ERCP (Endoscopic Retrograde Cholangiopancreatography): Kev Siv, Kev Txheej Txheem, Kev Pheej Hmoo thiab Kev Rov Zoo

Tus yuam sij takeaways

• ERCP yog qhov kho mob feem ntau. Kev kuaj mob xwb ERCP feem ntau tau hloov los ntawm MRCP thiab endoscopic ultrasound (EUS).
• ERCP kho qhov txhaws, tsis yog lub zais zis nws tus kheej. Cov pob zeb hauv lub zais zis tseem yuav tsum tau phais (cholecystectomy).
• Kab mob pancreatitis tom qab ERCP yog qhov kev pheej hmoo tseem ceeb tshaj plaws thiab tsis yog qhov tsawg tsawg; nws tshwm sim rau cov neeg mob tsawg tsawg thiab tuaj yeem ua rau mob hnyav.
• Daim duab cholangiogram zoo li qub tsis suav nrog tus kab mob. Cov pob zeb me me, cov qog nqaij hlav thaum ntxov thiab cov kab mob pancreatic parenchymal tuaj yeem pom tsis tau.
• Cov cai npaj sib txawv ntawm tsev kho mob. Ua raws li cov lus qhia sau los ntawm lub chaw ua koj li ERCP.

Ib nrais muag

Kuj hu ua

• Kev kuaj ERCP
• Kev kuaj mob ntawm cov kua tsib hauv cov hlab ntsha
• Kev tshem tawm pob zeb hauv cov kav dej kua tsib los ntawm kev siv txoj kev endoscopic (thaum kho mob)
• Kev kuaj mob cholangiopancreatography, endoscopic
• Feem ntau hais hauv cov chaw kho mob Indian li "pittey ki naali ki endoscopy" lossis "bile duct ki dooarbeen"

ERCP yog dab tsi

ERCP siv lub koob yees duab duodenoscope uas saib tau sab uas hla dhau lub qhov ncauj mus txog rau hauv duodenum, qhov chaw uas cov kav dej kua tsib thiab cov kav dej pancreatic qhib ntawm ampulla ntawm Vater. Ib lub catheter me me lossis cov hlau qhia kev hla lub koob yees duab mus rau hauv cov kav dej. Cov tshuaj contrast raug txhaj thiab cov duab X-ray (fluoroscopy) qhia cov duab ntawm lub kaw lus kav dej.

Los ntawm tib txoj kev, tus kws kho mob endoscopist tuaj yeem txiav cov leeg nqaij ampullary (sphincterotomy), rub cov pob zeb tawm nrog lub npas lossis lub pob tawb, nthuav qhov nqaim, txhuam lossis biopsy ib qho kev txwv, thiab tso cov yas lossis hlau stents. Yog li ntawd, ERCP ua haujlwm zoo li kev phais ua los ntawm sab hauv, yam tsis muaj kev phais plab.

Vim li cas ERCP thiaj ua tiav

• Cov pob zeb hauv cov kav dej ntawm cov kua tsib (choledocholithiasis): tshem tawm tom qab sphincterotomy, feem ntau rau cov neeg uas muaj mob jaundice lossis gallstone pancreatitis.
• Mob cholangitis: kev tso dej tawm sai ntawm cov kua tsib uas muaj kab mob thiab txhaws.
• Kev thaiv biliary phem: kev siv stenting los ntsuas mob qog noj ntshav ntawm lub taub hau pancreas, cov kav dej kua tsib (cholangiocarcinoma), ampulla lossis gallbladder, thiab kev kuaj cov nqaij los ntawm kev siv brush cytology lossis biopsy.
• Cov kev txwv tsis zoo: tom qab phais, tom qab hloov pauv, mob pancreatitis ntev lossis mob o.
• Kev xau kua tsib: tom qab cholecystectomy lossis phais siab, kho los ntawm stenting.
• Cov teeb meem ntawm cov hlab ntsha pancreatic: qee kis ntawm kev mob pancreatitis ntev nrog rau pob zeb lossis cov qhov nqaim, thiab kev puas tsuaj ntawm cov hlab ntsha pancreatic.
• Kab mob parasitic biliary: xws li ascariasis, qee zaum pom hauv qee qhov ntawm Is Nrias teb.

Leej twg yuav tsum muaj ERCP

ERCP yog qhov tsim nyog thaum muaj feem ntau ntawm cov teeb meem ntawm cov hlab ntsha uas tuaj yeem kho tau los ntawm kev siv endoscopically. Cov neeg mob feem ntau suav nrog cov neeg uas muaj:

• Mob daj ntseg nrog rau kev thaij duab qhia txog cov kav dej kua tsib qhib thiab tej zaum yuav muaj pob zeb lossis qhov nqaim.
• Pom tseeb tias muaj pob zeb hauv cov kua tsib ntawm MRCP, EUS lossis ultrasound.
• Mob cholangitis, kub taub hau, mob daj ntseg thiab mob plab sab saud, xav tau kev tso dej tawm.
• Kab mob Gallstone pancreatitis nrog rau kev thaiv biliary lossis cholangitis tas mus li.
• Xav tias muaj cov kua tsib tawm tom qab phais mob gallbladder lossis daim siab.
• Mob daj ntseg los ntawm qhov mob qog uas xav tau stenting ua ntej phais lossis chemotherapy, lossis rau kev pab kom lub plawv tsis txhob dhia ceev.

Feem ntau ERCP tsis tsim nyog ua thawj qhov kev kuaj mob plab uas tsis paub meej xwb, rau kev kuaj mob siab ib txwm nrog lub tshuab ultrasound ib txwm, lossis tsuas yog "tshawb xyuas" cov ducts. Hauv cov xwm txheej ntawd, qhov kev pheej hmoo ntawm cov txheej txheem tuaj yeem ntau dua li cov ntaub ntawv tau txais. Qhov kev txiav txim siab yog nyob ntawm tus kws kho mob plab hnyuv lossis pab pawg neeg mob siab thiab cov hlab ntsha uas yuav soj ntsuam tag nrho cov duab kho mob. Cov txiaj ntsig thiab cov txiaj ntsig sib txawv nyob ntawm tus kheej cov xwm txheej kho mob.

Yam uas ERCP tsis tuaj yeem nrhiav pom lossis tsis suav nrog

• ERCP tsis thaij duab daim siab, lub txiav pancreas lossis cov ntaub so ntswg ntawm lub zais zis. Nws qhia txog cov lumens ntawm cov kav dej. Ib qho qog pancreatic uas tsis ua rau cov kav dej puas tsuaj tej zaum yuav tsis pom.
• Cov pob zeb me me tuaj yeem plam. Kev siv cov xim sib txawv yuav ua rau cov pob zeb me me tsis pom kev, thiab cov pob zeb yuav tawm mus yam tsis tau npaj tseg ua ntej kev kho mob. Daim duab cholangiogram meej tsis qhia txog kab mob pob zeb.
• Cov txhuam hniav tsis zoo tsis zam tau mob qog noj ntshav. Cov qauv ntawm cov txhuam hniav los ntawm qhov nqaim muaj qhov rhiab heev tsawg; qhov tshwm sim tsis zoo txhais tau tias tsis pom cov hlwb phem, tsis yog tias tsis muaj mob qog noj ntshav.
• ERCP tsis qhia txog theem mob qog noj ntshav. Kev kis mus rau cov qog ntshav hauv lub cev, daim siab lossis peritoneum xav tau CT, MRI, EUS lossis PET.
• ERCP tsis kho cov pob zeb hauv lub zais zis. Nws ntxuav cov kav dej ntawm cov kua tsib; lub gallbladder nws tus kheej feem ntau tseem xav tau kev phais tshem tawm.
• ERCP tsis ntsuas qhov mob siab fibrosis, kab mob siab lossis kab mob siab sib kis.
• Cov stents tsuas yog tuaj yeem ncav cuag tau yog tias lub cev tso cai. Tom qab qee qhov kev phais mob plab lossis bypass, lub ampulla yuav tsis tuaj yeem ncav cuag nrog lub scope ib txwm muaj.

Yog tias cov tsos mob xws li mob daj ntseg, kub taub hau lossis mob tseem muaj lossis rov qab los tom qab ERCP ib txwm lossis "ua tiav", rov qab mus ntsib koj tus kws kho mob, tej zaum yuav xav tau kev thaij duab ntxiv lossis rov ua dua.

Kev ntsuam xyuas sib txuas tab sis sib txawv

Cov kev kuaj no teb cov lus nug sib txawv. Qhov twg los ua ntej nyob ntawm qhov teeb meem hauv kev kho mob: mob daj ntseg tsis mob nrog rau qhov poob phaus feem ntau pib nrog ultrasound ces CT lossis EUS; xav tias muaj pob zeb hauv cov kav dej tom qab mob gallstone pancreatitis feem ntau pib nrog MRCP lossis EUS; cholangitis nrog kev paub tias muaj kev thaiv mus ncaj qha rau ERCP rau kev ntws dej.

Yuav npaj li cas

Kev npaj yog teem los ntawm chav ua haujlwm uas ua cov txheej txheem. Cov lus qhia sau rau koj tau txais yuav tseem ceeb dua li cov lus qhia dav dav, suav nrog nplooj ntawv no.

• Kev yoo mov: feem ntau cov chav kho mob thov kom tsis txhob noj zaub mov khov rau ob peb teev thiab tsis txhob haus dej ntshiab rau lub sijhawm luv dua ua ntej noj tshuaj loog. Paub meej tias lub sijhawm tseeb nrog koj lub chav kho mob.
• Cov tshuaj kho mob: nqa ib daim ntawv teev tag nrho tuaj, suav nrog cov tshuaj uas ua rau cov ntshav nyias, cov tshuaj tiv thaiv cov ntshav txhaws, cov tshuaj insulin, cov tshuaj ntshav qab zib uas haus, cov tshuaj ntsuab thiab cov tshuaj AYUSH thiab cov tshuaj ntxiv rau hauv lub gym. Tsis txhob tsum lossis hloov cov tshuaj uas koj tau sau tseg rau koj tus kheej, nug tus kws sau ntawv lossis pab pawg endoscopy.
• Kev ua xua: qhia txog tej yam uas koj ua xua rau cov tshuaj iodine uas muaj cov tshuaj sib xyaw ua ke, tshuaj tua kab mob lossis tshuaj loog yav dhau los.
• Cov khoom siv cog thiab cov khoom siv: qhia rau pab neeg txog cov tshuab pacemakers, defibrillators thiab kev phais plab hnyuv yav dhau los, vim tias cov no cuam tshuam rau kev npaj.
• Tus neeg nrog caij: Kev siv tshuaj loog ua rau koj tsis muaj peev xwm txiav txim siab thiab ua haujlwm tau zoo rau hnub ntawd. Npaj ib tug neeg laus uas muaj lub luag haujlwm nrog koj mus tsev. Tsis txhob tsav tsheb.
• Tso Cai: piav qhia txog cov kev pheej hmoo, suav nrog pancreatitis, thiab kev pom zoo ua ntej noj tshuaj loog.

Cov neeg mob ntshav qab zib uas tab tom kho mob kom txo cov piam thaj

Kev yoo mov ua rau muaj ntshav qab zib tsawg. Tej zaum yuav xav tau kev hloov kho qhov ntau thiab tsawg thiab lub sijhawm ntawm cov tshuaj insulin lossis cov ntsiav tshuaj rau hnub ntawd, qhov no yuav tsum tau txiav txim siab los ntawm koj tus kws kho mob ua ntej, tsis yog los ntawm koj lossis los ntawm daim ntawv qhia dav dav.

Cov neeg noj cov tshuaj thinners los yog antiplatelet

Kev phais lub plawv (sphincterotomy) muaj feem yuav los ntshav, yog li ntawd qee zaum cov tshuaj no raug txwv tsis pub siv, tab sis kev tsum tsis txhob siv lawv tuaj yeem ua rau muaj kev phom sij rau cov neeg uas nyuam qhuav muaj cov stent lossis cov valve mechanical. Tsuas yog tus kws kho mob plawv lossis tus kws kho mob uas sau ntawv rau koj, nrog rau tus kws kho mob endoscopist, thiaj li yuav tsum txiav txim siab qhov no.

Cov neeg uas muaj mob plawv tsis ua haujlwm, CKD siab heev lossis kev txwv dej

Cov kua dej uas muab rau hauv cov hlab ntsha thaum lub sijhawm ERCP (feem ntau siv los txo qhov kev pheej hmoo ntawm pancreatitis) yuav tsum tau hloov kho rau cov pab pawg no. Qhia rau pab neeg txog koj qhov mob plawv lossis lub raum thiab txhua qhov dej uas txwv tsis pub haus ua ntej txoj kev kho mob.

Cev xeeb tub

ERCP thaum cev xeeb tub tsuas yog ua thaum tsim nyog xwb, feem ntau yog rau cov pob zeb hauv cov hlab ntsha lossis cholangitis, nrog rau kev ntsuas kom txo qis kev raug tshuaj loog thiab qee zaum tsis muaj fluoroscopy. Nws xav tau tus kws kho mob endoscopist laus thiab kev pab tswv yim rau kev yug menyuam.

Cov me nyuam

Kev kuaj mob ERCP rau menyuam yaus tsis tshua muaj thiab ua nyob rau hauv cov chaw tshwj xeeb hauv qab kev siv tshuaj loog dav dav nrog cov khoom siv me me rau menyuam yaus qhov twg muaj.

Yuav ua li cas thaum tus txheej txheem

Koj pw saum lub rooj X-ray, feem ntau koj yuav pw rau sab laug lossis pw hauv av. Lub npog qhov ncauj tiv thaiv cov hniav. Muab tshuaj loog lossis tshuaj loog los ntawm kev txhaj tshuaj, thiab muab oxygen thiab kev saib xyuas.

• Kev ntxig rau ntawm qhov Scope: lub koob yees duab ntawm txoj hnyuv plab hla dhau lub qhov ncauj, txoj hlab pas thiab lub plab mus rau hauv lub plab hnyuv plab. Nws tsis cuam tshuam rau kev ua pa.
• Kev siv koob txhaj tshuaj: Ib lub catheter thiab guidewire raug coj mus rau hauv cov kav dej ntawm cov kua tsib lossis cov kav dej ntawm lub ampulla. Cov kauj ruam no tuaj yeem siv sijhawm thiab tsis yog ib txwm ua tiav thaum sim thawj zaug.
• Kev kos duab: cov tshuaj sib piv raug txhaj tshuaj thiab cov duab fluoroscopic raug thaij.
• Kev Kho Mob: nyob ntawm seb puas muaj qhov nrhiav tau, kev phais lub sphincterotomy, kev rho tawm pob zeb nrog lub npuas dej lossis lub pob tawb, kev siv tshuab lithotripsy, kev nthuav lub npuas dej, kev siv txhuam cytology, kev kuaj nqaij, lossis kev tso stent.
• Rov qab: lub tsom iav raug tshem tawm thiab koj raug saib xyuas kom txog thaum cov tshuaj loog ploj mus.

Lub sijhawm ntev npaum li cas ERCP siv sijhawm

• Cov txheej txheem nws tus kheej: feem ntau siv sijhawm 30-90 feeb. Kev tshem tawm pob zeb yooj yim feem ntau yog luv dua; kev siv cannulation nyuaj, cov pob zeb loj uas xav tau lithotripsy, lossis stenting loj tuaj yeem siv sijhawm ntev dua.
• Kev npaj thiab kev kos npe nkag: pub sijhawm ntxiv nyob hauv tsev kho mob ua ntej cov txheej txheem.
• Kev rov zoo tam sim ntawd: feem ntau yog ob peb teev ntawm kev soj ntsuam tom qab kev siv tshuaj loog.
• tawm: qee chav tsev tawm hauv tib hnub; ntau tus neeg khaws cov neeg mob ib hmos, tshwj xeeb tshaj yog tom qab sphincterotomy lossis rau cov neeg uas muaj cholangitis lossis lwm yam kab mob.
• Rov qab mus rau kev ua neej niaj hnub: feem ntau yog hnub tom qab yog tias tsis muaj teeb meem, nrog rau ob peb hnub ntawm kev ua ub ua no tsawg dua tom qab ua haujlwm kho mob. Kev rov zoo sib txawv nyob ntawm tus kheej qhov xwm txheej.

Kev Nkag Siab Txog Koj Daim Ntawv Qhia ERCP

Tsis muaj tus lej "qhov ntau thiab tsawg ib txwm muaj" rau ERCP. Daim ntawv qhia no yog ib qho kev piav qhia txog yam uas tus kws kho mob endoscopist tau pom thiab ua. Cov ntsiab lus ib txwm muaj xws li:

• Kev siv koob txhaj tshuaj: seb puas tau nkag mus rau hauv cov kav dej kua tsib lossis cov kav dej pancreatic, thiab yuav tsum tau sim ua pes tsawg zaus.
• Cov txiaj ntsig ntawm Cholangiogram: qhov loj ntawm cov kav dej, qhov tsis zoo ntawm kev txhaws (feem ntau yog pob zeb), qhov nqaim, qhov nqaim tsis sib xws, thiab qhov xau.
• Cov kev cuam tshuam tau ua: kev phais lub sphincterotomy, kev tshem tawm pob zeb thiab seb nws puas tiav, hom stent, qhov loj thiab qhov chaw.
• Cov qauv coj los: cov txhuam hniav lossis cov biopsies xa mus rau cytology lossis histopathology, cov txiaj ntsig no tuaj tom qab thiab sib cais los ntawm daim ntawv qhia txog kev kho mob.
• Npaj: rov ua ERCP dua rau kev pauv stent, xa mus phais, lossis kev thaij duab ntxiv.

Daim ntawv qhia tias "tsis pom qhov tsis zoo ntawm lub qhov quav" txhais tau tias tsis pom muaj pob zeb thaum ntawd. Nws tsis yog pov thawj tias cov hlab ntsha yeej tsis muaj pob zeb. Txhua daim ntawv qhia xav tau kev txhais lus los ntawm tus kws kho mob uas tau thov kom ua qhov txheej txheem, nrog rau koj cov tsos mob, kev kuaj siab thiab lwm yam kev thaij duab.

Thaum cov ntaub ntawv ERCP tuaj yeem ua rau neeg nkag siab yuam kev

Cov kev tshawb pom uas tuaj yeem zoo li tsis zoo li qub

• Huab cua npuas txhaj tshuaj nrog cov tshuaj sib txawv tuaj yeem ua raws li cov pob zeb ua cov qhov tsis zoo.
• Kev mob los ntawm pancreatitis tsis ntev los no lossis stent ua rau lub raj zoo li nqaim thaum tsis muaj qog.
• Cov kab mob benign hauv kev mob pancreatitis ntev, kab mob cuam tshuam nrog IgG4 lossis thawj sclerosing cholangitis tsuas yog muaj peev xwm zoo ib yam li mob qog nqaij hlav ntawm cholangiogram xwb.
• Kev nias sab nraud los ntawm ib lub node lossis cov hlab ntsha tuaj yeem zoo li qhov txhab ntawm cov hlab ntsha hauv lub cev.

Cov kev tshawb pom uas zoo li tsis zoo li qub lossis raug kwv yees qis dua

• Ib lub pob zeb uas twb dhau los lawm tawm cov hlab ntsha dawb huv txawm tias ua rau mob jaundice lossis pancreatitis.
• Kev sib piv sib zog tuaj yeem zais cov pob zeb me me, uas tom qab ntawd pom ntawm kev thaij duab tom qab lossis rov ua ERCP dua.
• Kev txhaws ntawm cov kav dej tsis tiav saum toj ntawm qhov nruj nruj ua rau lub kaw lus sab saud tsis raug soj ntsuam.
• Cov cytology txhuam tsis zoo feem ntau tshwm sim txawm tias muaj mob qog noj ntshav los xij; ib qho qauv tsis pom muaj ib qho yuav tsum tsis txhob nyeem ua kev ntseeg siab.
• Ib lub duct uas tsis yog cannulated tsuas yog tsis tau ntsuam xyuas, tsis tau pov thawj tias zoo li qub.

Kev Pheej Hmoo thiab Kev Nyab Xeeb

ERCP muaj feem cuam tshuam ntau dua li kev kuaj mob endoscopy xws li gastroscopy lossis colonoscopy. Kev pheej hmoo txawv ntawm yam ua thiab tus neeg mob.

Kev kuaj mob pancreatitis tom qab ERCP

Qhov teeb meem loj tshaj plaws. Nws muaj txij li mob plab me me nrog rau kev nyob hauv tsev kho mob luv luv mus rau mob pancreatitis hnyav uas xav tau kev saib xyuas mob hnyav. Kev pheej hmoo siab dua rau cov neeg mob hluas, cov poj niam, cov neeg uas xav tias sphincter of Oddi ua haujlwm tsis zoo, cov ducts zoo li qub, cov cannulation nyuaj thiab cov pancreatic duct txhaj tshuaj tsis txhob txwm. Cov tshuaj NSAIDs ntawm lub qhov quav, kev haus dej kom ntau thiab cov pancreatic stents yog siv rau cov neeg mob xaiv los txo qhov kev pheej hmoo no.

Ntshav

Feem ntau cuam tshuam nrog kev phais lub sphincterotomy. Feem ntau tswj hwm los ntawm kev siv endoscopic; qee zaum xav tau kev hloov ntshav lossis kev kho mob radiological. Kev pheej hmoo nce ntxiv nrog cov teeb meem coagulation, kab mob siab thiab kev kho mob antithrombotic.

Kev kis kab mob (cholangitis, cholecystitis)

Feem ntau yuav tshwm sim thaum lub cev uas raug thaiv tsis pub qhib tab sis tsis tau ntws tag, thiab nyob rau hauv cov qhov nqaim heev. Cov tshuaj tua kab mob siv rau qee qhov xwm txheej.

Kev sib tshooj

Tsis tshua muaj tab sis mob hnyav; tej zaum yuav cuam tshuam rau phab ntsa duodenal, qhov chaw sphincterotomy lossis lub raj xa dej. Tej zaum yuav xav tau phais.

Kev Pheej Hmoo ntawm Kev Siv Tshuaj Sedation thiab Kev Siv Tshuaj loog

Kev ua pa nyuaj, ntshav siab qis, kev nqus pa thiab cov teeb meem plawv, tshwj xeeb tshaj yog rau cov neeg laus thiab cov neeg uas muaj kab mob plawv lossis ntsws.

Cov teeb meem ntsig txog Stent

Cov yas stents thaiv lossis txav mus los raws sijhawm thiab feem ntau xav tau kev hloov pauv raws sijhawm. Cov hlau stents kuj tuaj yeem thaiv. Kev tsis tuaj yeem hloov pauv stent raws sijhawm tuaj yeem ua rau mob cholangitis.

Tawg

Kev siv tshuaj fluoroscopy muaj xws li kev siv hluav taws xob ionizing. Kev raug hluav taws xob tsawg li tsawg tau thiab yog qhov yuav tsum tau xav txog tshwj xeeb thaum cev xeeb tub thiab rau cov neeg mob uas xav tau kev kho mob ntau zaus.

Cov xwm txheej tshwj xeeb

Cev xeeb tub

Ua tsuas yog rau kev qhia meej txog kev kho mob xws li cov pob zeb hauv cov hlab ntsha nrog cholangitis. Kev siv hluav taws xob tsawg kawg nkaus, siv cov hlau lead tiv thaiv, thiab qee lub chaw ua ERCP uas siv hlau coj yam tsis muaj fluoroscopy. Ultrasound thaum cev xeeb tub hauv Is Nrias teb yog tswj hwm los ntawm PC-PNDT Act 1994; kev txiav txim siab poj niam txiv neej raug txwv, thiab qhov no siv rau txhua qhov kev kuaj mob cev xeeb tub uas ua nyob ib puag ncig kev nkag mus.

Cov me nyuam

Cov cim qhia suav nrog choledochal cysts, pancreaticobiliary maljunction, pob zeb thiab kev raug mob. Ua raws li kev siv tshuaj loog dav dav hauv cov chaw uas muaj kev paub txog menyuam yaus.

Cov laus

Feem ntau nws yuav zam tau, tab sis qhov muaj feem yuav ua rau tsaug zog ntau dua. Tej zaum yuav zoo dua rau kev siv stenting dua li kev sim tshem cov pob zeb ntev ntev rau cov neeg mob uas tsis muaj zog.

Kev kho mob ntshav qab zib nrog kev txo qis glucose

Yuav tsum tau teem sijhawm yoo mov thiab noj tshuaj uas tau pom zoo los ntawm tus kws kho mob, thiab saib xyuas cov piam thaj hauv cov ntshav thaum lub sijhawm kho mob.

Mob raum kab mob

Cov tshuaj iodine uas muaj contrast no raug txhaj rau hauv cov hlab ntshav es tsis yog txhaj rau hauv cov ntshav, yog li ntawd kev txhaj tshuaj rau hauv lub cev tsis ntau, tab sis kev siv dej ntau dhau los tiv thaiv kab mob pancreatitis yuav tsum tau ua kom haum. Tej zaum yuav tsum tau hloov kho cov tshuaj loog thiab tshuaj tua kab mob.

Lub plawv tsis ua haujlwm

Cov txheej txheem dej haus uas siv zog ntau yuav tsis muaj kev nyab xeeb. Cov dej haus uas muaj ntau npaum li cas yuav tsum tau ua raws li tus neeg mob lub cev thiab saib xyuas.

Kev hloov pauv ntawm lub cev phais

Tom qab phais Billroth II, Roux-en-Y lossis Whipple, tus qauv ERCP yuav tsis mus txog ampulla. Tej zaum yuav xav tau Balloon enteroscopy-assisted ERCP, EUS-guided drainage lossis percutaneous drainage, thiab qhov muaj nyob txawv ntawm txhua lub tsev kho mob.

ERCP hauv Is Nrias teb

• Kab mob Gallstone qhia txog kev hloov pauv ntawm sab qaum teb mus rau sab qab teb hauv Is Nrias teb, nrog rau qhov muaj ntau dua tau tshaj tawm los ntawm Gangetic siv. Qhov no txhais tau tias ERCP ntsig txog pob zeb hauv cov kav dej ua rau muaj feem ntau ntawm cov haujlwm hauv ntau lub chaw sab qaum teb.
• Gallbladder mob cancer feem ntau pom muaj nyob rau sab qaum teb thiab sab qaum teb sab hnub tuaj ntawm Is Nrias teb thiab feem ntau tshwm sim ua mob daj ntseg uas xav tau kev phais biliary stenting.
• Kab mob biliary ascariasis tseem pom muaj nyob rau hauv qee thaj chaw thiab tuaj yeem kho tau los ntawm kev siv endoscopically.
• Mob Ntsws tuaj yeem ua rau cov kua tsib nqaim thiab cov hlab ntsha ntawm cov kua tsib; kev kho mob tiv thaiv kab mob ntsws feem ntau ua rau lub siab raug mob los ntawm tshuaj, uas tuaj yeem ua rau daim duab tsis meej pem thaum cov kev kuaj mob siab tsis zoo.
• Kab mob siab E thiab A ua rau mob daj ntseg yam tsis muaj kev thaiv cov hlab ntsha. Mob daj ntseg ib leeg tsis yog qhov qhia txog ERCP, kev thaiv yuav tsum tau ua kom pom tseeb ua ntej.
• Kev raug mob siab ntsig txog tshuaj ntsuab, AYUSH thiab kev noj tshuaj ntxiv rau hauv chaw dhia ua si yog ib qho tseem ceeb ua rau mob daj ntseg hauv Is Nrias teb thiab yuav tsum tau xav txog ua ntej xav tias muaj kev thaiv. Qhia rau koj tus kws kho mob txog txhua yam tshuaj uas tsis yog daim ntawv yuav tshuaj uas koj noj.
• Terminology: Feem ntau cov enzymes hauv siab raug tshaj tawm hauv Is Nrias teb ua SGPT (ALT) thiab SGOT (AST); qhov ultrasound yuav sau ua USG plab lossis sonography. Cov no yog cov kev kuaj mob zoo ib yam li lawv cov npe thoob ntiaj teb.
• Kev Nkag: kev kho mob ERCP, EUS thiab enteroscopy-assisted ERCP yog tsom mus rau cov chaw kho mob theem peb. Txoj kev xa mus thiab lub sijhawm tos sib txawv ntawm cov xeev thiab ntawm cov koom haum pej xeem thiab ntiag tug.

Tus nqi thiab kev pov hwm hauv Is Nrias teb

ERCP yog ib txoj kev kho mob, tsis yog ib qho kev sim yooj yim, yog li tus nqi yog muab ua ke es tsis yog ib qho nqi ruaj khov. Cov nqi hauv ? sib txawv ntau ntawm cov nroog, ntawm tsoomfwv thiab cov tsev kho mob ntiag tug, thiab ntawm cov rooj plaub yooj yim thiab nyuaj. Thov kom muaj kev kwv yees ua ntej nkag mus.

Dab tsi ua rau tus nqi nce siab

• Cov ntsiab lus kho mob: kev siv cannulation kuaj mob pheej yig dua li kev phais sphincterotomy nrog kev rho tawm pob zeb, lithotripsy lossis ntau lub stents.
• Tau txais kev pab: cov pob tawb, cov npas, cov xov hlau qhia thiab tshwj xeeb tshaj yog cov stents, cov hlau stent uas nthuav dav nws tus kheej kim ntau zaus dua li cov yas stent.
• Kev siv tshuaj loog: kws kho mob muab tshuaj loog lossis tshuaj loog dav dav ntxiv rau daim nqi.
• Nyob twj ywm: kev zov menyuam thaum nruab hnub piv rau kev pw thaum hmo ntuj piv rau kev pw hauv ICU tom qab muaj teeb meem.
• Rov ua cov txheej txheem dua: Feem ntau cov yas stents yuav tsum tau npaj hloov pauv, yog li npaj nyiaj rau ntau tshaj ib zaug zaum.
• Ntxiv-ons: ua ntej kev phais mob MRCP lossis EUS, cov nqi kuaj mob histopathology thiab cytology, tshuaj tua kab mob.
• Qib tsev kho mob thiab lub nroog: feem ntau cov tsev kho mob ntiag tug hauv nroog kim dua li cov chaw me me.

Insurance

Vim tias ERCP feem ntau cuam tshuam txog kev nkag mus rau hauv tsev kho mob, nws feem ntau raug txiav txim siab hauv qab cov txiaj ntsig kev kho mob hauv tsev kho mob lossis kev saib xyuas thaum nruab hnub hauv feem ntau cov cai pov hwm kev noj qab haus huv thaum muaj kev kho mob qhia. Kev them nqi nyob ntawm cov lus hauv txoj cai, lub sijhawm tos, cov kab lus kab mob uas twb muaj lawm, cov kev txwv xauj chav, cov kev txwv ntawm cov khoom siv thiab cov khoom cog xws li stents, thiab seb lub tsev kho mob puas nyob hauv lub network ntawm tus neeg pov hwm. Paub meej tias tau tso cai ua ntej nrog koj tus neeg pov hwm thiab lub rooj TPA ntawm tsev kho mob ua ntej cov txheej txheem. Cov phiaj xwm tsoomfwv xws li Ayushman Bharat PM-JAY npog cov pob khoom txhais ntawm cov tsev kho mob empaneled; xyuas seb puas tsim nyog thiab suav nrog pob khoom hauv zos.

Cov lus dab neeg thiab qhov tseeb

Lus nug cov lus nug

ERCP siv rau dab tsi?

ERCP feem ntau yog siv los kho cov kev thaiv ntawm cov kav dej kua tsib thiab cov kav dej pancreatic, tshem tawm cov pob zeb, qhib cov qhov nqaim, ntws cov kab mob thiab tso cov stent. Kev kuaj cov ntaub so ntswg los ntawm cov qhov nqaim yog ua tau. ERCP kuaj mob tam sim no tsis tshua muaj vim MRCP thiab endoscopic ultrasound muab cov ntaub ntawv zoo sib xws yam tsis muaj kev pheej hmoo ntawm kev phais.

Puas mob ERCP?

Cov txheej txheem no ua tiav los ntawm kev siv tshuaj loog tob lossis tshuaj loog dav dav, yog li cov neeg mob tsis hnov ​​​​​​nws. Tom qab ntawd, mob caj pas, o thiab mob plab me ntsis yog qhov tshwm sim rau ib hnub. Tsis xav tias yuav mob plab hnyav lossis mob zuj zus tom qab ERCP thiab xav tau kev kuaj mob sai, vim tias nws yuav qhia txog kab mob pancreatitis.

ERCP siv sijhawm ntev npaum li cas thiab kuv tuaj yeem mus tsev thaum twg?

Feem ntau cov ERCPs siv sijhawm 30-90 feeb, nrog rau kev ua haujlwm pob zeb lossis kev nruj nruj uas nyuaj siv sijhawm ntev dua. Xav tias yuav tau saib xyuas ob peb teev tom qab ntawd. Qee lub chaw tawm hauv tib hnub; ntau tus neeg mob cia ib hmos, tshwj xeeb tshaj yog tom qab phais lub sphincterotomy lossis rau cov neeg uas tsis zoo. Koj lub sijhawm tawm hauv tsev kho mob nyob ntawm koj qhov kev zoo rov qab thiab cov ntaub ntawv pom.

ERCP txawv ntawm MRCP li cas?

MRCP yog ib qho kev ntsuas MRI uas thaij duab cov kav dej tsis muaj cov cuab yeej, tshuaj loog lossis tshuaj sib piv rau cov kav dej, thiab tsis muaj kev pheej hmoo ntawm kev mob pancreatitis, tab sis nws tsis tuaj yeem kho dab tsi. ERCP yog kev phais mob uas nkag mus rau hauv lub cev thiab tuaj yeem tshem tawm cov pob zeb lossis muab cov stent tso rau tib lub sijhawm. MRCP feem ntau ua ua ntej los txiav txim siab seb puas xav tau ERCP.

Qhov kev pheej hmoo loj tshaj plaws ntawm ERCP yog dab tsi?

Kab mob pancreatitis tom qab ERCP yog qhov teeb meem tseem ceeb tshaj plaws thiab tsis yog qhov tshwm sim tsawg. Kev los ntshav tom qab sphincterotomy, kev kis kab mob ntawm cov kua tsib, kev tawg thiab cov teeb meem ntsig txog kev siv tshuaj loog kuj tuaj yeem tshwm sim. Kev pheej hmoo nyob ntawm tus neeg mob, qhov kev qhia thiab yam ua. Koj tus kws kho mob endoscopist yuav piav qhia koj qhov kev pheej hmoo ua ntej kev pom zoo.

Kuv puas tseem yuav tsum tau phais lub zais zis tom qab ERCP?

Feem ntau yog, yog tias lub zais zis tseem muaj pob zeb. ERCP ntxuav cov hlab ntsha hauv lub zais zis tab sis tso lub zais zis rau hauv qhov chaw, yog li cov pob zeb ntxiv tuaj yeem txav mus los thiab ua rau rov qab txhaws, mob lossis mob pancreatitis. Lub sijhawm ntawm cholecystectomy yog txiav txim siab los ntawm pab pawg phais raws li koj tus mob.

ERCP puas tuaj yeem kuaj pom mob qog noj ntshav?

ERCP tuaj yeem qhia cov qhov nqaim uas xav tias muaj mob qog noj ntshav thiab tso cai rau kev txhuam lossis kev kuaj mob. Txawm li cas los xij, qhov kev nkag siab ntawm kev kuaj mob yog txwv thiab qhov tshwm sim tsis zoo tsis suav nrog kev mob qog noj ntshav. Kev thaij duab hla ntu xws li CT lossis MRI, ntxiv rau kev siv endoscopic ultrasound nrog kev kuaj mob me me, feem ntau yog qhov xav tau rau kev kuaj mob thiab kev txiav txim siab theem.

Kuv puas yuav tsum tsis txhob siv kuv cov ntshav thinner ua ntej ERCP?

Tsis txhob tsum tsis txhob siv tshuaj thinner rau koj tus kheej. Qee qhov ERCPs yuav tsum txiav lub sphincter, uas muaj kev pheej hmoo ntawm kev los ntshav, yog li ntawd qee zaum yuav tsum tau hloov kho ib ntus, tab sis kev tsum tsis txhob siv tshuaj no yuav ua rau muaj kev phom sij rau cov neeg uas nyuam qhuav hloov cov stents plawv lossis cov mechanical heart valves. Tsuas yog koj tus kws kho mob thiab pab pawg endoscopy thiaj li yuav tsum txiav txim siab ua ke.

Kuv yuav tsum saib xyuas dab tsi tom qab mus tsev lawm?

Nrhiav kev kho mob thaum muaj xwm txheej ceev yog tias mob plab hnyav, ntuav tas li, kub taub hau heev nrog rau mob khaub thuas, ntuav ntshav lossis quav dub, lossis ua tsis taus pa. Hu rau chav kho mob tib hnub ntawd yog tias muaj mob ntshav daj tshiab, kub taub hau me ntsis lossis mob uas tsis ploj mus. Yuav tsum mob caj pas me ntsis thiab o rau ib lossis ob hnub.

Qhov chaw

• Lub Koom Haum Amelikas rau Kev Tshawb Fawb Txog Kab Mob Plab (ASGE), cov lus qhia txog lub luag haujlwm ntawm ERCP hauv choledocholithiasis thiab ntawm cov xwm txheej tsis zoo ntawm ERCP.
• European Society of Gastrointestinal Endoscopy (ESGE), cov lus qhia txog kev tiv thaiv kab mob pancreatitis tom qab ERCP, biliary stenting thiab kev tswj hwm endoscopic ntawm cov pob zeb hauv cov kav dej bile.
• Cov Lus Qhia rau Tokyo rau kev tswj hwm mob cholangitis thiab cholecystitis.
• Lub Koom Haum Indian ntawm Gastroenterology thiab Lub Koom Haum Gastrointestinal Endoscopy ntawm Is Nrias teb, cov lus hais txog txoj haujlwm thiab kev xyaum ntawm kev kho mob ERCP.
• Pawg Sab Laj Saib Xyuas Kev Tshawb Fawb Txog Kev Kho Mob ntawm Is Nrias teb / Lub Chaw Sau Npe Mob Cancer hauv Tebchaws tau tshaj tawm txog kev muaj mob qog noj ntshav hauv lub zais zis hauv Is Nrias teb.
• Txoj Cai Ua Ntej Cev Xeeb Tub thiab Kev Kuaj Mob Ua Ntej Yug Me Nyuam (Txwv Tsis Pub Xaiv Poj Niam Txiv Neej), 1994, Tsoomfwv Is Nrias teb.