Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) ndi njira imodzi yamakono komanso yothandiza kwambiri yodziwira matenda azachipatala, omwe amakupatsani mwayi wofufuzira matenda ndikupereka mankhwala othandiza kwa wodwala. Pansipa tikambirana zazikuluzikulu za njira yodziwitsira, zomwe zikuwonetsa kukhazikitsa kwake komanso zina zomwe madokotala ndi odwala akukumana nazo.

Kodi ndi chiyani ndipo lingaliro la kuchitapo kanthu?

ERCP ndi njira yapadera yoyesera yomwe imagwiritsidwa ntchito matenda a bile ducts ndi kapamba. Zimaphatikizanso kugwiritsa ntchito zida za X-ray ndi ma endoscopic, kuphatikiza komwe kumakupatsani mwayi wodziwa bwino ziwalo zomwe zapimidwa. Njira yofunsirayi idagwiritsidwa ntchito koyamba mu 1968. Mpaka pano, polingalira za chitukuko cha mankhwala, zakhala zikuyenda bwino kwambiri. ERCP imakupatsani mwayi wofufuza ngati muli ndi kudalirika kwakukulu, kuzindikira chithunzi cha matendawa ndikutsata njira zochizira.

Endoscopic retrograde cholangiopancreatography imachitika ndikuyambitsa endoscope mu duodenum, pomwe imalumikizidwa pakamwa pa duodenal papilla wamkulu, probe yokhala ndi njira yapadera yoperekera njira yosiyanitsira imakokedwa kudzera pa njira ya endoscope. Zinthuzi zikamalowa mthupi kudzera mu njira, katswiriyo amatenga zithunzi za malo omwe aphunziridwa pogwiritsa ntchito zida za x-ray. Kutengera ndi zithunzi zomwe zapezeka, matenda ena amadziwika. Kuchita ERCP titha kugawidwa m'magawo otsatirawa:

Kuyang'ana duodenum ndi duodenal papilla
Mapangidwe a papilla ndi kuyambitsa kwa kusiyana kwapakati pa x-ray yotsatira,
Kudzaza mitsitsi ya maphunzirowa,
Kuyerekezera za X-ray,
Kuchotsa kusiyana pakati pa ma ducts,
Kupewa kosafunikira.

Kuti mugwire ntchito ya ERCP, chipangizo chokhala ndi zotengeka zamaso ndizofunikira - kusinthaku kumathandiza kuyesa ziwalo zamkati moyenera. Probe, yomwe imadutsa mu endoscope, imakhala ndi cannula yapadera yopangidwa ndi chinthu chambiri, chomwe chimazungulira mbali ina kuti ikwaniritse bwino ma ducts ndi chinthu cha radiopaque. Monga lamulo, endoscopic retrograde cholangiopancreatography imachitika mu chipinda cha X-ray kuchipatala.

Mawonekedwe akukonzekera njirayi

Monga tanena pamwambapa, ERCP imatheka pokhapokha pachipatala. Asanayambe kulowererapo kwa endoscopic, ayenera kubaya jakisoni wothandiza, amene amathandiza kuti wodwalayo asade nkhawa. Popeza njirayi ndiyovuta kwambiri ndipo nthawi zina imakhala yopweteka, jakisoni wotere amakhala chinthu chofunikira pokonzekera ERCP. Nthawi zina, kuyambitsa masisitere kumatheka osati patsiku la njirayi, komanso usiku, ngati pali kuwonjezeka kwamanjenje kwa wodwalayo.

Pamaso pa njirayi, wodwala sayenera kudya chakudya ndi kumwa madzi - ERCP imachitika kokha pamimba yopanda kanthu. Hafu ya ola limodzi isanayambike njira yobwezeretsanso cholangiopancreatography, intramuscularly anagwiritsa ntchito mayankho a atropine sulfate, platifillin kapena metacin osakanikirana ndi mayankho a diphenhydramine ndi promedol. Izi zikuthandizira kukwaniritsa mpumulo wa duodenum ndikuloleza njira ya ERCP yopanda njira. Komabe, panthawi imodzimodzi, kukonzekera kwa morphine ndi morphine sikulimbikitsidwa mwapadera monga ma painkiller, chifukwa angayambitse kuchepa kwa Oddi sphincter. Ngati, ngakhale pakukhazikitsidwa kwa mayankho omwe ali pamwambapa, matumbo a matumbo akupitiliza, ndiye kuti musanabwezeretse cholangiopancreatographs, tikulimbikitsidwa kuperekera mankhwala omwe amachepetsa matumbo a ntchito. Ambiri mwa iwo ndi buscopan ndi benzohexonium.

Zizindikiro zazikulu za njirayi

ERCP ndi njira yovuta yolowerera, yoikika motsatira ndondomeko. Monga lamulo, zizindikiritso zazikulu zomwe zikuwonetsa kufunikira kwazidziwitso ndi kupezeka kwa ululu wam'mimba chifukwa cha kuvulala kwa bile duct patency chifukwa cha miyala, zotupa, ndi mitundu ina. Pankhaniyi, Zizindikiro ziyenera kukhala zovomerezeka kuti tipewe zolakwika zomwe zingachitike pakuzindikiritsa komanso kulandira chithandizo chotsatira.

Ngati tikhazikika pa izi mwatsatanetsatane, ndiye chifukwa chachikulu chochititsira ERCP ndi mitundu yamatendawa:

Jaundice wowopsa chifukwa cha mapangidwe okhwima (kupatulira) wamba duct, stenosis ya duodenal papilla kapena choledocholithiasis. Yotsirizira, imadziwoneka ngati yovuta pambuyo pa matenda a gallstone, pomwe miyala imangika mu mainini ducts ndikusokoneza mawonekedwe awo. Ululu m'matenda oterowo umatulutsidwa mu hypochondrium yoyenera ndipo umatha kuperekedwa kudzanja lamanja, lumbar, scapular ndi subscapular dera.
Chiwopsezo cha khansa ya kapamba. Kwenikweni, kukhalapo kwa chotupa choyipa kumakhazikitsidwa pogwiritsa ntchito ultrasound kapena complication tomography, koma nthawi zina njira zoterezi sizingakhale zothandiza. Kungotengera zoterezi, ndikotheka kugwiritsa ntchito ERCP ngati njira yoyeserera.
Matenda kapamba ndi zina.
Kukhalapo kwa pancreatic fistula ndi chizindikiritso cha njira zawo zoyenera.
Kuzindikiritsa Zizindikiro zoonjezera zochizira.

Mwanjira ina, musanachite izi, muyenera kuwunika bwino ngati pali zizindikiro zoyenera. Ndiye chifukwa chake muyenera choyamba kudziwa wodwala kuchipatala ndikuwongolera momwe aliri.

Chachikulu contraindication ndi zovuta

Popeza njira ya ERCP imalumikizidwa makamaka ndikulowerera kwakowerera, pali malire ndi mawonekedwe ake ogwiritsira ntchito. Pankhaniyi, kuphwanya kwakukulu kungatengedwe mkhalidwe uliwonse wa thupi momwe kulowererapo kwa endoscopic sikuloledwa.

Kuphatikiza apo, ngati wodwala angavomerezane ndi mankhwala omwe amalowetsedwa m'thupi pakukonzekera ndi kuchita kwa ERCP, kuzindikira kwa njira imeneyi sikungatheke.

Chimodzi mwazomwe zimayambitsa kupanikizika ndi kapamba kapamba kapena kuchepa kwa chifuwa.

Ngati matenda omwe atchulidwa pamwambawa atha kudziwikanso chifukwa cha kutsutsana kwadzaoneni, zinthu zotsatirazi ziyenera kukhazikitsidwa, koma osasiya mwayi wodziwika ndi matendawa:

Mimba
Matenda a mtima
Matenda a shuga ndi insulin
Kulandila kwa anticoagulants (mitundu yodziwika bwino imaphatikizapo aspirin).

M'mikhalidwe iwiri yomaliza, madokotala amalimbikitsa kusintha mlingo wa mankhwalawo kapena kusintha mankhwala kuti akhale mankhwala omwe samasokoneza ERCP.

Mwambiri, njira ya ERCP simakhala mayeso owopsa amoyo, komabe, zovuta za genesis zingapo zitha kuchitika pambuyo pake. Mavuto ambiri ndi matenda am'matumbo, kutsuka kwamatumbo, komanso magazi.

Komabe, akatswiri azachipatala oyenerera amatsutsa kuti ndizotheka kuchepetsa zovuta zomwe zingachitike ngati njira zopewetsedwako zimachitika. Choyamba, atazindikira kuti wodwalayo watha, wodwalayo ayenera kukhala maola angapo kuchipatala moyang'aniridwa ndi madokotala. Zomverera zosasangalatsa mu larynx pambuyo poti aike kafukufukuyo zitha kuchepetsedwa ndi khosi lozenges. Matenda a wodwalayo ayenera kukhazikika kwa maola 24 atatha matendawo atapezeka. Ngati zizindikiro monga kuzizira, chifuwa, kusanza ndi mseru, kupweteka kwambiri pamimba ndi chifuwa zimayang'aniridwa, ndiye kuti ndizofunikira kuti mudziwitse dokotala za iwo. Kukhalapo kwa zizindikiro zotere, monga lamulo, kumawonetsa zolakwika zomwe zimachitika panthawi yodziwitsa.

Chifukwa chake, kuchita bwino komanso mwaluso kwa ERCP kumakupatsani mwayi wodziwa wodwalayo momwe mungakhalire wodwalayo popanda kuvulaza thanzi komanso zotsatirapo zina zoyipa.

ERCP (endoscopic retrograde pancreatocholangiography)

ERCP ndi mawonekedwe a X-ray endoscopic a ziwalo za pancreatobiliary zone (duodenum, duodenal papilla, ducts bile, dancts, pancreatic duct.

Chinsinsi cha njirayi ndikuwunika kwa ma lumen a duodenum, duodenal papilla, ngati kuli kotheka, kutenga zitsanzo zazing'ono za mucous membrane (biopsy) yoyeserera zasayansi, komanso kupeza zithunzi za x-ray za kapangidwe ka kanyumba kamene kamayesedwa. Izi zimatheka pobweretsa esophagogastroduodenodenoscope mu duodenum, kudzera mu njira yolumikizira yomwe cannula imadutsa mu lumen ya bile ndi / kapena pancreatic kudzera mu duilla ya duodenal, ndikuwadzaza ndi X-ray zida. Iyi ndi njira yolumikizana yotsatana ndi ma radiology. Esophagastroduodenoscopy ndi chipangizo chapadera, chomwe chimasinthasintha, chimakhala chachitali, chachitali chofufuzira chokhala ndi fiber-optic fiber kapena chip video, chomwe chimakulolani kuti musamutse chithunzicho kuchokera mkati mwa thupi lanu ndikuwunikira.

Zida zapadera zimachitika panjira yolumikizira esophagogastroduodenoscope (cannulas yodziwitsa yankho, mafupa, mabasiketi otulutsa miyala, mipeni ya papillotomy yopangira tinthu tating'ono ndi zopinga, ndi zina).

Zambiri pazokhudza thanzi lanu, zopezeka mothandizidwa ndi esophagogastroduodenoscopy, ndizopadera ndipo zitha kutero, mutazindikira moyenera, kuti musankhe njira yoyenera yamankhwala.

An esophagogastroduodenoscopy amachitika mkati mwa esophagus, m'mimba ndi duodenum, kubwereza zopindika zawo. Uku ndi kuphunzira kopweteka, koma mutha kukumana ndi mavuto ndipo mutha kukumana ndi zovuta.

Kutengera ndi matenda omwe adadziwika, kulowererapo kosiyanasiyana kapena kuphatikiza kwawo pazinthu za pancreatobiliary zone:

ERPHG (kubwezeretsa cholangiopancreatography) - kukhazikitsidwa kwa X-ray kusiyanasiyana mu dongosolo la duct ndi kufalitsa,
EPT (endoscopic papillosphincterotomy) - magawano a papilla wa duodenal ndi ma ducts,
EPD (endoscopic papillosphincterodilation) - yotambasulira kwa papilla ya duodenal ndi ducts,
LITHOTRIPSY NDI LITHOEXTRACTion - chiwonongeko ndikuchotsa miyala kumiyeso,
Stinging and prosthetics of the ducts - kukhazikitsidwa kwa machubu apadera (stents, prostheses) kuti awone kutuluka kokwanira kwa bile ndi / kapena pancreatic madzi mu lumen ya duodenum.

Mtundu wa kuphatikizira kwa mitundu yolumikizana komanso kuyesa kwa X-ray kwachitika kwa zaka makumi angapo, njira ndi lusozi zaphunziridwa mokwanira, madotolo apeza luso lochita bwino, komabe, muzochitika zochepa kwambiri, kuchitapo kanthu kumatha kuchitidwa osakwanira kapena ndi zovuta. Zambiri zimatengera kapangidwe kanu ka ziwalo zanu, kupezeka kwa matembenuzidwe, matenda am'mbuyomu, kuchepera, kusintha kwa ziwalo zapafupi, kutulutsa kamvekedwe ka khoma lamatumbo, komanso kuchuluka kwa kupweteka kwanu komanso kumva kwanu. Nthawi zina kusintha kumeneku kumakhala kovuta kuthana ndi vuto la endoscopic ndipo ndizotheka kuzizindikira pokhapokha pazokha. Kuphatikizika kwa kulowererapo (komwe kukuwonetsedwa patebulo pansipa) ndi kufalikira kwa kapamba. Mosalephera, timagwira ntchito zomwe tikufuna kupewa mavuto. Tili ndi zonse (zokumana nazo, luso, chidziwitso, zida, mankhwala, gulu logwirizana la akatswiri othandizira opaleshoni ndi ma opaleshoni) kuti tikonze ndikuchepetsa zotsatira za zovuta.

Njira yofufuzira ya X-ray endoscopic ndi njira yolondola komanso yodalirika yodziwira komanso mtundu wovomerezeka wa matenda ambiri a pancreatobiliary zone, omwe amapeŵa opaleshoni yam'mimba. Chifukwa chake, chiwopsezo cha zovuta mu njirayi ndi chotsika kwambiri, komanso kulekerera kwa odwala kumakhala kosavuta ndikachira msanga.

Njira ya ERCP

Chida chapadera chikalowetsedwa pakhosi, dokotalayo amapatsirana mosamala kudzera m'mero, m'mimba ndi duodenum. Chipangizocho chikuyenera kufikira pomwe bile duct ndi pancreatic duct zimalumikizana. Pamalo ano, phokoso lalikulu la duodenal papilla limapangidwa, ndipo pakamwa pake pamakhala kuwala kwa duodenum.

Chipangizocho chitakhala koyambirira kwa chiwalochi, gastroenterologist imachita izi:

Katundu wapadera wa radiopaque imalowetsedwa mu kapamba ndi zimbudzi za bile.
Zida za X-ray zimakuthandizani kuti mupeze chithunzi cha duct system.
Ngati miyala ikupezeka pamalo owonera, ntchito ya endoscopic imachitidwa mwachangu, chifukwa chomwe patency imabwezeretseka ndikupanga miyala kuwonongeka.

Kukonzanso nthawi

Pambuyo pa ERCP, wodwalayo ayenera kukhala m'chipatala masana a nthawi yomwe akuwonetsa adokotala. Kutsiriza kumeneku kumachitika malinga ndi momwe thupi la wodwalayo limvera ndi zotsatira zake atazindikira. Monga lamulo, zinthu ziyenera kukhazikika masana. Kuchepetsa khansa kumathandizira kuti pakhale chisangalalo pakhosi.

Zizindikiro ndi contraindication

Kuzindikira kumachitika potsatira zomwe zikutsatirazi:

pachimake kutukusira kwa ma pancreatic ducts,
aakulu kapamba
chotupa choteteza
chotupa choganiziridwa mu kapamba kapena chikhodzodzo, kapena matenda a ndulu,
kufinya matumba a chikhodzodzo,
chizindikiritso cha endoscopic papillosphincterotomy.

Contraindication

Ndondomeko contraindicated kwa matenda:

pachimake kapamba
khansa ya kapamba
stenosis wa wamkulu duodenal papilla,
matenda othandizira
pachimake viral chiwindi,
cysts zovuta ndi magazi.

M'mikhalidwe yodwala ena, njira ndi yovomerezeka, koma yosayenera:

mimba
matenda a mtima
kutenga anticoagulants
matenda ashuga.

Mavuto

Akatswiri amati kuzindikira ngati kumeneku kungakhale kwabwinodi. Komabe, nthawi zina, zovuta zotsatirazi zingachitike:

matumbo mafuta
magazi
matenda am'mimba.

Zizindikiro zina zimafotokoza kuti zolakwitsa zinapangidwa munthawi ya njirayi. Mwa zina mwazovuta mungadziwike:

nseru
kuzizira
kusanza
kupweteka pachifuwa kapena pamimba.

Matenda a Mirizzy

Zipangizo zamakono. Njira ya ERPC ndi yovuta, imakhala ndi mayeso obisika am'munsi mwa mayeselogus, m'mimba, duodenum ndi BSC ndi X-ray kuwunika kwa ma pancreatic ducts ndi bile duct.

Kuchita ERCP endoscopes kusiyanasiyana ndi madongosolo amtundu wa kuwala ndi kupezeka kwa njira yolumikizira zida, yokhala ndi chida chomwe chimachitika.

Gastroduodenoscopes amapangidwa ndi makampani angapo akunja. Pali mitundu isanu ndi inayi ya chipangizochi. Kusiyana kwawo kofunikira kwambiri, komwe kumatsimikizira mtundu wa magwiritsidwe, ndi m'mimba mwake mwa chida chazida (kuchokera pa 2.2 mpaka 5.5 mm).

Njira yolowera m'mimba yaying'ono imakuthandizani kuti muzitha kuchita: 1) kulumikizira mphuno ya duodenal yokhala ndi catheter yotenga jakisoni wa sing'anga, 2) kuchotsedwa kwa calculi komwe kumakhala mu hepatico-choledochus, Dormia basket, 4) nasobiliary drainage.

Kutalika kwa zida zogwiritsira ntchito ndi chida chokhala ndi mulifupi mwake (3,3,3,7 mm) ndikofunikira kwambiri, chifukwa kuwonjezera pamanyengowo, zida izi zitha kugwiritsidwa ntchito kuwononga miyala mkati mwa duct yayikulu ndikutulutsa zofunikira. Mitundu iyi imapangidwanso kuti ikhale ndi kukokomeza, ma endoprosthetics komanso ngalande zokulirapo za nasobiliary.

Ma Endoscopes okhala ndi chida chokhala ndi mulifupi wa 4.2 mpaka 5.5 mm sindimasinthasintha.

Kugwiritsa ntchito mitundu iyi ya zida za ERPC kapena EPST kumalephereka ndi kuchepa kwapang'onopang'ono kwa gawo lakutali la gastroduodenoscope ndi kusiyana kwakukulu pakati pa mzere wa makulidwe ndi miyeso ya catheter ndi diathermosond ogwiritsidwa ntchito pacholinga ichi.
Nthawi yomweyo, ma endoscopes a kapangidwe kameneka ndiofunika kwambiri kuti chiwonongeko cha calculi chachikulu. Kuphatikiza apo, ngalande yothandizirana modabwitsa idapangidwa kuti izigwiritsa ntchito kukhetsa kwa mainchesi akulu kwambiri, ma bougienage komanso kununkhira kwa magawo a zinthu zokhazo za exthepatic bile duct.
Kutengera ndi zida izi, mather-baby tata adapangidwa, poyambirira adapangira transduodenal choledochoscopy, ndipo amagwiritsidwa ntchito posachedwa kuwononga calculi pogwiritsa ntchito ukadaulo wa laser.
Kuphatikiza pa ma endoscopes, zida zina zimafunikira kwambiri kuti zitheke kulowerera X-ray endoscopic, yomwe imayimilidwa mwapadera ndi Olimpiki, Pentax, Cook, ndi Fujinon.

Sizingatheke kutengera chilichonse mwazida izi mwatsatanetsatane chifukwa cha kuchuluka kwa kapangidwe kake, chifukwa chake tikhala pamalingaliro ofunikira kwambiri.

Zonse omvera cholinga cha ERPC, chitha kugawidwa m'magulu akulu atatu: 1) cylindrical or spherical distal end, 2) with endical distal end, 3) with conductor.

Ngakhale mawonekedwe am'mphepete mwa distal, mu gulu lirilonse lomwe laperekedwa pali x-ray yabwino catheters, yomwe imathandizira kuwongolera kwa x-ray kutsogolo komwe akupita ndipo amalola kusankha catheterization ndi kusiyanasiyana kwa njira yomwe "akufuna".

Ntchito yomweyo imagwiridwa ndi operekera osinthika omwe akudutsa mkati mwa catheter, komanso mawonekedwe ake kumapeto kwa distal. Chifukwa chake, ma catheters omwe adawonetsedwa mgulu loyambalo sangakhale oyenera kusankha mayeso.

Malupu a diathermic, Chofunikira pakulekanitsa nsonga ya duodenal ingagawanidwenso m'magulu atatu: 1) papillotome yooneka ngati anyezi, pomwe "chingwecho" ndicho gawo logwirira ntchito, lomwe limayambira kutsogolo kwa gawo lachigawo cha shehe la vinyl, lomwe liyenera kukokedwa popatula BSS, 2) Soma papillotus ", Momwe zingwe zachitsulo zimapezekanso chimodzimodzi, koma kuti achite opareshoni ndiyofunika kutuluka kuchokera ku kuwunikira kwa catheter, ndikupanga chiuno cholowera, 3) papillotome ya singano, yomwe chitsulo chimagwira ngati gawo logwira ntchito eskaya chingwe exiting pa mtunda chosinthika ku kutsegula kwa mapeto a catheter lapansi. Ma papillotomas a mapangidwe awiri oyambirawa ali ndi mawonekedwe osiyana am'mphepete mwa distal, amasiyana pamlingo ndi njira yokonzera gawo lodulira, kutalika kwake kuyambira 15 mpaka 35 mm. Kapangidwe ka catheter kamene kali pamwamba pa gawo locheka la diathermosond, kumathandizira chidwi pamene chayikidwa gawo lachiberekero cha bile duct, pomwe papillotomas osachotsera izi amafunikira kuchita "chisanadze" pazomwe zimayesa kuyambitsa chida kuzama kwofunikira. Pulogalamu yowoneka ngati ma diathermic ndiyofunikira kuti athe kutsegula kuwala kwa BSS kuchokera ku duodenum, kenako kugwira ntchito kwa endoscopic ndikosiyana ndi ziwiri pamwambapa ndipo kumatchedwa kuti non-cannulation papillotomy.

Mapangidwe Dormia basiketi, opangidwa kuti atulutse calculi ku lumen ya hepaticoholedoch, ndiwosiyanasiyana monga zida zomwe zaperekedwa pamwambapa. Choyamba, amasiyana manambala achitsulo omwe amapanga gawo logwiritsira ntchito, momwe amapangira, mawonekedwe a mtanga, zomwe amapangira, komanso mainchesi akunja.

Dengu likakhala ndi zochulukirapo, chimayimitsa mulifupi mwake mwala womwe umatha kujambulidwa ndikuwumitsa ndikutsetsereka. Zotsatira zomwezi zimatheka mukamagwira calculi yaying'ono ndikuwunika kwambiri pochita ndi chida ngati piston, i.e.

osatenga miyala mkati mwa mtanga. Zing'onozing'ono kuchuluka kwa zitsulo zomwe zimapanga gawo la chida, mwalawo umakulirapo.

Mwachitsanzo, mudengu lomwe limakhala zingwe zitatu, lingaliro lalitali pafupifupi masentimita awiri limatha kugwidwa, komabe, kuyesera kukonzekera kupanga calculus ndi mainchesi osakwana 1 cm mkati mwake nthawi zambiri sikuyenda bwino.

Zingwe za zingwe zopangira dengu zimatsimikizira momwe zimayendera mosavuta.

Chifukwa chake, mabasiketi okhala ndi chiwongolero cholunjika cha zingwe, kuphatikiza kutanthauzira kosinthika kwa zida zonse ndikatsekedwa, panthawi yotseguka pang'ono kapena kutsegulidwa kwathunthu, amatha kuzungulira pang'ono kuzungulira axis yautali, yomwe imathandiza chida kuti chizidutsa pamwamba pautali pamene mbali zake zikumana. khoma lamkati la duct wamkulu. Izi zimagwiritsidwa ntchito kudutsa gawo la proximal hepatic choledochus. Kuphatikiza apo, kugwiritsa ntchito mtanga wa kapangidwe kameneka kumakhala kothandiza kwambiri pochotsa miyala yaying'ono mulifupi mwake poyerekeza ndi ena omwe akuwongolera zingwe.

Pali mitundu itatu yayikulu ya basiketi ya Dormia, yopangidwa kuti ichotse calculi mundondomeko ya biliary: spherical, polygonal ndi parachute. Mtundu wa dengu ungatsimikizidwe pokhapokha kutsegulidwa kwathunthu, komwe kumakupatsani mwayi wodziwa chida chake.

Tiyenera kudziwa kuti, ngakhale kuli kofunikira pakupanga mawonekedwe a zida, ma endoscopic ndi chidziwitso cha radiology ndikofunikira pakuwongolera bwino kwa choledocholithiasis.

Kuphatikiza apo, osati kokha pathogenesis, kukula, kuchuluka, mawonekedwe, malo a calculi mu bile duct, komanso mawonekedwe a anatomical ndizofunikira kwambiri pazotsatira.
Zambiri pazokhudza chilichonse cha zinthuzi zidzafotokozedwa pansipa, ndipo m'gawoli tikunena za zida za zida zowonongera mu calculi.
Makina opangira lithotriptors Amasiyana kwambiri, ena omwe amadalira wopanga, pomwe ena amadziwika ndi zochizira.
Zipangizo zamphamvu kwambiri zimakhala ndi bawa yachitsulo, mainchesi lakunja kwake kuchokera ku 2.2 mpaka 3 mm, omwe amawongolera kusankha kwa endoscope. Pakadali pano, mitundu iwiri ya ma endoscopes ingagwiritsidwe ntchito ngati zida zazing'onoting'ono, pomwe lithotripter yokhala ndi mulifupi wa 3 mm, TJF yokha kuchokera ku Olimpus ndi yomwe ingagwiritsidwe ntchito.
Ndi mphamvu yofanana, zida zazing'onoting'ono ndizothandiza kwambiri, koma mphamvu ya madengu a gulu lachiwiri ndiyofunika kwambiri.
Pakuwonongeka kwamakina mkati mwa duct ya bile, mapangidwe awiri azogwirira ntchito apangidwa: chimodzi mwazo ndi drum motero ali ndi kuthekera kwakuwononga kwakukulu kuposa mzake, wopangidwa mwa mawonekedwe a silinda

Dziwani kuti mukamagwiritsa ntchito chida choyamba, gawo logwiritsa ntchito, kupatulapo kuluka, limasinthika mosasinthika mukangogwiritsa ntchito kamodzi ndipo singathe kubwezeretsedwanso. Nthawi inanso, kugwiritsanso ntchito kachipangizako ndi kotheka, ngakhale kuwongolera kwenikweni kwa dengu.

Zojambulajambula zopangidwa kuti zigwire kukoka kwa nasobiliary zimasiyana m'mimba mwake yakunja, yomwe ndiyambira 2 mpaka 2.8 mm, komanso mawonekedwe akumapeto a distal.

Mawonekedwe ooneka ngati mphete kumapeto kwa distal, komanso gawo lake lomwe lili mu duodenum, amathandizira kukhazikika kodalirika kwamadzi mu lumenoc hepatic choledochus.

Mutha kudziwa momwe mawonekedwe a chubu yomakamo madzi mukangochotsa kondakitala wachitsulo.

Kulondola kwa chizindikirocho, komanso zotsatira za kulowerera kwa x-ray endoscopic, zimatengera zomwe zimagwiritsidwa ntchito Zida za X-ray nthawi yomweyo, zofunika kwa izo sizili zachindunji.

Zofunikira zake ndi chosinthira cha elekitirodiyida (EOP), kuthekera kochita kafukufuku wa polypos, kutenga zithunzi, kuphatikizapo cholinga, komanso chitetezo chodalirika cha wodwalayo ndi antchito ku ionizing radiation.

Pakadali pano, makina ambiri a x-ray amakwaniritsa izi.

Kukhazikitsa ma x-ray endoscopic examinations ndi ntchito ziyenera kuyang'aniridwa kwathunthu, chifukwa chokwanira kuthetsa ntchito zazikulu zotsatirazi:

1) bungwe la chipinda chogwiritsira ntchito chokhala ndi zida za x-ray,
2) Kupereka zida zoyenera,
3) kupezeka kwa ogwira ntchito ofunikira - X-ray endoscopist, radiologist ndi namwino,
4) Asanayambe ntchito, dokotala amayenera kuphunzitsidwa pamalo apadera.

Kukonzekera odwala a REV. Pokonzekera odwala a REV, ndikofunikira kukumbukira kuti kupatukana kwakanthawi kwa njira yodziwira matenda (ERCP) ndi opaleshoni ya endoscopic (EPST) sikungopindulitsa kokha, komanso kudziwitsidwa ndi kukulira kapena kuwonjezeka kwa machitidwe a zovuta monga pachimake cholangitis ndi pancreatitis.

Njirayi ikufotokozedwa ndikuti mu milandu yambiri, kulowererapo kwa X-ray kumachitika pokhapokha kupatula zomwe zachitika pakanthawi pano kapena kuthana ndi zomwe zimayambitsa milandu pomwe ikuwonetsedwa ndi jaundice yovuta.

Mwachidziwikire, kuyambitsa kusiyanitsa kwapakati pamabowo ogwirira, ngakhale pang'ono, kumakulitsa matenda oopsa ngati pakuchitapo kanthu kuti vutolo lithe.

Chifukwa chake, kukonzekera kwa odwala, makamaka kukonzekereratu, kuyenera kuchitika ndi chiyembekezo chakuchita osati ERCP ndi EPST, komanso kuganizira mwayi wogwiritsa ntchito makina a lithotripsy ndi draobiliary drainage.

Kukonzekeretsa odwala kwa REV ndikosavuta ndipo kumakhala kotulutsira kumtunda kwa m'mimba thirakiti kuchokera pazomwe zili mkati mwaphunziro mwadzidzidzi kapena, zomwe ndizofala kwambiri, pakukana chakudya cham'mawa patsiku la phunziroli, i.e. pamimba yopanda kanthu.

Pretification imakhala ndi mankhwala omwe amakhala ndi mphamvu yosintha ndipo, amayambitsa kanthawi kochepa kwa peristalsis ya duodenum. Chotsirizachi ndichofunikira kwambiri pakuthana kwa gawo la mano la duodenal.

Malinga ndi deta yathu, ganglio-blockers (benzohexonium, pentamine) amathandizira kuti akwaniritse bwino - 0.5-1 ml ya mphindi 10-15 asanafike mayeso a endoscopic. Kugwiritsa ntchito mankhwalawa kwa zaka 19 sikunakhalepo limodzi ndi zovuta zowonekera, kuphatikizapo kuchepa kwakukulu kwa kuthamanga kwa magazi.

Nthawi yomweyo, kugwiritsa ntchito mankhwala monga buscopan ndi metacin kumapereka mphamvu yokhazikika komanso yolankhulidwa pamene maresi a duodenum akwaniritsidwa.

Muzochitika zachipatala cha opaleshoni, milandu yovuta kwambiri ya odwala, siyomwe imachitika ndi zovuta zazikulu zokha, komanso matenda opatsirana, makamaka mtima wamtima, sizachilendo.

Pansi pa izi, kukonzekera ndi mayendedwe a REV sizosiyana ndi omwe amagwira ntchito, i.e. monga mankhwala omwe amathandizanso kukonza ziwalo zofunika.

Kutengera ndi momwe zinthu ziliri, mankhwalawa amatha kugwiritsidwa ntchito isanachitike, panthawi ndi pambuyo pa kulowererapo, malinga ndi wodwala yemwe ali nawo pa kafukufukuyu.

Kufunika kochita opaleshoni ya REV ndikosowa kwambiri ndipo, malinga ndi momwe timadziwira, mwa anthu omwe ali ndi matenda amisala. Kugwiritsa ntchito njirayi pochita opaleshoni ziwalo zam'mimba, ngakhale kuli kotheka, ndikuganiza kwathu, sikofunika kwambiri chifukwa chosowa mwayi wotsata x-ray.

Pomaliza gawoli, tazindikira kuti pokonzekera odwala a REV palibe chifukwa chogwiritsira ntchito mankhwalawa.

Kubwezeretsa cholangiopancreatography (RCHP)

Kubwezeretsa cholangiopancreatography (RCHP) Kodi njira yophatikiza endoscopy ndi mayeso amodzi a fluoroscopic. Njirayi imagwiritsidwa ntchito ngati choledocholithiasis yomwe akuganiza kuti ingadziwe mtundu wa jaundice wolepheretsa komanso kuti aphunzire ma anatomy a ma ducts asanafike opaleshoni.

Popeza RCHP ndi njira yolowerera, zizindikiritso zake ziyenera kutsutsidwa mwamphamvu .Retrograde cholangiopancreatography idachitidwa koyamba mu 1968. Pakadali pano, mitundu yosiyanasiyana yochizira RCP imachitika m'makliniki ambiri.

Komabe, monga tanena kale, umboni suyenera kutsutsidwa, chifukwa kukhazikitsa izi kungaphatikizidwe ndikukula kwa zovuta zowopsa komanso kubweretsa imfa (kuchuluka kwa zovuta kumasiyana kuchokera ku 4.0% mpaka 4.95% mu gulu la endoscopic papillosphincterotomy ( PST) imafika pa 9.8%).

Njira zingapo zakhala zikufunsidwa kuti muchepetse zovuta, monga kapamba, pambuyo pa RCP.

Kwenikweni, awa ndi mfundo zaukadaulo: pewani kubwereza mobwerezabwereza kwa konkire kapena popanda kusiyanitsa, gwiritsani ntchito magetsi osakanikirana ndi predominance ya kudula mukamayendetsa PST, pochita kuyambitsa PST, kusagwirizana sikuchokera mkamwa mwa BDS ndi pharmacotherapy.

Endoscopic retrograde cholangiopancreatography (ERCP) ndi njira yothandizira pofukula ndulu ya duct ndi pancreatic duct pogwiritsa ntchito njira zaposachedwa za njira za endoscopic ndi x-ray.

Njira iyi imakuthandizani kuti mupeze matenda osiyanasiyana a kapamba (kutupa pachimake kapena kupweteka, chotupa, chotupa), komanso kusintha kwa ndulu ya ndulu ndi chikhodzodzo cha ndulu (miyala, kupendekera madontho, zotupa).

Kafukufukuyu akusiyana ndi njira zina zonse zofufuzira zofufuzira kudzera pazomwe zili ndi chidziwitso chambiri komanso kudalirika kwake, komanso kuthekera kuchita zinthu zingapo zothandizira odwala. ERCP imachitika pokhapokha pachipatala. Phunziro lotere lisanachitike, jakisoni wothandizila amapangidwa nthawi zonse.

Pambuyo pa mankhwala oletsa kukamwa ndi pharynx, chida chapadera cham'maso (duodenofibroscope) chimadutsa pakamwa, m'mimba ndi m'mimba kulowa mu duodenum kupita kumalo komwe kuli duct wamba ya pancreatic, kamwa yomwe imatsegukira ku lumen ya duodenum. . Mothandizidwa ndi chubu yapadera, yomwe imadutsa mu ngalande ya endoscope, kamwa ya papilla imalowetsedwa mu ducts ya bile ndi pancreatic duct yokhala ndi chinthu cha radiopaque. Kenako, pogwiritsa ntchito zida za X-ray, katswiriyo amalandira chithunzi cha duct system. Ngati matenda aliwonse, akuchepetsa mzere kapena miyala mwapezeka, kumachitika ntchito yotsikirako, yomwe cholinga chake ndikuchotsa kutsekeka ndi chizolowezi chomveka cha bile ducts. Kuti izi zitheke, pogwiritsa ntchito zida zapadera zomwe zimayendetsedwa kudzera mumsewu wa endoscope, mawonekedwe amtunduwu amapangidwa kudzera potulutsa miyala momwe amachotsamo miyala.

Endoscopic retrograde cholangiopancreatography ndi njira imodzi yamakono yodziwira matenda a pancreatobiliary zone.

Endoscopic retrograde cholangiopancreatography ku Novorossiysk

Endoscopic retrograde cholangiopancreatography (RCHP) ndi imodzi mwazomwe anthu amafufuzira, mu Israel nthawi zambiri amagwiritsidwa ntchito pozindikira matenda am'mimba.

Mu kapangidwe ka RCHP, ndizotheka kudziwa kusokonezeka kwa patency (pang'ono ndi kutsekeka kwathunthu) kwa ndulu ndi ma pancreatic ducts, kukhalapo kwa miyala, zotupa ndi zina zokhudzana ndi pathological. Ku Meir Medical Center, RCPs samachitidwa pongofufuza chabe, komanso othandizira odwala.

Panthawi ya ndalamayi, mutha kubwezeretsanso patali, mwachitsanzo, kuchotsa miyala kapena kuyika stent yothandizira.

Zisonyezero za cholangiopancreatography

Jaundice kapena kupweteka kwam'mimba kwamatenda osadziwika a etiology
Ma gallstones oyengedwa kapena miyala ya duct ya bile
Matenda a chiwindi, kapamba, khunyu
Kutsekeka kapena kutupa kwa ma ducts a bile kumachitika chifukwa cha cholelithiasis
Pancreatitis
Biopsy kapena kununkha
Manometry - kuyeza kukakamiza mu ndulu ya gallbladder komanso mu duct wamba wa bile

Kukonzekera kwa endoscopic retrograde cholangiopancreatography

Ngati muli ndi ndondomeko ya HRCG, chonde tsatirani malangizo apa:

Chakudya chomaliza chimaloledwa maola 8 musanachitike njirayi. Zitatha izi, pewani kudya ndipo, ngati zingatheke, osamwa. Ngati mwapatsidwa mankhwala a matenda oopsa kapena matenda ena a mtima pafupipafupi, osatengera maola atatu RCP itatha, mutha kumwa mankhwalawa ndikumwa kumwa ndi madzi. Pambuyo pa izi, kumwa zakumwa ndizoletsedwa.
Kugwiritsa ntchito mankhwala omwe amachepetsa kugwa kwa magazi (coumadin, synthroma) kuyenera kuyimitsidwa sabata sabata lisanafike RCP. Kutenga aspirin kutha kupitilizidwa popanda zoletsa. Kambiranani nkhaniyi ndi omwe amakuthandizani pazaumoyo.
Njirayi imayendera limodzi ndi kugwiritsa ntchito zinthu zina, zomwe zimapangitsa kuti chikumbumtima chizikhala chochepa. Chifukwa chake, ndikofunikira kupita kuchipatala ndi woperekeza komanso osayendetsa galimoto tsiku lomwelo.
Odwala omwe amalandila insulin sayenera kukhala ndi jekeseni wam'mawa wokhazikika. Syringe ya insulini iyenera kubweretsedwa nanu.
Bwerani machitidwe mu zovala zabwino komanso wopanda zodzikongoletsera.
Pamaso pa njirayi, ndikofunikira kuchotsa chikhodzodzo, chotsani mano ndi mano.

Njira ya RCHP

ECHO imagwira ntchito popanga ziwonetsero ndi zochizira cholangiopancreatography pogwiritsa ntchito zida zamakono - ma endoscope oonda osasunthika omwe amakhala ndi fiber.

End Endope ili ndi kamera ya kanema yaying'ono yotumizira zithunzi zazitali kwambiri polojekiti yomwe yaikidwa mchipinda chamankhwala.

Komanso mothandizidwa ndi endoscope, zida zapadera zimatha kuyambitsidwa mu gawo logaya chakudya la wodwalayo kuti mugwire zofunikira.

Kutalika kwa njirayi ndikuchokera pa mphindi 30 mpaka 60. Pambuyo pake, wodwala adzafunika kuyang'aniridwa ndi ogwira ntchito kuchipatala kwa maola awiri. Ngati mankhwalawa atachitika mu RCHP, wodwalayo atha kufunsidwa kuti azikhala kuchipatala mpaka m'mawa wotsatira.

Pofuna kutsogolera gawo la endoscope kudzera pamkamwa ndi pharynx, mumagwiritsidwa ntchito mankhwala ochita kupanga. Asanayambe njirayi, othandizira ndi opanikizika amaperekedwa kwa wodwalayo mwamitsempha. Mwambiri, njirayi ndiyopweteka komanso imakhala yovuta pang'ono. Danga la endoscope ndi laling'ono ndipo silidapitilira kukula kwa chakudya chomwe munthu am'meza ndi chakudya.

Dokotalayo amadutsa masikono am'mphepete mwa m'mimba ndi m'mimba, amawunika zamkati, ndikufika ku duodenum, komwe zimatseguka zotupa za pancreatic duct.

Mpweya pang'ono umalowetsedwa m'mkatikati mwa duodenal, ndipo wogwirizira mosemphana ndi mnzake amayamba ndikulowetsa ndulu ndi kapamba. Kenako pangani ma X-ray angapo. Panthawi ya ndondomeko, mawonekedwe a wodwalayo angasinthidwe: mutembenukire kumbali yake kapena m'mimba mwake.

Izi ndizofunikira kuti mawonedwe a anatomical apangidwe nthawi ya radiology.

Kupyola pa njira yomwe ili kumapeto kwaumoyo, mutha kujambula zida zapadera kuti muthe kuchita biopsy - tengani zitsanzo za minofu kuchokera pamalo omwe amakayikira kuti muwunikenso. Ndi chithandizo chawo, nthawi zina, mutha kuchotsa mwala womwe umalepheretsa kutuluka kwa bile, kapena kupaka stent.

Fungo ndi chitsulo kapena chubu la pulasitiki. Imathandizira makoma a bile duct kapena pancreatic duct, kupewa kwake (kutsekeka).

Chizindikiro chimodzi cha kununkha ndi kupezeka kwa chotupa chomwe chimalepheretsa chimbudzi kapena dera la nipple ya Vater - malo omwe ma ducts amalowa mu duodenum.

Mukamaliza njirayi, ma endoscope amachotsedwa mosamala.

Kubwezeretsa nthawi

Pafupifupi ola limodzi kuchokera ku RCP, mutha kuyamba kumwa. Patsiku loyamba ndikulimbikitsidwa kugwiritsa ntchito zakumwa zokha ndi chakudya chofewa chophika-monga.

Lumikizanani kuchipinda chodzidzimutsa ngati mukumva chimodzi mwazotsatira:

Kutentha kopitilira 38 madigiri
Kupweteka kwam'mimba
Kuyenda ndi magazi
Kutulutsa magazi mlengalenga, ndowe zakuda

Ligation of varicose veins of esophagus

Njira yothandizira kumapeto kwa mankhwalawa komanso kupewa kutaya magazi kuchokera m'mitsempha ya m'mimba ndi m'mimba.

Pambuyo pa gastroscope yokhala ndi mphuno yapadera, nyambo ya endoscopic imayamba ndi gawo la kusintha kwa esophagocardial, pamwamba pa mzere wa mano. Mphetezo zimayikidwa mkati, kenako zimatayidwa pambuyo poti mwala womwe wapangika utalowa mchilale osachepera theka la kutalika.

Kwa gawoli (kutengera kuuma kwa mitsempha ya varicose) imatanthawuza 6-10 liglines.

Monga lamulo, kunyanja kumachitika ndi mphete za latex. Udindo wa mphete ya elastiki imathanso kuchitika ndi nyambo yolumikizira yopingasa ya 11 ndi 13 mm, yolingana ndi kukula kwa cap cap.

Pambuyo pa sabata pambuyo pa njirayi, amathandizira endoscopy kuti athe kuwunika zotsatira za opaleshoniyo.

Ngati magazi akutuluka, kulumikizana kwa endoscopic kuyenera kubwerezedwa.

Endoscopic nyambo ya zotupa zaminyempha zotsekemera

Pakadali pano pali kuwonjezeka kwakukulu kwa matenda a chiwindi, makamaka kuwonongeka kwa chiwindi mu hepatitis yayitali komanso kugwiritsa ntchito mankhwala osokoneza bongo a hepatotoxic, omwe popita nthawi amapititsa patsogolo matenda a cirrhosis.

Chimodzi mwazinthu zodziwika bwino kwambiri za matenda a hepatitis ndi cirrhosis ndi kupangika kwa mitsempha ya varicose pamimba ndi m'mimba, chifukwa cha kutuluka kwa magazi kudzera pachiwindi, komwe mu 50% milandu imayendera limodzi ndi kukhetsa magazi kwambiri. Imfa, popanda thandizo ladzidzidzi, ndikutulutsa magazi koyamba ndi 30-40%, ndipo kutuluka magazi pafupipafupi 70%.

Fibrogastroscopy iyenera kuchitidwa kwa onse odwala cirrhosis a chiwindi osiyanasiyana, komanso odwala matenda a chiwindi, chifukwa Nthawi zambiri chitukuko cha mitsempha ya varicose imachitika ngakhale isanayambike gawo la cirrhotic la matenda a chiwindi.

Pali maopareshoni ambiri ovuta kuwachotsera mitsempha ya varicose, omwe samaloledwa bwino ndi odwala omwe ali ndi vuto la chiwindi, amakhala opweteka ndipo amathandizidwa ndi kufa kwaposachedwa kwambiri.

Chifukwa chake, endoscopy tsopano yatenga malo ofunikira pakuwunika ndi mitsempha ya varicose ya esophagus ndi m'mimba.

Endoscopic nyambo ya zotupa zaminyempha zotsekemera

Endoscopic ligation ya mitsempha yotupa ya esophagus imakhala ligation ya varicose mfundo mothandizidwa ndi ang'onoang'ono zotanulira mphete. Gastroscope wamba yokhala ndi mawonekedwe otsirizira imayambitsidwa mkati mwa esophagus ndipo kafukufuku wowonjezereka amachitika motsogozedwa. Kenako gastroscope imachotsedwa ndikugwiritsa ntchito nyambo kuti ikonzeke.

Pambuyo pake, gastroscope imapangidwanso mu distal esophagus, mitsempha ya varicose imawululidwa ndipo imathandizidwa ndikuwunikira kwa chida chamkono. Kenako, kukanikiza ulumikizira waya, umakhala ndi mphete ya elastic. Njirayi imabwerezedwa mpaka mitsempha yonse ya varicose imapindika.

Iliyonse mwa iwo amaika mphete za 1 mpaka 3.

Endoscopic ligation ya mitsempha yotupa ya m'magazi imapereka zovuta zochepa kuposa sclerotherapy, ngakhale magawo ochulukirapo amafunikira kuti azichulukitsa mitsempha ya varicose. Vuto lodziwika bwino ndi dysphagia wosakhalitsa, kukula kwa bacteremia kumafotokozedwanso.

Kafukufuku wowonjezera angapangitse kukonzekera kwa esophagus. M'malo okuta mphete, zilonda zimatha kuyamba. Mphezi nthawi zina zimatha, ndikupanga magazi ambiri.

Chifukwa chake, tikulimbikitsa kulumikizana kwamitsempha yotupa ya m'mphepete mwa akatswiri azachipatala okha.

Kuyambika kwa varicose vein node pogwiritsa ntchito mphete kumagwiritsidwa ntchito pochita opaleshoni mwadzidzidzi kuti magazi asiye kutuluka kwa mitsempha ya varicose ya esophagus. Komabe, kuchitako opareshoni ngati magazi akupitiliza magazi kumakhala kovuta kwambiri, ndipo kukonzekera kwakukulu sikumatheka.

Chifukwa chake, tikupangira kuti odwala onse omwe ali ndi vuto la chiwindi komanso matenda opatsirana a hepatitis azichitira gastroscopy munthawi yake, ngati kuli kotheka, azichita ligation ndi kupewa kutaya magazi.

Endoscopic retrograde pancreatocholangiography and papillosphincterotomy for jaundice yovuta

Bregel A. I. (wamkulu wa dipatimenti yopanga zam'mbuyomu, pulofesa wa dipatimenti yopanga opaleshoni yopeka),
Andreev V.V. (endoscopist), Yevtushenko V.V. (endoscopist), Borkhonova O. R. (radiologist) MAUZ Clinical Hospital No 1 of Irkutsk,
Irkutsk State Medical University

Endoscopic retrograde pancreatocholangiography (ERCP) njira yodalirika kwambiri yodziwira chomwe chimayambitsa matenda a jaundice, ndipo papillosphincterotomy (EPST) ndiwothandiza kwambiri pophwanya gawo la bile kulowa mu duodenum (duodenum). Phunziroli nthawi zambiri limachitika molingana ndi zofunikira pozindikira masiku atatu osakhalitsa a odwala kuchipatala.

Zotsatira za ERCP ndi EPST kwa zaka 5 mwa odwala 312 zidasanthulidwa.

Mwa odwala 240, kuwunika kwa mbiri ya milandu kunachitika, ndipo mu 72 - ma protocol a maphunziro a endoscopic okha. Kafukufuku anachitika pazochitika zovuta pakudziwunika kwamatenda ndipo ngati kuli koyenera, kukhazikitsa kwa EPST. Ngati panali zisonyezo mu 265 odwala, EPST idachitidwa. Panali amuna 86 (27,56%), azimayi 226 (72.44%).

Odwala adagawidwa ndi zaka motere: 14 (4.49%) odwala anali ochepera zaka 30, 6 (1.92%) anali ndi zaka 31 mpaka 40, 24 (7.69%) odwala anali wazaka 41-50, 58 (18.59%) odwala - zaka 51-60, 76 (24.36%) odwala - zaka 61-70, 89 (28,53%) odwala - azaka 71-80 ndi odwala 45 (14.42%) zaka zopitilira 80.

Mu zaka 3 zapitazi, kuchuluka kwa odwala okalamba komanso osachiritsika kwakwera kuchoka pa 62.67% mpaka 68.13%.

Mwa kuchuluka kwa odwala, kuopsa kwa vutoli kunakulitsidwa ndi kukhalapo kwa matenda osiyanasiyana ophatikizika: matenda oopsa (75), matenda a mtima (73), kulephera kwamtima (4), myocardial infarction (4), zilonda zam'mimba za duodenal (3) ) ndi ena.

Kuyesa kwa Ultrasound (ultrasound) kwamayendedwe a biliary kunavumbulutsa miyala ya duct ya 16.67% ya odwala, choledocholithiasis sichinatsimikizidwe mu 60.83% ya odwala, ndipo kukhalapo kapena kusakhalapo kwa calculi mu choledochus sikunakhazikitsidwe molondola pamaziko a mayeso a ultrasound mu 22.20% ya odwala. Odwala ambiri omwe ali ndi ultrasound, duct wamba ya bile idakulitsidwa kuti ikhale madigiri osiyanasiyana.

Composed tomography (CT) scan inachitika mwa odwala 13 (5.42%).

Mwa asanu mwa iwo, CT adapezeka kuti ali ndi pancreatitis yowonongeka, mu 3 - choledocholithiasis, komanso mwa odwala 2 kusintha kwina kwa hepatopancreatoduodenal dera.

Dongosolo lalikulu la duodenal nipple (BDS) nthawi zambiri silidutsa 5 mm. Timasiyanitsa mitundu ingapo yamkamwa ya BDS. Mwa odwala ambiri (266) kapena 85.26% anali ozungulira, mu 33 (10.58%) odwala pakamwa anali otsetsereka, mwa odwala 5 (1.60%) anali oopsa, ndipo mwa 3 (0.96%) - mawonekedwe amafomu, ndipo 4 (1.28%) anali ndi mawonekedwe osiyana.
Atypical localization of BDS hole anapezeka mwa 39 (12.50%) odwala. Mwa 15 (4.81%) mwa iwo, kutsegulidwa kwa nipple kudali mu parapapillary diverticulum ya duodenum ndipo mwa odwala 24 (7.69%) m'mphepete mwa diverticulum.
Mu odwala 19 (5.56%), phunziroli limangokhala ndi wirsungography. Mwa awiri mwa iwo, BDS inali mu diverticulum, mu 4 - pafupi ndi diverticulum, ndipo mwa odwala 13 panali zifukwa zina zochitira wirsungography okha.
Odwala ena 30, ma ducts sakanadulidwa, nthawi zambiri ndi malo a BDS.
Pambuyo catheter atayikidwa mu dzenje la BDS, jekeseni woyeserera wa 1-2 ml ya madzi osungunuka a 50% ndende (verographin, urographin, ndi zina zotero). Mapeto a catheter anali mu duct system, yotsimikiziridwa ndi chithunzi cha chosakanikirana cha choledochus pa polojekiti, chinali chotsogola kulowera chiwindi.

Kuzama kwa kukhazikitsa kwa catheter mu ducts ya bile kunali kosiyana kwambiri ndipo kuyambira 1 mpaka 12 cm, kutengera mtundu wa momwe amapangidwira, ubale wa anatomical wa duct system, duodenum, BDS ndi zina.

Mitsempha ya bile ndi ndulu ya ndulu inasiyanitsidwa ndi makonzedwe a 20-30 ml a 50% osasungunuka amadzi ndi mawonekedwe owoneka a kapangidwe kake m'mphepete mwa bile. Pambuyo podzaza dongosolo la duct ndi ndulu ndi gawo lothandizira, 1 mpaka 3 x-ray adatengedwa.

Pambuyo pa radiology, ma ducts adatsukidwa ndi njira ya 0.5% novocaine. Malinga ndi zomwe zikuwonetsa zizindikiro za cholangitis, lumenoch lumen inabayidwa ndi yankho la antibayotiki.

Kuzindikiritsa pambuyo pa endoscopic retrograde pancreatocholangiography kunakhazikitsidwa pamaziko a matendawa a endicopic, zotsatira za canalization wa BDS komanso kupititsa patsogolo kwa catheter pamphepete mwa bile, chikhalidwe chofalikira mosiyana pamiyendo yolowera pazenera komanso malinga ndi x-ray.

Malinga ndi ERPC, m'mimba mwake mwa duct wamba bile mu 32 (10.92%) odwala anali ochepera 6 mm, mwa 73 (24.91%) odwala anali ochokera 7 mpaka 10 mm, mwa odwala 100 (34.13%) anali 11-15 mm, Odwala a 68 (23.21%) anali ndi 16-20 mm, ndipo odwala 20 (6.83%) anali ndi oposa 20 mm.

Malinga ndi zotsatira za ERCP, zifukwa zotsatirazi za jaundice zidapezeka.

Nthawi zambiri - mu 193 (61.86%) miyala yamankhwala amapezeka odwala bile duct, mu 46 (14.74%) odwala - microcholecholithiasis, mwa odwala 5 (1.60%) - zotupa za bile duct, mu 3 (0.96%) - BDS adenoma, mwa odwala 2 (0.64%) odwala a intrahepatic block adapezeka, ndipo mwa 1 (0.32%) wodwala chotupa cham'mimba adapezeka. Mwa odwala 50 (16.03%) omwe ali ndi ERPC, chifukwa cha jaundice sichinakhazikitsidwe, kapena mawonekedwe a jaundice sanaperekedwe.

Endoscopic papillosphincterotomy (EPST) idachitidwa ndi cannulation komanso osakanika mu odwala 265 (77.49%). Kutalika kwa papillotomy incision kunali mpaka 10 mm mwa odwala 126 (47,55%), 1115 mm mwa odwala 114 (43.02%), ndi 16-20 mm mwa odwala 25 (9.43%) (mkuyu. 1) )

Pambuyo pa EPST, pakuyesa kwa endoscopic, ma calculi adachotsedwa pamizere ya bile mu odwala 133 (mkuyu. 2), ndipo mwa odwala 110, palibe miyala yomwe idapezeka mumiyala.

Mwa odwala 69, miyala kuchokera ku duct wamba ya bile sanachotsedwe.

Zomwe sizinalole kuti miyala ichotsedwe ku duct ya bile nthawi yayitali inali kukula kwakukulu kwa calculi (54), kukhazikika kwamphamvu kwamiyala mu ducts ya bile (13), ndi zifukwa zina (2).

Zovuta pambuyo pa ERCP zimawonedwa mwa odwala 36 (15.00%).

Kutuluka kwa mapapo a papillotomy kudachitika mwa 23 (9.58%), mwa odwala 22 adayimitsidwa pomwe panali duodenoscopy, mu 2 imachitikanso kumapeto kwa kafukufukuyu. Ndikayambanso kutaya magazi m'modwala m'modzi, heestasis ya endoscopic idachitika bwino, ndipo wodwala m'modzi adachitidwa.

Acute pancreatitis yomwe idapangidwa mu odwala 5 (2.08%), mafuta ophikira a duct wamba a bile amachitika mwa odwala 6 (2.50%), mafuta a duodenum mu 1 (0.42%) ndi papillitis mu 1 (0.42%) ya wodwalayo.

Pambuyo pake, odwala 104 (43.33%) adathandizidwa pa. Anachita cholecystectomy, yomwe odwala a chastobolny amaphatikizidwa ndi choledochotomy, kuchotsa calculi ku duct ya bile, kuperekedwa kwa choledochoduodenostomy ndi zosankha zingapo zakukhetsa mitsuko ya bile. Mwa odwala 9, microcholecystostomy idakhazikitsidwa ndipo odwala 2 adathandizidwa chifukwa cha pancreatitis pachimake.

Chifukwa chake, zomwe takumana nazo za endoscopic retrograde pancreatocholangiography ndi papillosphincterotomy zimatsimikizira chidziwitso chawo chokwanira komanso chothandiza kwambiri. ERCP ndi ultrasound ya choledocholithiasis nthawi zambiri imakupatsani mwayi wokhazikitsa chifukwa cha jaundice, kukula, kuchuluka kwa miyala komanso m'mimba mwake mwa choledochus.

Zambiri zamtundu wa ERPC za choledocholithiasis ndizapamwamba kuposa ultrasound.

Pamaso pa calculi mu choledochus, ERPC iyenera kutha EPST ndikutulutsa miyala kuchokera kumiyala ya bile.

Nthawi yomweyo, ndikofunikira kuzindikira kuti mwina pali zovuta zazikulu nthawi ya ERCP ndi HEPT. Kuchita kwa maphunzirowa ndi kotheka ndi zida zamakono za endoscopic, ma anesthetics okwanira, endoscopists oyenerera komanso opaleshoni.

Pomaliza Zomwe takumana nazo mu endoscopic diagnostic komanso chithandizo cha zilonda zam'mimba za gastroduodenal zimatsimikizira kuti zimagwira ntchito kwambiri. Medical endoscopy osakanikirana ndi chikhalidwe chosasinthika amaloleza hemostasis mu 98.3% ya odwala ndi kulowererapo kwa opaleshoni mu 95,5% ya odwala.