Endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) bụ otu n'ime ụzọ kachasị mma ma dị irè nke nchọpụta ahụike, nke na-enye gị ohere ịme nchọpụta ziri ezi ma depụta usoro ọgwụgwọ na usoro ọgwụ dị mma maka onye ọrịa. N’okpuru, anyị ga-atụle njiri mara nke usoro nchọpụta a, ihe ngosipụta maka mmejuputa ya na atụmatụ ndị ọzọ ndị dọkịta na ndị ọrịa chere ihu.

Kedu ihe ọ bụ na gịnị bụ ụkpụrụ nke ịrụ ọrụ?

ERCP bu usoro nlere anya puru iche nke eji aru aru oria aru. Ọ gụnyere iji ray-ray na ngwa endoscopic, ihe jikọrọ nke ga-enyere gị aka ịmata nke ọma ọnọdụ dị ugbu a nke akụkụ ahụ nyocha. Emere usoro nyocha a na mbu n’afọ 1968. Ruo taa, na-eburu n'uche mmepe nke ọgwụ, ọ kawanye ọfụma. ERCP na-enye gị ohere ịchọpụta ihe na ntụkwasị obi dị elu, chọpụta ihe osise nke ọrịa ahụ ma mejuputa usoro ọgwụgwọ.

A na-eme endoscopic retrograde cholangiopancreatography site na iwebata endoscope n'ime duodenum, ebe a na-etinye ya n'ọnụ ọnụ nnukwu paodenal papilla, akwụkwọ nyocha nwere ọwa pụrụ iche maka ịnye ọdịiche dị n'etiti oghere endoscope. Mgbe ihe a mechara banye n’ahụ site na ọwa, onye ọkachamara na-ewere foto nke mpaghara ahụ jiri ngwa x-ray. Dabere na foto ndị enwetara, a na-achọpụta otu ọrịa. Enwere ike ịduzi ERCP n'ime usoro ndị a:

Na-enyocha duodenum na paodenal papilla
Cannulation nke papilla na iwebata ihe di iche maka x-ray na-esote,
Na-ejuputa usoro nke usoro omumu ihe,
X-ray foto,
Weputa ihe di iche site na eburu mmiri,
Mgbochi nke nsonaazụ achọghị.

Iji duzie ERCP, ekwesịrị iji ngwaọrụ tinye akụkụ anya dị mma - nhazi a na - enye ohere inyocha akwara dị n'ime ahụnke kachasị mma. Nyocha, nke a na-agafe na endoscope, nwere ihe pụrụ iche e ji eme ihe, nke na-agbagharị n'otu oge maka ihe zuru ezu iji jupụta akwara ndị ahụ site na iji ihe na-arụ ọrụ rediopaque. Dịka iwu, a na-eme endoscopic retrograde cholangiopancreatography n'ime ụlọ X-ray n'ụlọ ọgwụ.

Njirimara nke nkwadebe maka usoro a

Dịka anyị kwurula, ERCP ga-ekwe omume naanị n'ụlọ ọgwụ. Tupu ịme ọgwụ endoscopic, a ga-etinye ọgwụ mgbochi, nke ga-eme ka ahụ erughị ala na ahụ́ ịma jijiji nke onye ọrịa ahụ belata. Ebe usoro ahụ siri ezigbo ike ma na-egbu mgbu oge ụfọdụ, ọgwụ dị otú ahụ na-aghọ ihe achọrọ dị na nkwadebe maka ERCP. N'ọnọdụ ụfọdụ, iwebata ọgwụ mgbochi enwere ike ọ bụghị naanị n'ụbọchị usoro ahụ, kamakwa n'ehihie, ma ọ bụrụ na enwere ụba iwe iwe nke onye ọrịa.

Tupu usoro a, onye ọrịa ekwesịghị iri nri ma drinkụọ mmiri - a na-ebu ERCP nanị na afọ na-enweghị isi. Ọkara otu awa tupu mmalite nke usoro retrograde cholangiopancreatography, ngwọta intramuscularly gbara ọgwụ atropine sulfate, platifillin ma ọ bụ metacin na ngwakọta nke diphenhydramine na promedol. Nke a ga - enyere aka nweta izu ike kachasị nke duodenum ma kwe ka usoro ERCP na-enweghị mgbochi. Agbanyeghị, n'otu oge ahụ, a na-akwadoghị ọgwụ morphine na morphine nwere dị ka ndị na-egbu mgbu, ebe ọ bụ na ha nwere ike ime ka mbelata Oddi sphincter. Ọ bụrụ na, n'agbanyeghị ntinye nke ụzọ ndị ahụ dị n'elu, nrụrụ eriri afọ na-adịgide, yabụ tupu retrograde cholangiopancreatographs, a na-atụ aro ịnye ọgwụ nke na-egbochi ọrụ eriri afọ. Kacha nkịtị n'ime ha bụ buscopan na benzohexonium.

Isi ihe ngosipụta maka usoro ahụ

ERCP bụ usoro ịkpa oke aghara, nke edobere etu esi egosi. Dịka iwu, isi ihe mgbaàmà na-egosi na ọ dị mkpa ịchọpụta ụdị nchọpụta a bụ ọnụnọ nke afọ n'ihi ụbụrụ isi n'ihi mmerụ ahụ, etuto ahụ na usoro ndị ọzọ. N'okwu a, ngosipụta ndị ahụ kwesịrị ka akwadoro ya nke ọma iji zere njehie enwere ike nchọpụta ahụ yana ọgwụgwọ ọzọ.

Ọ bụrụ na anyị atụkwasị obi na nke a, yabụ ọtụtụ ihe kpatara eji eduzi ERCP bụ ụdị ọrịa ndị a:

Ihe mgbochi jaundice n'ihi ihe gbasara mgbochi (warara) nke agịga duleenal, stenosis nke paodenal papilla ma ọ bụ choledocholithiasis. Nke ikpeazu, gosipụtara onwe ya dịka ihe mgbagwoju anya mgbe ọrịa ọrịa gallstone gasịrị, mgbe okwute kwụsịrị na isi ihe na-akpata ma na-akpaghasị ikike ha. A na-ahụta mgbu n'ime ọrịa ndị dị na hypochondrium dị mma ma enwere ike ịnye ya n'aka nri, lumbar, scapular na mpaghara subscapular.
Ewu nke oria akwara. N'ụzọ bụ isi, a na-eji ọnụnọ etolite etolite site na iji ultrasound ma ọ bụ ihe ngosi tomography, mana mgbe ụfọdụ usoro nchọpụta dị otú a nwere ike ọ gaghị abụ ihe ọmụma zuru oke. Naanị maka ọnọdụ ndị a, enwere ike iji ERCP dị ka usoro nyocha.
Ọrịa mgbu na-egbu oge na-ewe iwe ọkụ oge.
Ọnụnọ nke ọrịa akwara na-achọpụta ihe dị mma maka ọgwụgwọ ha.
Mata njiri mara nke usoro ọgwụgwọ ọzọ.

Otu ụzọ ma ọ bụ ụzọ ọzọ, tupu ịme usoro a, ịkwesịrị iji nlezianya lelee ọnụnọ nke mgbaàmà kwesịrị ekwesị. Ọ bụ ya mere ị ga-eji buru ụzọ kpebie onye ọrịa n'ụlọ ọgwụ ma nye ikike ịchịkwa ọnọdụ ya.

Ihe ndị bụ isi contraindications na nsogbu

Ebe usoro ERCP nwere njikọ jikọtara ya na nnabata na-adịghị emerụ ahụ, enwere ọtụtụ njedebe na atụmatụ nke ngwa ya. N'okwu a, enwere ike ịtụle contraindication bụ isi ọ bụla nke ahụ na - anaghị anabata ntinye endoscopic.

Na mgbakwunye, ọ bụrụ na onye ọrịa ahụ anabataghị ọgwụ ndị ewepụtara n'ime ahụ n'oge nkwadebe na omume nke ERCP, mgbe ahụ nchọpụta nke usoro a agaghị ekwe omume.

Otu n'ime contraindications bụ nnukwu pancreatitis ma ọ bụ nkụda mmụọ nke pancreatitis na-adịghị ala ala.

Ọ bụrụ na enwere ike ịdabere na ọrịa ndị dị n'elu nwere ọgwụ mgbochi siri ike, ọnọdụ ndị a na-eso na-amachibido ụfọdụ iwu, mana ịkagbula enwere ike ịchọpụta ụdị nchọpụta ahụ:

Ime
Ọrịa nke obi
Ọrịa shuga na insulin
Nnabata anticoagulants (ụdị ndị kachasị ewu ewu gụnyere aspirin).

N'ime ọnọdụ abụọ gara aga, ndị dọkịta na-atụ aro ịgbanwe nhazi nke ọgwụ ahụ ma ọ bụ gbanwee ya na ọgwụ ọgwụ ndị yiri ya na-anaghị egbochi ERCP.

Na mkpokọta, usoro ERCP esighi na nyocha ahụike na-eyi ndụ egwu, agbanyeghị na nsogbu nke mkpụrụ ndụ dị iche iche nwere ike ịpụta mgbe ọ mechara. Ọrịa ndị a na-ahụkarị bụ ọrịa eriri afọ, imeju afọ, na ọbara ọgbụgba.

Agbanyeghị, ndị ọkachamara n'ịgwọ ahụike ruru eru na-arụ ụka na ọ nwere ike belata nsogbu ndị nwere ike ịdapụta ma ọ bụrụ na ewere usoro mgbochi. Nke mbu, mgbe emechara nyocha ahụ, onye ọrịa ahụ kwesịrị ịnọ ọtụtụ awa n'ụlọ ọgwụ n'okpuru nlekọta ndị dọkịta. Ahụhụ na-adịghị mma na akwara ka etinyere ya mgbe nyocha ga-ebelata mkpọtụ akpịrị belata. Ọnọdụ onye ọrịa ahụ kwesịrị ịnọgidesi ike ruo awa 24 mgbe nchọpụta ọ gwụsịrị. Ọ bụrụ na ọrịa dị ka akpata oyi, ụkwara, ọgbụgbọ na ọgbụgbọ, a na-ahụ ihe mgbu dị n’afọ na n’obi, mgbe ahụ ọ dị mkpa ịgwa dọkịta banyere ha. Ọnụnọ nke mgbaàmà ndị dị otú a, dịka iwu, na-egosi njehie emere n'oge nchọpụta.

Yabụ, omume tozuru oke ma nwee ọgụgụ isi nke ERCP ga - enyere gị aka ịnweta ozi a pụrụ ịdabere na ya gbasara ahụ onye ọrịa na - enweghị mmerụ ahụ ike yana nsonaazụ ndị ọzọ na - adịghị mma.

ERCP (endoscopic retrograde pancreatocholangiography)

ERCP bụ nyocha nke endoscopic X-ray nke anụ ahụ nke mpaghara pancreatobiliary (duodenum, paodenal papilla, dule bile, dual pancreatic).

Ihe dị mkpa nke usoro ahụ bụ nyocha nke anya nke lumen nke duodenum, paodenal papilla, ọ bụrụ na ọ dị mkpa, na-ewere obere ntanetị nke akpụkpọ mucous akpụkpọ ahụ (biopsy) maka nyocha ụlọ nyocha, yana inweta foto x-ray nke usoro nke sistemụ akwara nke pancreatobiliary. A na-enweta nke a site na iwebata esophagogastroduodenodenoscope n'ime duodenum, site na ọwa na-arụ ọrụ nke gafere cannula na lumen nke bile na / ma ọ bụ nke a na-agbanye site na paodilla papilla, na-emeju ha site na ihe X-ray, nke na-eso foto X-ray. Nke a bụ nkwonkwo endoscopic na usoro nyocha redio. Esophagastroduodenoscopy bụ ngwaọrụ pụrụ iche, nke bụ ihe na-agbanwe agbanwe, mara mma, ogologo oge nyocha nwere eriri fiber optic ma ọ bụ mgbawa vidiyo, nke na-enye gị ohere ịnyefe ihe onyonyo site n'ime ahụ gị na nyocha.

A na-eduzi ngwa pụrụ iche n'akụkụ ọrụ na-arụ ọrụ nke esophagogastroduodenoscope (cannulas maka iwebata ụzọ edozi, ogwe osisi, nkata maka iwepụta okwute, mma papillotomy maka dissecting anụ ahụ na ntinye, wdg).

Ihe omuma banyere onodu ahu ike gi, nke enwetara site n’enyemaka nke esophagogastroduodenoscopy, puru iche ma gha eme ka o kwe omume, n’inyochaputa ezi ogwu, iji hota usoro ọgwụgwọ kwesiri ekwesi.

A na-eme esophagogastroduodenoscopy n'ime esophagus, afọ na duodenum, na-emeghachi azụ. Nke a bụ ihe ọmụmụ enweghị mgbu, mana ị nwere ike ịnweta ịma jijiji ma nwee ike inwe ahụ erughị ala.

Dabere na usoro nchọpụta akọwapụtara, ihe dị iche iche ma ọ bụ njikọta ha na akụrụngwa nke mpaghara pancreatobiliary:

ERPHG (retrograde cholangiopancreatography) - iwebata ihe X-ray nke dị iche na sistemụ duct na nnyefe,
EPT (papillosphincterotomy endoscopic) - dissection nke duodenal papilla na proximal ducts,
EPD (paosilicspoocterodilation endoscopic) - ịgbatị duodenal papilla na proximal ducts,
IKPUTA NA EGO NA-EKWETA - mbibi na nbupu nke okwute site na akwara,
Stenting na prosthetics nke ducts ahụ - iwebata tubes ndị pụrụ iche (stents, prostheses) iji hụ na mmiri zuru oke na / ma ọ bụ ihe ọ pancụ orụ na-abanye na lumen nke duodenum.

Emeela ụdị nnabata endoscopic a na nyocha X-ray kemgbe ọtụtụ iri afọ, a mụọla usoro na usoro ahụ zuru ezu, ndị dọkịta enwetala ahụmịhe nke ọrụ na-aga nke ọma, agbanyeghị, na ọnụ ọgụgụ dị nta, enwere ike ịme ihe ọhụụ na-ezughi ezu ma ọ bụ nwee nsogbu. Ọtụtụ na-adabere n'ụdị akụkụ ahụ gị, ọnụnọ nke diverticula, ọrịa ndị bu ụzọ, warara, mgbanwe na akụkụ akụkụ, ụda olu nke akụkụ eriri afọ, na ọkwa nke ihe mgbu na mmetụta uche gị. Mgbe ụfọdụ mgbanwe ndị a na-aghọ ihe a na-agaghị emeli emeri maka ịme ihe endoscopic ma ọ ga-ekwe omume ịchọpụta ha naanị n'oge etinye onwe ya. Mgbagha nke ndenye a (nke egosiri na tebụl dị n'okpuru ebe a) bụ ihe na-egbu ahụ mgbu nke pancreatitis. N’emezughị afọ, anyị na-eme ihe omume iji gbochie nsogbu. Anyị nwere ihe niile (ahụmịhe, nkà, ihe omuma, akụrụngwa, ọgwụ, otu ezigbo ndị dọkịta na-awa ahụ na ndị na-akụnwụ ahụ) iji mezie ma belata nsonaazụ nke nsogbu.

Researchzọ nyocha nke endoscopic X-ray bụ ụdị nchọpụta ziri ezi ma bụrụkwa nke a pụrụ ịdabere na ya na ụdị ọgwụgwọ a na-adịghị ahụkebe maka ọtụtụ ọrịa nke mpaghara pancreatobiliary, nke na-ezere ịwa ahụ. Yabụ, ihe ọghọm nke nsogbu na usoro a pere mpe, ịnagide ndidi na-adị mfe site na mgbake ngwa ngwa.

Usoro ERCP

Mgbe etinyere ngwaọrụ pụrụ iche n’ime akpịrị, dọkịta na-eji nwayọ gafere mkpụrụ afọ, afọ na duodenum. Ngwaọrụ ahụ kwesịrị iru ebe eriri ọkpọ na ebe a na-ejikọ ọnụ. N'ebe a, ampoule nke nnukwu paodenal papilla na-etolite, n'ọnụ ya ka enwere oghere nke duodenum.

Mgbe ngwaọrụ gachara na mmalite nke akụkụ a, eriri afọ na-eme nyocha ndị a:

A na-agwakọta ihe pụrụ iche nke anwụrụ ọkụ na-abanye n'ime akwara.
Ngwunye x-ray na-enye gị ohere inweta onyogho nke sistemụ.
Ọ bụrụ na achọtara okwute na mpaghara ebe a na-elele, a ga-arụ ọrụ endoscopic ozugbo, n'ihi nke a ga-eweghachi ikike ma mebie usoro ahụ.

Oge mmegharị

Mgbe ERCP gachara, onye ọrịa ahụ kwesịrị ịnọ n'ụlọ ọgwụ ụbọchị nke oge dọkịta na-ahụ maka ịga gosipụtara. A na-eme nkwubi okwu a dabere na ọnọdụ ahụike nke onye ọrịa ahụ niile na nsonaazụ ndị enwetara mgbe achọpụtara ya. Dịka iwu, ọnọdụ ahụ kwesịrị ịgbagha ụbọchị. Oge ụfụ ga-enyere gị aka iwepu ahụ erughị ala na akpịrị.

Ihe ngosi na contraindications

A na - eme nchọpụta nchọpụta a ma ọ bụrụ na ihe ndị a na - egosi:

nnukwu mbufụt nke pancreatic ducts,
mgbu na-adịghị ala ala
jaundice mgbochi
na-enyo enyo na akwara ma ọ bụ ọnya afọ ma ọ bụ ọrịa gallstone,
warara nke akwara nile,
njirimara nke njiri mara papillosphincterotomy endoscopic.

Ihe ngbanwe

Usoro ahụ dị maka ọrịa ndị a:

nnukwu pancreatitis
Ọrịa cancer akpa ume
stenosis nke nnukwu paodenal papilla,
oria ojoo,
nnukwu ọrịa ịba ọcha n'anya,
cysts gbagwojuru anya site na obara obara.

N'ọnọdụ ụfọdụ ndị ọrịa, usoro a nabatara, mana ekwesighi:

tụụrụ ime
ọrịa nke obi usoro,
na-ewere ọgwụ anticoagulants
ọrịa shuga mellitus.

Nsochi

Ndị ọkachamara na-ekwu na ụdị nchọpụta a dị mma. Agbanyeghị, n'ọnọdụ adịghị obere, nsogbu ndị a nwere ike ime:

perforation nsia
ọbara ọgbụgba
ọrịa eriri afọ.

Symptomsfọdụ mgbaàmà na-atụ aro na e mehiere n'oge usoro ahụ. N'ime nsogbu ndị a nwere ike ịchọpụta:

ọgbụgbọ
akpata oyi
vomiting
mgbu n'ime obi ma ọ bụ afọ.

Ọrịa Mirizzy

Ngwá ọrụ nka na ụzụ. ERzọ ERPC dị mgbagwoju anya, mejupụtara nyocha endoscopic nke akụkụ ala nke esophagus, afo, duodenum na BSC na X-ray nke usoro akwara nke etisa.

Iji mee ERCP endoscopes ọdịiche dị n'etiti ndị ọzọ site na nhazi akụkụ nke ngwa anya na ọnụnọ nke igwe eji arụ ọrụ nwere nkwalite, na ntinye nke emeghari na ara nke duodenal.

Ọ bụ ọtụtụ ụlọ ọrụ si mba ọzọ na-emepụta ụdị gastroduodenoscopes. Enwere ugbu a ụdị 5 nke ngwaọrụ a. Ọdịiche kachasị dị mkpa nke nhazi ha, nke na-ekpebi ogo ngwa, bụ dayameta nke ọwa akụrụngwa (site na 2.2 ruo 5.5 mm).

Channelzọ ọrụ nke obere dayameta na-enye gị ohere ịrụ: 1) mmachi nke duodenal nipple with a catheter for retrograde injection of a far dhexdhe, 2) endoscopic dissection nke duodenal nipple, 3) mwepụ nke calculi dị na hepatico-choledochus, nkata Dormia, 4) nasobiliary drainage with tubes of 2 karịa karịa.

Uzo nke ngwa eji enwe uzo eji udiri ihe nke kariri (3.2-3.7 mm) di nkpa karie, nihi na mgbakwunye na ntuzo ndi a a di elu, enwere ike iji ihe ndi a mebie okwute n’ime uzo abuo ya na ntinye ya na ibe ya. A na-ezube ụdị ndị a maka ịmị, endoprosthetics na dayameta nasobiliary dayameta.

Endoscopes nwere ọwa ngwaọrụ nke nwere dayameta nke 4.2 ruo 5.5 mm abụghị ụdị dịgasị iche.

Na-egbochi ojiji nke ụdị ngwaọrụ ndị a maka ERPC ma ọ bụ EPST site na mmachi nke njedebe njedebe nke gastroduodenoscope yana ọdịiche dị ukwuu n'etiti dayameta ọwa ahụ na akụkụ nke catheter na diathermosond ejiri maka ebumnuche a.
N'otu oge, endoscopes a chepụtara dị mkpa maka mbibi calculi nke nnukwu dayameta. Na mgbakwunye, a na-ahazi nnukwu oghere maka iji na-agbapụta mmiri nke nnukwu dayameta, bougienage na stent nke akụkụ ndị gbanyere mkpọrọgwụ nke ma ọ bụ duct.
Dabere na ngwaọrụ ndị a, emebere ihe omumu nke mather-nwa, ebidobere maka transduodenal choledochoscopy, ma ejiri nso nso a maka mbibi ịla arụ nke calculi site na iji teknụzụ laser.
Na mgbakwunye na endoscopes, a na-achọ ngwa ndị ọzọ maka ịme ihe metụtara endoscopic X-ray, nke a na-anọchi anya na nkọwapụta nke Olympas, Pentax, Cook, na Fujinon.

Ọ gaghị ekwe omume ịkọwapụta nke ọ bụla n'ime ngwaọrụ ndị a n'ụzọ zuru ezu n'ihi ụba nke atụmatụ ha dị iche iche, n'ihi ya, anyị ga-elekwasị anya na njirimara kachasị mkpa nke bara uru.

Ihe niile catheters ezubere maka ERPC, enwere ike ekewa atọ dị mkpa: 1) nwere njedebe cylindrical ma ọ bụ okirikiri, 2) ya na njedebe nke ihe, 3) ya na onye na-eduzi ya.

Na agbanyeghị udi njedebe dị warara, n'ime otu ọ bụla egosipụtara enwere catheters mma-ray, nke na-eme ka njikwa x-ray na-aga n’ihu n’ihu n’ihu ha ma na-enye ohere ịhọrọ catheterization na iche nke sistemụ “chọrọ”.

A na-arụ otu ọrụ ahụ site n'aka ndị na-agbanwe agbanwe na-agafe na kateeti, yana njiri mara atụmatụ njedebe. Yabụ, katebul ndị a gosipụtara n'onye nke mbụ adịchaghị mma maka nyocha nhọrọ.

Diathermic loops, odi nkpa maka okpukpo okpukpo duodenal, a nwekwara ike ekewa ya n’otu n’otu: 1) papillotome nke nwere yabasị, ebe “uda okpukpo ahu” bu oru nke akwara oru, nke na-aga n’azu uzo ihe di nso nke vinyl shea, nke kwesiri idetu ya mgbe o na-ekesa BSS, 2) Soma papillotus ", N'ime nke eriri eriri ahụ dịkwa otu a, mana iji rụọ ọrụ ahụ ọ dị mkpa ịgbatị site na lumen nke katuetị ahụ, na - akpụ ụdọ ọpụpụ, 3) papillotome agịga, nke ígwè ahụ na - arụ ọrụ dị ka akụkụ na - arụ ọrụ. eskaya eriri exiting na kemeghi anya si oghere nke njedebe nke catheter. Papillotomas nke ihe osise abụọ mbụ nwere ọdịdị dị iche na njedebe nke ịdị anya, dị iche na ọkwa na usoro iji dozie akụkụ ịkpụ, ogologo ya bụ site na 15 ruo 35 mm. Condị catheter ahụ, nke dị n'elu akụkụ nke diathermosond, na-eme ka a mata ihe a na - eme mgbe a na - akpọbata ya n'ime akụkụ abụọ nke pale dupe, ebe papillotomas na - enweghị nke a bu n'uche ịme “ihe ga - aga n'ihu” n'okpuru ọnọdụ mgbe ịnwa ịmebata ngwa ọrụ a chọrọ. Atherkpa agwa dị mkpa iji mepee oghere nke BSS ampule site na duodenum, wee rụpụta ọrụ endoscopic dị iche na abụọ a dị n'elu, a na-akpọkwa papillotomy na-enweghị ike igbo.

Nmechi Dormia nkata, Ezubere iji wepụta kalculi na lumen nke ịba ọcha n'anya, dị iche iche dị ka ngwaọrụ ndị dị n'elu. Nke mbu, ha di iche na onu ogugu igwe nke ha na aru oru nke oru ha, uzo ha, udiri nkata ahu, ihe eji eme ya, na dayameta di n’elu.

Ọ bụrụ na ọtụtụ ngalaba nkata ahụ nwere ntakịrị nke dayameta nke nkume nke enwere ike ijide ya na lumen ya ma wedata ya n'ime duodenum. Enwere ike nweta otu nsonaazụ ahụ mgbe ị na-ejide obere calculi na calculi dị mkpa karịa site na iji ngwá ọrụ dị ka piston, i.e.

ghara inweta nkume n’ime nkata. Obere nọmba nke eriri igwe na-arụ ọrụ nke ngwaọrụ ahụ, okwute buru ibu nwere ike ịbanye n'ime ya.

Dịka ọmụmaatụ, n'ime nkata nke nwere eriri 3, enwere ike ijide akpụrụ akpụ banyere 2 cm n'obosara, agbanyeghị, ịnwale idozi akịrịkọ nwere dayameta na-erughị 1 cm n'ime ya anaghị enwe isi.

Ntuziaka nke eriri igwe nke na-akpụzi nkata ahụ na-ekpebi nrụzi ya.

Yabụ, nkata nwere ntụgharị nke eriri, na mgbakwunye na njirimara ntụgharị ntụgharị nke akụrụngwa niile mgbe emechiri, n'oge nke akụkụ ma ọ bụ mmeghe zuru oke, nwere ikike ịtụgharị ube n'akụkụ ogologo akụkụ, nke na-enyere aka na ngwaọrụ gafere elu akwara mgbe akụkụ ya dị nso mgbidi dị n'ime nke isi mmiri. Ejiri nke a mee ihe iji wee nwee ike ịnagide akụrụngwa nke ịba ọcha n'anya. Na mgbakwunye, ojiji nke nkata nke imewe a na-arụ ọrụ nke ọma mgbe ị na-ewepụ nkume nke obere dayameta ma e jiri ya tụnyere ndị ọzọ na-enwe vetikal nke eriri ndị ahụ.

Enwere ụzọ atọ dị mma na nkata Dormia, nke edepụtara iji wepụ calculi na traktị biliary: spherical, polygonal na parachute. Candị nkata ahụ nwere ike ikpebi naanị mgbe emepere ya nke ọma, nke ga-enye gị ohere inwe echiche gbasara ikike nke akụrụngwa ahụ.

Okwesiri iburu n’uche na n’agbanyeghi ihe di nkpa nke njiri mara nke ihe eji eme ihe, endoscopic na ozi redio di nkpa maka uzo choledocholithiasis nke oma.

Ọzọkwa, ọ bụghị naanị pathogenesis, nha, oke, ọdịdị, ọnọdụ nke calculi na dule bile, kamakwa ọnọdụ anatomical bụ ihe kachasị mkpa maka nsonaazụ ahụ.
A ga-atụle nkọwa ndị ọzọ gbasara ọrụ nke ihe ndị a n'otu akụkụ, na ngalaba a anyị ga-atụle atụmatụ nke ngwaọrụ maka mbibi intra-Calculi.
Ihe eji arụ ọrụ okwu nwere ọdịiche dị oke mkpa, ụfọdụ na-adabere na onye nrụpụta, ebe ndị ọzọ na-emetụta ụzọ izizi ọgwụgwọ.
Ngwaọrụ kachasị ike nwere braid ọla, nke dị mpụta nke sitere na 2.2 ruo 3 mm, nke na-achịkwa nhọrọ nke endoscope. Ugbu a, enwere ike iji ụdị endoscopes abụọ maka obere nke dayameta, ebe maka lithotripter nwere dayameta 3 mm, enwere ike iji TJF si Olimpus mee ihe.
Site n'ike nke dịtụ nha, ngwaọrụ nke dayameta pere mpe karịa, mana ike nkata nke ngwaọrụ nke abụọ dị mkpa karịa.
Maka mbibi akụrụngwa nke akwara dị n'ime dule dule, e mepụtala usoro abụọ: otu n'ime ha bụ drum ma nwee nnukwu mbibi karịa nke ọzọ, nke edobere ya n'ụdị sịlịnda.

Mara na mgbe ị na-eji njikwa ụdị nke mbụ, akụkụ ọrụ nke ngwaọrụ ahụ, ma ewezuga braid ahụ, a na-agbanwe mgbanwe ndị na-enweghị mgbanwe mgbe otu ojiji agaghị enwe ike weghachi ya. N'aka ozo, iwepu ihe eji eme ihe bu ihe kari apughi isi emebi nkata.

Katidra ndị edobere ịrụ nasobiliary igbapu dị iche na dayameta dị n'ime, nke bụ ihe dị ka 2 ruo 2.8 mm, yana ọdịdị nke njedebe dịpụrụ adịpụ.

-Dị yiri mgbaaka nke njedebe dị anya, yana akụkụ ya nke dị na duodenum, na-enye aka na ndozi ọzọ nwere ntụkwasị obi karịa na lumen nke hepatic choledochus.

Nwere ike nweta echiche maka ụdị nke ọkpọ mmiri ahụ na - ewepu ya naanị mgbe ị wepụrụ onye na - eduzi ihe igwe.

Izi ezi nke nchoputa ya, yana ihe ndi mmadu mere n’iru mmadu ejikọtara site na iji ya Ngwunye ọkụ n'otu oge, ihe ndị a chọrọ maka ya anaghị akọwapụtakarị ya.

Ihe ndị dị mkpa bụ ihe ntụgharị elektrọn (EOP), ikike iji duzie ọmụmụ polypositional, were eserese, gụnyere ebumnuche, yana nchedo ntụkwasị obi nke onye ọrịa na ndị ọrụ site na radion ionizing.

Ka ọ dị ugbu a, ọtụtụ igwe igwe ray-emezu ihe ndị a chọrọ.

A ga-enyocha nyocha nke nyocha x-ray na arụmọrụ nke ọma, nye ohere nke idozi ọrụ ndị a:

1) nzukọ nke ime ụlọ nwere ngwa x-ray,
2) inye ngwa ọrụ dị mkpa,
3) nnweta nke ndị ọrụ dị mkpa - onye ọrịa X-ray endoscopist, ọkachamara n'ihe gbasara redio na onye nọọsụ,
4) tupu ịmalite ọrụ, dọkịta ga-enwerịrị ọzụzụ n'ụlọ ọrụ pụrụ iche.

Pkwadebe ndị ọrịa maka REV. Mgbe ị na-akwadebe ndị ọrịa maka REV, ọ dị mkpa iburu n'uche na nkewa n'oge usoro nchọpụta (ERCP) na endoscopic ịwa ahụ (EPST) abụghị naanị ihe na - adịghị mma, kama ọ na - agbasawanye na mmepe ma ọ bụ na - akawanye njọ nke nsogbu ndị dị ka nnukwu cholangitis na pancreatitis.

A kọwara usoro a site n'eziokwu ahụ bụ na n'ọtụtụ ihe, X-ray endoscopic na-eme ihe iji wepu ọbara mgbali elu ugbu a ma ọ bụ wepu ihe kpatara ya n'ọnọdụ enwere ike igosipụta ya.

O doro anya na iwebata ihe dị iche na nke dị n'ime obere ngwa agha, ọbụlagodi na obere obere, ga - agbalite ọbara mgbali elu ma ọ bụrụ na ewereghị ihe iji dozie ya.

Ya mere, nkwadebe nke ndị ọrịa, ọkachasị prematication, kwesịrị ka eburu ya na atụmanya nke ịme ọ bụghị naanị ERCP na EPST, kamakwa na-eburu n'uche ohere iji sistemụ elektrik na ntopute nke nasobiliary.

Pkwadebe ndị ọrịa maka REV dị mfe ma gụnye ịtọhapụ akụkụ nke akụkụ eriri afọ site na ihe ndị dị na n'oge ọmụmụ ihe mberede ma ọ bụ, nke kachasịkarị, na ịjụ nri ụtụtụ n'ụbọchị ọmụmụ, i.e. n’akpa afọ.

Premedication mejuputara banyere ogwu nke nwere nsogbu ogwugwo na, na mgbakwunye, na-ebute mgbochi mkpirisi nke peristalsis nke duodenum. Nke ikpeazụ a dị mkpa kachasị mkpa maka mgbasa nke endoscopic nke ara duodenal.

Dabere na data anyị, ndị na-egbochi ganglio-blockers (benzohexonium, pentamine) na-enye aka n'ị nweta nsonaazụ ka ukwuu - nkeji oge 0,5-1,15 10-15 tupu nyocha endoscopic. Ojiji nke ọgwụ ndị a ruo afọ 19 agbanyebeghị nsogbu ọ bụla pụtara ìhè, gụnyere mbelata ọbara mgbali elu.

N'otu oge ahụ, iji ọgwụ ọjọọ eme ihe dịka buscopan na metacin na-enye mmetụta na-adịgide adịgide ma na-ekwu okwu mgbe enwere paresis nke duodenum.

N'ime usoro ọgwụgwọ nke ụlọ ọgwụ ịwa ahụ, ikpe nke ọnọdụ dị oke njọ nke ndị ọrịa, ọ bụghị naanị site na peculiarities nke isi ahụ, kamakwa site na ọrịa concomitant, karịsịa usoro obi, abụghị ihe a na-ahụkarị.

N'okpuru ọnọdụ ndị a, nkwadebe na omume nke REV adịghị iche na ndị na-ebute ụzọ, i.e. gụnyere ọgwụ ndị na-enyere aka ibido akụkụ ahụ na sistem dị mkpa.

Dabere n'ọnọdụ a kapịrị ọnụ, enwere ike iji ọgwụ ndị a mee ihe tupu, n'oge na mgbe ntinye aka ahụ, dịka onye nyocha ọgwụ metụtara na nyocha ahụ kpebiri.

Mkpa ịkụnwụ ahụ n'ozuzu maka REV dị ụkọ na, dịka data anyị si dị, naanị na ndị mmadụ nwere ọrịa isi na-aga n'ihu. Ojiji nke usoro a n’oge ịwa ahụ n’elu akwara afọ, n’agbanyeghi na enwere ike, bụ n’uche anyị, enweghị atụ dị ukwuu n’ihi enweghị ohere njikwa x-ray zuru oke na nke nchekwa.

Na mmechi akụkụ a, anyị na-arịba ama na n'oge nkwadebe nke ndị ọrịa maka REV enweghị ọgwụ eji eme ọgwụ.

Retrograde cholangiopancreatography (RCHP)

Retrograde cholangiopancreatography (RCHP) Bụ usoro ijikọ endoscopy na nyocha fluoroscopic n'otu oge. A na - eji usoro a maka enyo enyo choledocholithiasis, iji chọpụta ọdịdị nke jaundice mgbochi na ịmụba mmewere ahụ nke akwara mmiri tupu ịwa ahụ.

Ebe ọ bụ na RCHP bụ usoro a na-ahụkarị, ihe ngosi maka ya kwesịrị ịgbagha agbagha. Ugbu a, a na-arụ ụdị RCP dị iche iche na-agwọ ọrịa n'ọtụtụ ụlọ ọgwụ.

Agbanyeghị, dị ka ekwuputara, ekwesighi ịgbagha ihe ọhụụ, ebe ọ bụ na mmejuputa ntinye a nwere ike jikọta ya na mmepe nke nnukwu nsogbu ma ọ bụ bute ọnwụ (Onu ogugu nke nsogbu dịgasị iche site na 4.0% ruo 4.95% na endoscopic papillosphincterotomy group ( PST) ruru 9.8%).

A tụpụtala ọtụtụ usoro iji belata nsogbu nke nsogbu, dị ka ọrịa ọrịa pancreatitis, RCP.

N'ụzọ bụ isi, ihe ndị a bụ eziokwu maka ọrụ aka: zere ugboro ugboro cannulation nke akụkụ akwara nke nwere ma ọ bụ na-enweghị ọdịiche, jiri jikọtara ọnụ dị ugbu a na akara nke ịkpụ mgbe ị na-arụ PST, mgbe ị na-eme PST mbido, dissection esiteghị n'ọnụ BDS na ọgwụ ọgwụ.

Endoscopic retrograde cholangiopancreatography (ERCP) bụ usoro dị mkpa maka nyochaa dule duct na ọgwụ ntụrụndụ site na iji arụpụta ọhụụ nke usoro endoscopic na raa-ray.

Usoro a ga - enyere gị aka ịchọpụta ọrịa dị iche iche nke ọrịa kansa (akpịrị ma ọ bụ nke na - adịghị ala ala, ọnya, ọnya) yana mgbanwe maka ọgịga na ọnya afọ (okwute, mkpụchi nke obere akwara).

Ihe omumu a di iche na uzo nyocha ndi ozo site na ihe omuma ya di elu na ntukwasi obi ya, ya na ikike nke ime ihe otutu ọgwụgwọ .. ERCP ka emere naani ulo ogwu. Tupu n'ọmụmụ ihe dị otú a, a na-eme ọgwụ na-akụ ihe mgbe niile.

Ka ogba ume nke ọnụ na pharynx, ihe ngwa anya pụrụ iche (duodenofibroscope) gafere n'ọnụ, esophagus na afọ banye na duodenum ebe ọnya na-ahụkarị na paịlị na-ejikọta ọnụ (paodilla papilla), nke ọnụ ya na-emeghe n'ime lumen nke duodenum. . Site n'enyemaka nke ọkpọ pụrụ iche, nke a na-agbanye n'ọwaosos endoscope, a na-etinye ọnụ papilla n'ime mmiri dupe na paịlị nwere ihe radiopaque. Mgbe ahụ, na-eji ngwa X-ray, ọkachamara ahụ enweta ihe onyonyo nke sistemụ. O buru na achoputara oria obula ma obu okwute, emechara endoscopic n’ime ya, nke acho iwepu ihe mgbochi na ikike nke ndi bile. Iji mezuo nke a, na-eji ngwaọrụ dị iche iche pụrụ iche arụ ọrụ nke sitere na endoscope, a na-enwe ntanetị site na mpekere eriri ahụ ebe ewepu okwute ya.

Endoscopic retrograde cholangiopancreatography bụ otu n'ime ụzọ kachasị mkpa ọhụụ iji chọpụta ọrịa nke mpaghara pancreatobiliary.

Endoscopic retrograde cholangiopancreatography na Novorossiysk

Endoscopic retrograde cholangiopancreatography (RCHP) bụ otu n’ime ụzọ esi achọpụta ọrịa, n’Israel, ana - ejikarị ya chọpụta ọrịa nke eriri afọ.

Na usoro nke RCHP, ọ ga-ekwe omume ịchọpụta nsogbu nke pat patial (nkebi na mgbochi zuru oke) nke bile na pancreatic ducts, ọnụnọ nke okwute, akpụ na ọnọdụ ndị ọzọ. N'ime ụlọ ọgwụ Medical Meir, a na-eme RCPs ọ bụghị naanị maka nchọpụta, kamakwa maka ebumnuche ọgwụgwọ.

N'ime usoro a, ịnwere ike iweghachi ikike nke obere pọpụ, dịka ọmụmaatụ, iji wepụta okwute ma ọ bụ tinye ihe nkwado.

Ihe ngosi maka cholangiopancreatography

Jaundice ma ọ bụ afọ mgbu nke etiology amaghi
A na-enyo enyo ma ọ bụ obere okwute dule
Ọrịa nke imeju, pancreas, ọnya biliary
Mmebi ma ọ bụ mbufụt nke ọgịrịga nke ihe na-eto eto sitere na cholelithiasis
Ọrịa mgbu
Ọgwụ nje ma ọ bụ stent
Manometry - ịbawanye nrụgide n'ime eriri afọ na ogologo dule nkịtị

Nkwadebe maka endoscopic retrograde cholangiopancreatography

Ọ bụrụ na ịnwere usoro HRCG, biko soro ntuziaka dị n'okpuru:

A na-ahapụ nri ikpeazụ ka elekere asatọ tupu usoro ahụ. Mgbe nke a gasịrị, zere iri ihe, ma ọ bụrụ na ọ ga-ekwe omume, ị fromụ mmanya. Ọ bụrụ n’enyere gị ọgwụ maka ọbara mgbali elu ma ọ bụ ọrịa ọrịa obi ọzọ oge niile, na-erughi elekere atọ tupu RCP, ị nwere ike medicineụọ ọgwụ dị mkpa ma withụọ ya na nnukwu mmiri. Mgbe nke a gasịrị, a machibidoro ị drinkingụ ihe ọidsụ drinkingụ mmanya ọkụ kpamkpam.
Ekwesịrị ịkwụsị ọgwụ iji belata coagulation ọbara (coumadin, synthroma) otu izu tupu ụbọchị RCP. Asakingụ ọgwụ aspirin nwere ike ịga n’ihu n’enweghị mgbochi ọ bụla. Gị na ndị na-ahụ maka ahụike gị kparịta ụka.
Usoro a na iji ọgwụ mgbochi eme ihe, na - akpata mkpirikpi oge nke mmụọ. N'ihi ya, ọ ga-adị mma ka gị na onye enyemaka gị rute ebe ahụike ahụ wee ghara ịkwọ ụgbọ ala ụbọchị ahụ.
Ndị ọrịa na-anata insulin ekwesịghị inwe ọgwụ ụtụtụ kwa ụbọchị. A ga-akpọrịrị gị sirinji insulin.
N'ime uwe ndị dị mma na-enweghị ọla na-abịa usoro a.
Tupu usoro ahụ, ọ dị mkpa ịtọpụ eriri afo, wepu ezé na lenses kọntaktị.

Usoro RCHP

ECHO nwere ọkachamara n'ịrụ ọrụ nchọpụta na ọgwụgwọ cholangiopancreatography site na iji ngwa ọgbara - endoscopes dị nro nwere eriri anya.

A kwadebere endoscope nwere obere igwefoto vidiyo pere mpe na-enyefe ihe osise dị elu na onye nyocha arụnyere n'ime ụlọ ọgwụgwọ.

Ọzọkwa, site n'enyemaka nke endoscope, enwere ike ịmebata ngwa ngwa pụrụ iche na ngọngọ nke onye ọrịa ahụ iji mepụta usoro dị mkpa.

Ogologo oge nke usoro ahụ sitere na minit 30 ruo 60. Mgbe emechara ya, onye ọrịa ahụ ga-achọ nlekọta nke ndị ọrụ ahụike ruo awa 1-2. Ọ bụrụ na emere mgbatị ahụike n'oge RCHP, enwere ike ịgwa onye ọrịa ka ọ nọrọ n'ụlọ ọgwụ ahụ ruo n'ụtụtụ echi ya.

Iji mee ka ngwụcha nke endoscope gafere site na oghere ọnụ na pharynx, a na-eji ọgwụ mgbochi na mpaghara. Tupu ịmalite usoro ahụ, a na-enye onye ọrịa ọgwụ mgbochi na ihe mgbu. Na mkpokọta, usoro a adịghị egbu mgbu ma nwee obere ahụ erughị ala. Ọgwụ nke endoscope pere mpe ma ọ gafere ogo nke nri mmadụ riri nri.

Dọkịta ahụ ga-akpachara anya endoscope site na esophagus na afọ, na-enyocha ihe dị ha n'ime, wee ruo duodenum, n'ime ya ma ọ bụrụ na ọnya na-apụta.

A gbanye obere ikuku n'ime oghere duodenal, a na-ewebata ihe dị iche n'ime mkpụkọ akwara na pancreas. Mgbe ahụ mee usoro x-ray. N'oge usoro ahụ, enwere ike ịgbanwe ọnọdụ onye ọrịa: gbanye ya n'akụkụ ma ọ bụ n'afọ ya.

Nke a dị mkpa iji anya na-ahụ ihe owuwu mgbe a na-ese foto.

Site na ọwa na endoscope, ị nwere ike ịdọrọ obere ngwa pụrụ iche iji wee me biopsy - were nlele anụ ahụ site na mpaghara enyo maka nyocha. Site n'enyemaka ha, n'ọnọdụ ụfọdụ, ị nwere ike iwepu okwute na-egbochi mmụba nke bile, ma ọ bụ tinye stent.

Stent bụ ọkpọkọ ma ọ bụ plastik. Ọ na-akwado mgbidi nke bile duct ma ọ bụ paịlị na-egbochi ya, na-egbochi ihe mgbochi ya (mgbochi).

Otu n’ime ihe na-egosi maka mkpọta bụ ọnụnọ nke akpụ na-egbochi lumen nke ma ọ bụ mpaghara ahụ nke akpa Vater - ebe ebe nsị na-abanye duodenum.

Mgbe emechara usoro ahụ, a na-ewepụ nke ọma endoscope.

Oge mgbake

Ihe dị ka otu elekere RCP gasịrị, ị nwere ike ịmalite ị .ụ mmanya. N’ụbọchị mbụ, a na-atụ aro ka ọ useụọ naanị ihe ọ andụ andụ na nri anụ dị nro.

Kpọtụrụ ụlọ mberede nke ụlọ ọgwụ ma ọ bụrụ na ịnwee otu n'ime mgbaàmà ndị a:

Okpomọkụ dị elu karịa ogo 38
Ihe mgbu
Vomiting na ọnya nke ọbara
Rectal ọbara ọgbụgba, nwa feces

Ọkpụkpụ nke ụdọ varicose nke esophagus

Endzọ endoscopic maka ọgwụgwọ na mgbochi ọbara ọgbụgba site na akwara nke esophagus na afọ.

Mgbe ọnya na-enwe oghere pụrụiche, ngwụsị endoscopic na-amalite site na mpaghara mgbanwe akụkụ esophagocardial, dị n’elu ahịrị dentate. A na-atụnye mgbaaka ndị ahụ na gburugburu, tụfuo mgbe akwara nke ahọpụtara ahọrọ ka a na-etinye n'ime cylinder ma ọ dịkarịa ala ọkara elu.

Maka nnọkọ ahụ (dabere na ogo varicose veins) wetara mkpado 6-10.

Dịka iwu, a na-eme ligation site na mgbaaka latex. Ọrụ nke na-agbanwe agbanwe nwekwara ike ịrụ site naịlọn naịọnị nwere dayameta nke 11 na 13 mm, nke kwekọrọ nha nke okpu ahụ distal.

Otu izu mgbe usoro ahụ gasịrị, a na-eme endoscopy iji nyochaa nsonaazụ nke ịwa ahụ.

N'ọnọdụ mgbapụta ọbara ọgbụgba, a ga-agharịrị ikpere akwara endoscopic.

Ọgwụ endoscopic nke akwara mkpụrụ akụkụ akpụ akpụ

Ugbu a, enwere ịrị elu nke ọnụọgụ ọrịa ọrịa imeju, ọkachasị, mmebi imeju na ọrịa ịba ọcha n'anya na ị ofụbiga mmanya na ọgwụ ịba ọcha n'anya, nke na-eme ka oge na-eduga n'ọrịa cirrhosis.

Otu n'ime nsogbu na -emekarịkarị nke ịba ọcha n'anya na ọrịa nrịanrịa bụ ịkpụcha ọbara ụkwara arụ na afọ, n'ihi ọbara ọgbụgba na-erugharị site na 50% nke ikpe ọbara na - esochi oke ọbara. Ọnwụ, na-enweghị enyemaka ihe mberede, yana mpaghara mbụ nke ọbara ọgbụgba bụ 30-40%, yana ọbara ugboro ugboro 70%.

Ekwesịrị ịme Fibrogastroscopy maka ndị ọrịa niile nwere ọrịa imeju nke usoro dị iche iche, yana ndị ọrịa nwere ọrịa ịba ọcha n'anya. Ọtụtụ mgbe mmepe nke varicose veins na-apụta tupu ịmalite mmepe nke ngagharị cirrhotic nke ịba ọcha n'anya.

Enwere ọtụtụ ọnya ịwa ahụ siri ike iji wepu varicose veins, nke ndị ọrịa nwere ọrịa imeju na-anabataghị nke ọma, na-akpata obi mgbawa ma na-eso ọnwụ dị oke egwu.

Yabụ, endoscopy ewerewo ọnọdụ dị mkpa na nchọpụta na ọgwụgwọ nke varicose veins nke esophagus na afọ Ọtụtụ mgbe, endoscopic ligation nke ọnya ọgbụgbọ nke esophagus na-eme.

Ọgwụ endoscopic nke akwara mkpụrụ akụkụ akpụ akpụ

Ọkpụkpụ endoscopic nke akwara ozi nke esophagus nwere njikọ nke oghere varicose site n'enyemaka nke obere mgbaaka. A na-ewebata eriri afọ nkịtị na -ele njedebe na njedebe n'akụkụ akụkụ nke esophagus ma na-eme nyocha ọzọ n'okpuru ya. Ekem ewepu gastroscope ma dozie akwara akwara na njedebe ya.

Mgbe nke ahụ gasị, eriri afọ ga - enweteghachi n'ime akpịrị esorogus, ekpughere varicose vein a na - achọ ya n'ime akwara nke akwara. Mgbe ahụ, na ịpị igwe ọkpọ a na-etinye na ya, a na-etinye mgbaaka na-agbanwe na akwara. A na-emeghachi usoro ahụ ruo mgbe akwara varicose niile na-aga n'ihu.

Na nke ọ bụla n'ime ha wetara site na 1 ruo 3 yiri mgbaaka.

Ọkpụkpụ endoscopic nke akwara ozi nke esorogus na-enye obere nsogbu karịa sclerotherapy, ọ bụ ezie na a chọrọ oge ndị ọzọ iji wee nwee ike ịgbatị ụbụrụ varicose. Ihe na-ebutekarị nsogbu bụ dysphagia transient, a na-akọwakwa mmepe nke bacteremia.

Inwekwu nyocha nwere ike ibute mkpo azụ. N'ebe a na-agbanye mgbanaka, ọnya nwere ike imecha. Mgbe ụfọdụ, mgbaaka na-amịpụ, na-akpata nnukwu ọbara ọgbụgba.

Yabụ, anyị na-atụ aro ka ligation nke veins nke mkpụrụ nke akpọrọ naanị na ụlọ ọrụ ahụike pụrụ iche.

A na-eji ọgbụgba akwara varicose vein nodes na-eji mgbaaka eme ihe n’egwuregwu mberede ka ịkwụsị ọbara ọgbụgba site n’akwara nke varicose veins nke esophagus. Agbanyeghị, iji rụọ ọrụ ahụ n'ọnọdụ ọnọdụ ọbara ọgbụgba na-esikarị ike karị, enweghị ike nweta radicalism.

Ya mere, anyị na-akwado ndị ọrịa niile nwere ọrịa imeju na ịba ọcha n'anya ịba ọcha n'anya n'oge kwesịrị, ma ọ bụrụ na ọ dị mkpa, mee ligation ma gbochie ọbara ọgbụgba.

Endoscopic retrograde pancreatocholangiography na papillosphincterotomy maka nsogbu jaundice

Bregel A. I. (onye isi nke ngalaba endoscopic, prọfesọ nke ngalaba nke usoro ịwa ahụ echiche),
Andreev V.V. (endoscopist), Yevtushenko V.V. (endoscopist), Borkhonova O. R. (onye na-ahụ maka redio) MAUZ Clinical Hospital Nke 1 nke Irkutsk,
Mahadum Ahụike Irkutsk State

Endoscopic retrograde pancreatocholangiography (ERCP) bụ usoro kachasị atụkwasị obi maka ịchọpụta ihe kpatara ọrịa jaundice, yana papillosphincterotomy (EPST) bụ enyemaka kachasị mma nke obere mpụ maka mmebi nke uzo bile n'ime duodenum (duodenum). A na-eme nnyocha ahụ dịka ihe ngosi pụtara na ụbọchị mbụ nke 1-3 nke ọnụnọ nke ndị ọrịa n'ụlọ ọgwụ.

Nyochaa nsonaazụ nke ERCP na EPST maka afọ 5 na ndị ọrịa 312.

N'ime ndị ọrịa 240, a na-eme nyocha banyere akụkọ ikpe, na na 72 - naanị usoro nyocha nke ọmụmụ endoscopic. Emere ihe omumu n'oge ikpe siri ike maka nyocha ogwu nke oria a ma, oburu na odi nkpa, ntinye nke EPST. Ọ bụrụ na enwere ihe ngosi n’ime ndị ọrịa 265, emere EPST. Weremụ nwoke dị 86 (27.56%), ụmụ nwanyị 226 (72.44%).

E kesara ndị ọrịa site n'afọ dị ka ndị a: 14 (4,49%) ndị ọrịa dị afọ 30, afọ 6 (1.92%) dị afọ 31-40, afọ 24 (7.69%) ndị ọrịa dị afọ 41-50, 58 (18.59%) ndị ọrịa - 51-60 afọ, ndị ọrịa 76 (24.36%) - afọ 61-70, ndị ọrịa 89 (28.53%) - afọ 71-80 na afọ 45 (14.42%) ihe karịrị afọ 80.

N'ime afọ atọ gara aga, mmụba nke ndị agadi na ndị ọrịa nwere ịrị elu site na 62.67% ruo 68.13%.

N'ọtụtụ ndị ọrịa, ọnọdụ nke ọrịa ahụ ka njọ site na ọnụnọ nke ọrịa dịgasị iche iche: ọbara mgbali elu (75), ọnya obi (73), nkụchi obi na-adịghị ala ala (4), ọnya afọ (4), ọnya duodenal (4), ọrịa shuga mellitus (3 ) na ndị ọzọ.

Nnyocha nke ultrasound (ultrasound) nke biliary traktị kpughere okwute dupe dupe na 16.67% nke ndị ọrịa, ekwenyeghị na choledocholithiasis na 60.83% nke ndị ọrịa, na ọnụnọ ma ọ bụ enweghị calculi na choledochus bụ nke ndabere ịdabere na ndabere nke nyocha ultrasound na 22.20% nke ndị ọrịa. N'ime ọtụtụ ndị ọrịa ultrasound, a na-agbatị dule nkịtị na-agbasa ruo ogo dịgasị iche.

Emere nyocha nke tomography (CT) na ndị ọrịa 13 (5.42%).

N'ime mmadụ ise n'ime ha, CT chọpụtara ọrịa pancreatitis na-emebi emebi, n'ime 3 - choledocholithiasis, na ndị ọrịa 2 mgbanwe ndị ọzọ na mpaghara hepatopancreatoduodenal.

Dayameta nke nnukwu ara duodenal (BDS) anaghị agafe 5 mm. Anyi n’ado iche iche udi onu nke onu odi BDS. N'ime ọtụtụ ndị ọrịa (266) ma ọ bụ na 85.26% ọ gbara, na 33 (10.58%) ndị ọrịa ọnụ pere mpe, dịka ndị ọrịa 5 (1.60%) ọ bụ ihe jọgburu onwe ya, na 3 (0.96%) - ụdị ntụpọ, yana 4 (1.28%) nwere ụdị dị iche.
Achọtara uzo di otutu na oghere BDS n'ime ndi oria 39 (12.50%). Na 15 (4.81%) n'ime ha, oghere oghere dị na parapapillary diverticulum nke duodenum yana n'ime ndị ọrịa 24 (7.69%) na nsọtụ nke diverticulum.
N'ime ndị ọrịa 19 (5.56%), ọmụmụ ihe ahụ bụ naanị maka wirsungography. N'ime mmadụ abụọ n'ime ha, BDS dị na diverticulum, na 4 - n'akụkụ diverticulum na n'ime ndị ọrịa 13 enwere ihe ndị ọzọ mere naanị wirsungography.
N'ime ndị ọrịa 30 ọzọ, enweghị ike ịghapu ducts, na-enwekarị ọnọdụ BDS na-adịghị ala ala.
Mgbe etinyere catheter ahụ n'ime oghere BDS, a na-eme ntụtụ nyocha 1-2 ml nke mmiri na-emetụta ọdịiche 50% (verographin, urographin, wdg). Mgbe njedebe nke catheter dị na sistemụ dupe, nke onyinyo nke choledochus dị iche na nyocha, enwetara ya na akụkụ nke imeju.

Omimi nke ntinye nke catheter ahụ n'ime dule nke bile na-agbanwe agbanwe nke ukwuu site na 1 ruo 12 cm, dabere n'ụdị usoro ahụ, mmekọrịta anatomical nke usoro duct, duodenum, BDS na ihe ndị ọzọ.

Nleta nke ihe ndi mmadu na ihe otutu nwantiri site na njikwa nke 20-30 ml nke 50% mmiri na-agbanye mmiri site na njikwa anya ya na nkesa ya tinyere otu bebi na nyocha. Mgbe emejuputara sistekoro ụyọkọ na mọstad na ihe dị iche, achọrọ 1-3 x-ray.

Mgbe onyonyo gbasasịrị, a na-eji akwa novocaine sachaa dupe ahụ. Dika njiri mara maka ihe iriba ama cholangitis, choledoch lumen ka eji ogwu ogwu wuo ya.

Achọpụtara nchọpụta ahụ mgbe endoscopic retrograde pancreatocholangiography na ndabere nke akara endoscopic nke ọrịa ahụ, nsonaazụ nke canDing nke BDS na nkwalite nke catheter tinyere otu bele, ọdịdị nke mgbasa nke ọdịiche tinyere ducts na ihuenyo nyocha yana data x-ray.

Dabere na ERPC, dayameta nke ndị ọrịa bile na 32 (10.92%) ndị ọrịa erughi 6 mm, na 73 (24.91%) ndị ọrịa ọ bụ site na 7 ruo 10 mm, na 100 (34.13%) ndị ọrịa ọ bụ 11-15 mm, Ndị ọrịa 68 (23.21%) nwere ndị 16-20 mm, na ndị ọrịa 20 (6.83%) nwere ihe karịrị 20 mm.

Dabere na nsonaazụ ERCP, a chọpụtara ihe ndị na-esonụ nke ọrịa jaundice.

Ọtụtụ mgbe - na 193 (61.86%) a hụrụ nkume ndị ọrịa na-ahụkarị na bile dupe, na ndị ọrịa 46 (14.74%) - microcholecholithiasis, na 5 (1.60%) ọrịa - bile duct tumor, na 3 (0.96%) - BDS adenoma, n'ime mmadụ abụọ (0.64%) ndị ọrịa intrahepatic ka achọpụtara, na n'ime 1 (0.32%) onye ọrịa chọpụtara ọnya akwara. Na iri ise (16.03%) ndị nwere ọrịa ERPC, ebughi ihe kpatara jaundice, ma ọ bụ ekweghị ka eke jaundice.

Emere endoscopic papillosphincterotomy (EPST) site na ndi cannulation na ndi mmadu adighi anaghari na 265 (77.49%). Ogologo nnabata nke papillotomy ruru 10 mm na 126 (47.55%) ndị ọrịa, ndị ọrịa 11-15 na 114 (43.02%), na 16-20 mm na 25 (9.43%) ndị ọrịa (Fig. 1 )

Emechara EPST, n'oge nyocha endoscopic, a na-ewepụ calculi site na dule bile n'ime ndị ọrịa 133 (Fig 2), na ndị ọrịa 110, ọ nweghị okwute ahụ na ebupute ahụ.

N'ime ndị ọrịa 69, ewepụghị okwute si na ihe abụọ na-apụ apụ.

Ihe kpatara na ekwenyeghi ka ewepu okwute n’otu ebe bile n’oge endoscopy bu akuko okpokoro aru (54), ndozi siri ike nke okwesiri n’ime bile du 13 (13), na ihe ndi ozo (2).

Achọpụtara nsogbu mgbe emesịrị ERCP na ndị ọrịa 36 (15.00%).

Ọbara sitere na ọnya papillotomy mere na ndị ọrịa 23 (9.58%), n'ime ndị ọrịa 22 a kwụsịrị ya n'oge duodenoscopy, na 2 ọ na-agbake mgbe ngwụsị nke ọmụmụ ahụ. Site na nlọghachi ọbara ọgbụgba na otu onye ọrịa, a rụrụ ọrụ endoscopic hemostasis nke ọma, a wara onye ọrịa 1 ọrụ.

Nnukwu ọrịa a na - eme ka ọ dị n ’ọrịa (5,88%) nke ndị ọrịa, mwepu nke otu ọrịa ihe na - emekarị na 6 (2.50%), mwepu nke duodenum na 1 (0.42%) na papillitis na 1 (0.42%) nke onye ọrịa.

Nke a mechara, ndị ọrịa 104 (43.33%) rụrụ ọrụ. Ọ rụrụ ọrụ cholecystectomy, na chastobolny ndị ọrịa jikọtara ya na choledochotomy, mwepụ nke calculi site na otu ihe ọzọ na-agakọ, ịdabere choledochoduodenostomy na nhọrọ dị iche iche maka ịba mmiri dule. N'ime ndị ọrịa 9, a machibidoro microcholecystostomy ma rụọ ndị ọrịa 2 maka nnukwu ọrịa pancreatitis.

Ya mere, ahụmịhe anyị na endoscopic retrograde pancreatocholangiography na papillosphincterotomy na-akwado ọdịnaya ozi ha dị elu na arụmọrụ ọgwụgwọ. ERCP na ultrasound maka choledocholithiasis n'ọtụtụ oge na-enye gị ohere igosipụta ihe kpatara ọrịa jaundice, nha, ọtụtụ okwute na dayameta nke choledochus.

Ihe omuma ndi ERPC maka choledocholithiasis di elu karie ultrasound.

Na ọnụnọ nke calculi na choledochus, ERPC kwesịrị ịkwụsị EPST site na mmịpụta nke okwute site na paịlị.

N'otu oge ahụ, ọ dị mkpa ịchọpụta ma enwere ike ọghọm n'oge ERCP na HEPT. Arụ ọrụ nke ọmụmụ ndị a ga - ekwe omume na akụrụngwa endoscopic ọgbara ọhụrụ, ọgwụ zuru oke zuru ezu, ndị ọkachamara n'ọgwụ na ndị dọkịta na - awa ahụ.

Mmechi Ahụmahụ anyị na nchọpụta endoscopic na ọgwụgwọ nke ọnya afọ na-egosi oke arụmọrụ na-egosi arụmọrụ ha dị elu. Usoro ọgwụgwọ endoscopy na ọgwụgwọ ọdịnala omenala mere ka o kwe omume iji nweta hemostasis na 98.3% nke ndị ọrịa na izere itinye aka na ịwa ahụ na 95.5% nke ndị ọrịa.