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新型子母镜诊治胆胰疾病的临床应用
Development and application of a neotype “mother-baby” endoscopy system for cholangiopancreatography
文章发布日期:2013年02月01日  来源:  作者:王 蒙,王广义,张小博,等  点击次数:2688次  下载次数:459次

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【摘要】:经十二指肠内镜逆行胰胆管造影术(ERCP)是诊断胆胰管病变常用方法,但因不能区别病变的良恶性使其应用受到限制。1974年,胆胰管造影影像系统的发展促进了疾病病理诊断的进步。然而,子镜的结构和操作困难的相关技术问题及方便胰管活组织检查工作通道的缺乏使它的临床应用和普及受到限制。近来,我院采用了德国铂立公司的超细胆胰管镜影像系统。这种新型子镜系统有更细的外径,通过小切口或柱状气囊扩张就很容易插入,更易于操作。这种高分辨率的可调节操控镜身的子镜系统能最大范围直视胆胰管病变,有足够的工作孔道便于治疗操作,如肝内胆管结石的取石,支架的放置及药物注射等,有足够的工作孔道便于治疗操作,如肝内胆管结石的取石,支架的放置及药物注射等。通过临床10例患者的应用实践,总结治疗方法,包括适应证和禁忌证、术后并发症如急性胰腺炎,组织损伤导致的出血和胆汁瘘等。目前,我们正在不断探索这种新型子镜系统的临床效果,改进操作技术以提高子镜可操控性,同时开展液电或激光石碎石的有效应用,以减少组织损伤和降低住院费用。
【Abstract】:The traditional method of diagnosing lesions of the biliary pancreatic duct, endoscopic cholangiopancreatography retrograde angiography (ERCP), is limited in its ability to differentiate benign and malignant lesions. The cholangiopancreatography picture-mirror system developed in 1974 allowed for improved pathological diagnosis; however, its clinical utility and widespread application were limited by technical challenges associated with the construction and difficult use of the sub-mirror (“baby”), and the lack of a working channel that would otherwise facilitate simultaneous pancreatic duct biopsy. Recently, our hospital generated a new picture-mirror system integrated with an ultrafine cholangiopancreatography mirror developed by PolyDiagnost (Pfaffenhofen, Germany). The new PolyDiagnost sub-mirror system boasts a smaller outer diameter for easy insertion through a small incision or narrow balloon-dilated columnar segment, and easy operation. The high-resolution adjustable steering mirror achieves a full-range visualization of the biliary pancreatic duct and provides a sufficient working channel for therapeutic procedures, such as removal of intrahepatic bile duct stones, placement of stents, and injection of medications. The operation methods, including patient indications and contraindications, are described, along with a brief description of our clinical experience with 10 patients. The postoperative complications have included acute pancreatitis, and tissue injury leading to bleeding and bile leakage. Currently, we are continuing to explore the clinical efficacy of this new sub-mirror system and investigating modifications of the technique to improve the sub-mirror steering, to facilitate effective simultaneous application of electrohydraulic or laser lithotripsy, and to reduce tissue damage and monetary cost.
【关键字】:胰胆管造影术,内窥镜逆行;胆道疾病;胰腺疾病
【Key words】:cholangiopancreatography, endoscopic retrograde; biliary tract diseases; pancreatic diseases
【引证本文】:

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