引導線於肝膽疾病之臨床應用

Clinical Application of Guide Wire in Hepatobiliary Diseases

對於肝膽和胰臟病變的診斷和處置，膽胰管造影術是很重要的檢查項目。內視鏡逆行性膽胰管造影術（ERCP），及經皮穿肝膽管造影術（PTCD）是很精巧的技術，必須由熟練的內視鏡醫師、技術員使用完善的器械，才能操控自如，引導線是其中最重要的器械之一，它能提高導管插入膽道或胰管的成功率，對於已插入的膽道或胰管，引導線可確保其通暢無阻。引導線有很多種類，不同種類的引導線各有其特性。塗鐵弗龍的引導線是最常見的種類，它具有強軔、便宜的特性，並能用於一些內視鏡器械的置換。塗聚合体的引導線具有親水性的聚合体，因此十分滑溜，不易打結、扭曲；用於穿過膽道狹窄處非常有用。檢查或治療過程成功與否，除受各種引導線不同特性的影響之外，能否有效操控各種引導線也是很重要的因素。一個熟悉引導線特性及精通操作技術的技術員，對於內視鏡醫師完成內視鏡逆行性胰膽管造影術（ERCP）或經皮穿肝造影術（PTC），很有幫助。

CholangiCholangiopancreatogram is a crucial image for diagnosis and management of hepatobiliary and pancreatic disorder. Endoscopic retrograde cholangiopancre-aticography (ERCP) and percutaneous transhepatic cholangiography (PTC) are sophisticated techniques that need be mastered by skilled endoscopist, technician and powerful accessory devices. The guide wire is the most important accessory device to enhance the successful rate of channel cannulation and to maintain the patency of cannulated channel. There are many kinds of guide wires of them each has its own advantage and availability. The teflon-coated wire is the most popular wire that is robust and inexpensive, and can be used for the exchange of endoscopic accessories. The polymer-coated wire whith hypdrophilic polymer is extremely slippery and unkinkable, and is very useful for negotiating of bile duct stricture, The techniques to hande different wire are also very important for a successful procedure. Technicians who understand the wire and skill are very helpful to the endoscopist in canying out ERCP or PTC.