā poʻe maʻi a me nā poʻe senile mai ka 62.67% a 68.13%.

I ka nui o nā mea maʻi, ua nui ka paʻakikī o ke kūlana ma ka loaʻa ʻana o nā ʻano maʻi like ʻole: hypertension (75), maʻi ʻeha coronary (73), pilikia kūloko (4), myocardial infarction (4), ulia duodenal (4), maʻi mellitus (3) ) a me kekahi.

ʻO ka loiloi ultrasound (ultrasound) o ka biliary tract ka mea i hōʻike ʻia nā pōhaku dile ma 1667% o nā maʻi, ʻaʻole i hoʻopaʻa ʻia ʻo choledocholithiasis ma 60.83% o nā maʻi, a me ka hele a ʻaʻole i kūlepa i ka lāuli ma ka choledochus ʻaʻole i hilinaʻi ʻia ma ke kumu o ka nānā ʻana i ka ultrasound ma 22.20% o nā maʻi. I ka hapa nui o nā poʻe maʻi me ka ultrasound, ua hoʻonui ʻia ka dile bile maʻamau i nā pae like ʻole.

Hana ʻia ka scan tom tom (CT) i nā mea maʻi 13 (5.42%).

I ka 5 o lākou, ua ʻike ʻia ʻo CT me ka pancreatitis e luku ʻia ai, ma 3 - choledocholithiasis, a ma 2 mau mea maʻi hou aʻe o nā maʻi hepatopancreatoduodenal.

ʻO ke anawaena o ka nipple duodenal nui (BDS) ma mua o ka 5 mm. Kūlike mākou i nā ʻano akahi o ke ʻano o ka waha o ka BDS. I ka hapa nui o nā mea maʻi (266) a i ʻole 85.26% ua puni ia, i 33 (10.58%) nā mea maʻi ua hoʻohālikelike ʻia ka waha, ma 5 (1.60%) nā mea maʻi he mea pōʻino, a ma 3 (0.96%) - wahi puka, a me 4 (1.28%) he ʻano like.
Loaʻa ka hoʻokaʻawale ʻana o nā kinipōpō Byp i nā maʻi 39 (12.50%). Ma 15 (4.81%) o lākou, aia ka wehe nipple i loaʻa i ka diverticulum parapapillary o ka duodenum a ma ma (24 (7.69%)) nā mea maʻi ma ke kihi o ka diverticulum.
I nā 19 (5.56%) mau maʻi, ua palena ʻia ka noiʻi ʻana i kahi wirsungography. I loko o 2 o lākou, aia ka BDS i loko o ka diverticulum, ma 4 - kokoke i ka diverticulum, a ma nā mea maʻi 13 he mau kumu ʻē aʻe e hana wale ai i kahi wirsungography.
Ma nā mea maʻi 30 ʻē aʻe, ʻaʻole hiki ke hoʻopili ʻia nā halihali, ʻoi aku ka nui o kahi wahi o ka atypical o ka BDS.
Ma hope o ka hoʻokomo ʻana i ka catheter i loko o ka lua BDS, ua hoʻokō ʻia ka hōʻike hōʻike ʻana ma kahi o 1-2 ml o kahi ʻano hoʻonaninani wai ʻole o 50% (verographin, urographin, etc.). I ka pau ʻana o ka catheter i loko o ka ʻōnaehana wai, i hōʻoia ʻia e ke kiʻi o ka choledochus hoʻohālikelike i ka loiloi, ua kū i ke ala o ka ate.

ʻO ka hohonu o ka hoʻopili ʻana i ka catheter i loko o nā kaile bile he ʻano like loa a mai ka 1 i ka 12 cm, e like me ke ʻano o ke kaʻina pili, nā pilina anatomical o ka ʻōnaehana wai, duodenum, BDS a me nā mea like ʻole.

Ua hoʻohālikelike ʻia nā kumu kāwili a me ke kīpili uila i ka hoʻokō o 20-30 ml o ka wai o 50% e hoʻomāhala ai ka hoʻokahe wai i ka manaʻo o kona neʻe ʻana ma ka ʻaoʻao o nā bile ma ka lepa. Ma hope o ka hoʻopiha ʻana i ka ʻōnaehana wai a me ka gallbladder me kahi māka kūʻokoʻa, lawe ʻia ka lā 1 a 3 x-ray.

Ma hope o ka radiography, holoi ʻia nā papa me ka hoʻonā a 0.5% novocaine. Wahi a nā hōʻailona no nā hōʻailona o ka cholangitis, ua paʻi ʻia ka lumen choledoch me kahi hopena antibiotic.

Ua hoʻokumu ʻia ka maʻi ma hope o ka pancreatocholangiography retroscade endoskopika ma ke kumu o nā hōʻailona endoskopika o ka maʻi, nā hopena o ke kanalization ʻana o ka BDS me ka holomua o ka catheter ma nā ʻaoʻao o ka bile, ke ʻano o ka pālahalaha ʻana i ka hoʻohālikelike ʻia ma nā ʻaoʻao o ka pale kāʻei a me nā ʻike x-ray.

Wahi a ERPC, ʻo ka lōʻihi o nā maʻi bile maʻamau ma 32 (10.92%) mau mea maʻi ma lalo o 6 mm, ma 73 (24.91%) nā mea maʻi mai 7 a 10 mm paha, ma 100 (34.13%) nā mea maʻi he 11-15 mm. 68 (23.21%) nā maʻi he 16-20 mm, a he 20 (6.83%) nā mea maʻi ma mua o 20 mm.

Wahi a nā hopena o ERCP, ua ʻike ʻia nā kumu ʻoiai ʻo Jaundice.

I nā manawa pinepine - i ka makahiki 193 (61.86%) i loaʻa nā pōhaku maʻi i nā maʻi bile maʻamau, ma 46 (14.74%) nā mea maʻi - microcholecholithiasis, ma 5 (1.60%) nā mea maʻi - nā maʻi dile bile, i loko o 3 (0.96%) - ʻO ka adenoma BDS, i loko o 2 (0.64%) nā mea maʻi i loaʻa kahi poloka intrahepatic i hōʻikeʻia a loaʻa i ka mea maʻi 1 (0.32%) kahi maʻi maʻi maʻi pancreatic i hōʻike ʻia. Ma 50 (16.03%) nā mea maʻi me ERPC, ʻaʻole i hoʻokumu ʻia ke kumu o ka Jaundice, a i ʻole i haʻalele ʻia ke ʻano o ka jaundice.

Ua hana ʻia nā Endillopic papillosphincterotomy (EPST) e ka cannulation a me ka non-cannulation ma 265 (77.49%) nā mea maʻi. ʻO ka lōʻihi o ka huhū o ka papillotomy a hiki i 10 mm i nā 126 (47.55%) nā mea maʻi, 11-15 mm ma 114 (43.02%) nā mea maʻi, a me 16-20 mm o 25 (9.43%) nā maʻi (Fig. 1 )

Ma hope o ka EPST, i ka wā o ka hoʻokalakupapa i ka endoskopika, ua lawe ʻia ka calculi mai nā papa bile i ka nui o nā maʻi 133 (Fig. 2), a i nā poʻe maʻi 110, ʻaʻole i loaʻa nā pōhaku i nā papa.

I nā poʻe maʻi maʻi 69, ʻaʻole i lawe ʻia nā pōhaku mai nā kahe umauma maʻamau.

ʻO nā kumu i ʻole i ʻae ʻia e neʻe ʻia nā pōhaku mai ka papa o ka bile maʻamau i ka wā o ka endoscopy ka nui ka nui o ka calculi (54), i ka paʻa ikaika ʻana o nā pōhaku i nā papa lepo (13), a me nā kumu ʻē aʻe (2).

Nā hopena ma hope o ko ERCP i nānā ʻia ma nā mea maʻi 36 (15.00%).

Kūkulu ʻia mai kahi kuhi papillotomy i hele mai i ka poʻe maʻi (23,58%) i nā maʻi maʻi he 22, ma nā mea maʻi 22 ua paʻa ia i ka wā o duodenoscopy, ma 2 mau hou i ka pau ʻana o ka hoʻopaʻa ʻia. Me ka hoʻi hou ʻana o ke kahe i loko o kahi maʻi hoʻokahi, ua hana maikaʻi ʻia ka hemostasis endoscopic, a ua mālama ʻia 1 ka mea maʻi.

Hoʻokumu ʻia ka pancreatitis hakakā i loko o nā mea maʻi 5 (2,08%), ka hoʻihoʻi o ka umauma bile maʻamau i 6 (2.50%) nā mea maʻi, e hoʻokaʻawale ana i ka duodenum ma 1 (0.42%) a me ka papillitis i 1 (0.42%) o ka mea maʻi.

A laila, hana ʻia nā mea maʻi (43.33%) ma. Ua hana ʻo ia i ka cholecystectomy, ka mea i hui pū ʻia me nā cholobolny i hui pū ʻia me ka choledochotomy, ka hoʻoneʻe ʻana i ka calculi mai ka punawai bile maʻamau, ka hoʻokau ʻana o ka choledochoduodenostomy a me nā koho ʻē aʻe no ka hoʻoheheʻe ʻana o nā kumu bile. I nā mea maʻi 9, ua kau ʻia kahi microcholecystostomy a ua hoʻohana ʻia nā mea maʻi 2 no ka maʻi pancreatitis maʻa.

Pēlā, ko mākouʻike me ka endoscopic retrograde pancreatocholangiography a me ka papillosphincterotomy ke hōʻoia i kā lākou ʻike nui a me ka hana therapeutic efficacy. ʻO ka ERPC a me ka ultrasound no ka choledocholithiasis e hāʻawi i ka hapa nui i hoʻokumu i ke kumu o ka jaundice, ka nui, ka helu o nā pōhaku a me ka diameter o ka choledochus.

ʻO kaʻikepiliʻikepili o ka ERCP me ka choledocholithiasis ke kiʻekiʻe i ka ultrasound.

Ma mua o ka calculi i loko o ka choledochus, pono e hoʻopau ʻo ERPC i ka EPST me ka lawe ʻia ʻana o nā pōhaku mai nā kumu bile.

I ka manawa like, pono e hoʻomaopopo i ka hiki o nā hōʻeha koʻikoʻi i ka wā o ka ERCP a me HEPT. Hiki ke hana i kēia mau aʻo ʻana me nā mea hana endoskopika o kēia manawa, kahi anesthesia lawa, nā endoscopist hoʻokūkū a me nā kauka.

Hoʻohālikelike ʻO ko mākouʻike i ka nānā ma ka endoskopika a me ka mālama ʻana i nā maʻa maʻi gastroduodenal i hōʻoia i ko lākou hana kiʻekiʻe. ʻO ka endoscopy Therapeutic i hui pū me ka lāʻau mālama conservative i hiki iā ia ke hoʻokō i ka hemostasis ma 98.3% o nā mea maʻi a pale i ka hōʻemi hōʻemi ma ka 95,5% o nā maʻi.