Chithandizo cha endoscopic cha zotupa za exmocass za m'mimba: 3 mfundo zazikuluzikulu zomwe zidafotokozedwa m'nkhani imodzi

Zotupa za ku Hermucas (SMT) za m'mimba mwake zimapangidwa kuchokera ku Muscularis mucosa, submucosa, kapena musculasa, ndipo zingakhale zotupa. Ndi chitukuko chaukadaulo chamankhwala, zosankha zachikhalidwe zachikhalidwe zayamba kale mankhwala osokoneza bongo, monga lopaleshoni ya Aparoscopic ndi opaleshoni. Komabe, muchipatala, zimapezeka kuti "opaleshoni" sioyenera odwala onse. M'zaka zaposachedwa, phindu la chithandizo cha endoscopic chalandira chidwi. Mtundu waposachedwa wa katswiri waku China ku matenda a Endoscopic matenda ndi chithandizo cha SMT yatulutsidwa. Nkhaniyi iphunzirapo kanthu mwatsatanetsatane chidziwitso choyenera.

1.smt mlidenti wa chartemaphunziro

(1) Zochitika za SMT ndi yosagwirizana ndi zigawo zosiyanasiyana za m'mimba, ndipo m'mimba ndi malo wamba a SMT.

Zotsatira za VariouMagawo a thirakiti yazigaya ndi osasinthika, ndi thirakiti lakumwamba lomwe lili ponseponse. Mwa awa, 2/3 imachitika m'mimba, kenako ndi esophagus, duodenum, ndi colon.

(2) histonelogicaMitundu ya SMT ndi yovuta, koma ambiri SMT ndi zotupa, ndipo ochepa okha ndi ochepa.

A.Smt imaphatikizapo ayiN-neoplastic zotupa monga ectopic pancreatic minofu ndi zotupa.

B.AMOng neoplastic zotupaS, m'mimba kwambiri, lipomas, Brucellas adenomas, granulosa ma cell, otupa a Schwannomas, ndi ochepera 15% amatha kuwoneka ngati minofu imaphunzira zoyipa.

C.GASTRIAN SEGOMAotupa (gist) zotupa (ukonde) mu SMT ndi zotupa ndi kuthekera kwina, koma zimatengera kukula kwake, koma zimatengera kukula kwake, malo ndi mtundu wake.

D.Kodi malo a SMT amakhudzanaku magulu a patloologication: a. Leioloolomas ndi mtundu wamba wa SMT mu esophagus, amawerengera 60% mpaka 80% ya Esophogeal SMS, ndipo amapezekanso m'magawo a esophagus; B. Mitundu yamitundu ya chapamimba imp ili yovuta, ndi gist, leiomroma ndi ectopic kapaka yemwe amafala kwambiri. Pakati pa chapamimba sm smt, gist nthawi zambiri amapezeka mu fundus ndi thupi la m'mimba, leiomyoma nthawi zambiri imakhala mu mtima, komanso kumtunda kwa thupi ndi ectopic kapamba. Lipomas ndiofala kwambiri mu arrum antrum; c. Lipomas ndi cysts ndizofala kwambiri mu otsika ndi akulu a duodenum; d. Mu SMT ya m'mimba thirakiti, lipomas ndizofalikira m'bwalo lamatumbo, pomwe maukonde ndi otchuka mu rectum.

. Kwa SMTS omwe amakaikidwira kuti akhale owononga kapena kukhala ndi zotupa zazikulu (zazitaliDiameter> 2 cm), CT ndi MRI tikulimbikitsidwa.

Njira zina zongoganizira, kuphatikiza ct ndi MRI, ndizofunikiranso pakuzindikira kwa SMT. Amatha kuwonetsa mwachindunji malo otupa, kukula kwazithunzi, kukula kwake, kapena kusapezeka, ndi malire, komanso kuchuluka kwa zokulirapo.Kulowa kwa khoma lam'mimba. Ndi njira yayikulu yochitira malonda, chithandizo chamankhwala ndi zotupa.

(4) minyewa ya minofu siyikupezekansoWomenzedwa ndi Benig Smts zomwe zitha kupezeka ndi EUSCOPY wamba kuphatikiza ndi Eus, monga Lipomas, cysts, ndi ectopic kapamba.

Chifukwa zotupa zomwe zikuwoneka kuti ndizovuta kapena zikakhala kuti euscoscopy yophatikizaeedle asping / biopsy, Eus-FNA / FNB yokhazikika biops (mucosal sturded biops (mucosas information biopy, Miab), etc. Poona malire a Eus-FNA ndi zomwe zimakhudzanso matenda a Endoscopic, kwa omwe ali oyenera opaleshoni ya endoscopic imatha kuthandizidwa ndi endoscopic mwachindunji.

Njira iliyonse yopezera ziganizo zathanzi zomwe zachitika pangozi zisanachitike ndipo zimawononga minyewa ya incosa, potero ndikuwonjezera zovuta za opaleshoni ndipo mwina zikuwonjezera kuwopsa kwa magazi, zotupaChakudya, ndi chotupa. Chifukwa chake, zothandizira biopopyy sizofunikira kwenikweni. Pofunika, makamaka kwa SMTS zomwe zitha kupezeka ndi EUSCY CASCOPY, monga lipomas, cysts, ndi ma petropic pakapita.

2.smt endoscopic mgwirizanont

(1) Mfundo Zachidziwitso

Zotupa zomwe zimakhala ndi lymph node metastasis kapena chiopsezo chochepa kwambiri cha m'mimba, zimatha kuwonekeratu pogwiritsa ntchito ma endoscopic, ndikukhala ndi vuto lokhalapo ndi mankhwala. Kuchotsedwa kwathunthu kwa chotupa chocheperako chimachepetsa chotupa chotsalira komanso chiopsezo chobwereza. AMfundo ya chithandizo chaulere kuyenera kutsatiridwa pa nthawi ya endoscopic, ndipo kukhulupirika kwa kapisozi kuyenera kutsimikiziridwa panthawi yomwe ikuchitika.

(2) Zizindikiro

i.Tumiors ndi vuto lolowera poyeserera kapena kutsimikiziridwa ndi matenda a biopsy, makamaka omwe akuwaganizira GISt ndi kafukufuku wamkulu wa chotupa cha ≤2cm ndi chiopsezo chochepa chobwereza komanso cha metastasis, komanso kuthekera kofanizira kwathunthu; Kwa zotupa zokhala ndi mainchesi ataliatali a gist> 2cm, ngati lymph node kapena ma metastasis omwe amachitidwapo ndi kuwunika mwaluso kwambiri. kukonzanso.

ii. Chizindikiro (mwachitsanzo, magazi, kutulutsa).

III.PORARS OGULIRA AMENE ANAKHALA NDI CHIWEREZO CHOKHUDZA KAPENA KUGWIRA NTCHITO KAPENA KUGWIRA NTCHITO KAPENA KUPANGIRA MTIMA WOSATHAe za mankhwala a endoscopic.

(3) Contraindication

i. Dziwani zotupa zomwe ndili nazokugwidwa ndi lymph node kapena malo akutali.

ii. Kwa ena osakhala ndi mawu omvekanodeKapenanso metastasis, biliyoni biopsy amafunika kupeza matenda, omwe amatha kuwonedwa ngati chotsutsana.

iii. Pambuyo pogonanaKuunikiratu, kumatsimikizika kuti onse ali ndi opaleshoni yosauka komanso endoscopic sizotheka.

Benign zotupa monga Lipoma komanso ectopic pancreas nthawi zambiri sizimayambitsa zizindikiro monga zowawa, kutuluka magazi, komanso kutsekeka. Pamene sMawonekedwe a mt monga kukokoloka, zilonda, kapena kuwonjezeka kwakanthawi kwakanthawi, kuthekera kwa kuti kukhala chotupa chowonda kumawonjezeka.

(4) Kusankha kwa methoction meod

Tsombu la endoscopic:SMT yomwe ili yopambana

Maphunziro apakhomo ndi akunja atsimikizira kuti ndiotetezeka komanso othandiza pa Superfial SM <2cm, ndi chiopsezo cha magazi a 4% mpaka 13% ndi mankhwalachiopsezo cha 2% mpaka 70%.

Endoscopic Hubmucal Rummucal, ESE: Kwa smts ndi diameter yayitali ≥2 cm kapena ngati mayeso olingalira monga EuS ndi CT ndikutsimikizira thPa chotupa chotupa mutsekeke, ESE ndi wotheka kuti alembetse ma endoscopic.

Ese imatsata ukadaulo waEndoscopic submucas disction (ESD) ndi endoscopic mucal incals, ndikugwiritsa ntchito mawu ozungulira "kuzungulira chotupacho kuchotsa mucosa ndikuwulula zotupa. , Kuti mukwaniritse cholinga chosunga umphumphuwo, kukonza kuperewera kwa opaleshoni, ndikuchepetsa zovuta zokhazikika. Kwa zotupa ≤1.5 masentimita, kuchuluka kwathunthu kwa 100% kungakwaniritsidwe.

Submucas Tunnelling Reposcopic ReportIon, STT: Kwa SMCART kuchokera ku Musclular Trumpgus, Hilum, gawo locheperako ndi recrum yomwe mungakonde

Sternology yatsopano yomwe idapangidwa chifukwa cha petroscorcopic esophageal sphinctetemy (ndakatulo) ndi yowonjezera ya ESD technomoni. Mtengo wa bloc wofanizira wa schesi ya schesi ya SMT yamankhwala 84.9% mpaka 97.59%.

Endoscopic Full-MakulidweIon, Eftr: Itha kugwiritsidwa ntchito kwa SMT komwe kuli kovuta kukhazikitsa msewu kapena pomwe mulifupi kwambiri wotupa wa chotupa ndi. Ngati chotupa chimatulutsa muyeso wofiirira kapena umakula kunja kwa chapamwamba, ndipo chotupacho chimapezeka kuti chikhale cholumikizidwa mwamphamvu ku sewero la sewerolo pakuchita opaleshoni ndipo sangathe kulekanitsidwa, zitha kugwiritsidwa ntchito. Eftr amachita mankhwala othandizira endoscopic.

Kuwononga koyeneraTsamba litatha ekfr ndiye chinsinsi cha kupambana kwa Eftr. Pofuna kuwunika molondola chiopsezo cha chotupa ndikuchepetsa chiopsezo chotupa, sichikulimbikitsidwa kudula ndikuchotsa chotupa chomwe EFTR. Ngati kuli kofunikira kuchotsa chotupacho, kutanthauza kuti pempho liyenera kukonzanso koyamba kuti muchepetse chiopsezo chotupa chotupa ndikufalikira. Njira zosinthira zimaphatikizapo: Chitsulo chopindika, chosakanikirana, chosungunula "njira yotsekera

(5) Zovuta

Kutulutsa magazi: Kutuluka magazi komwe kumapangitsa hemoglobin ya wodwalayo kutsika ndi 20 g / l.
Kupewa magazi opatsa chidwi,Kapangidwe kokwanira kanthawi kochepa kuyenera kuchitidwa mukamawafotokozera zam'mitchire zazikulu ndikuwongolera electroculation kusiya magazi. Kutulutsa magazi kosatheka kumatha kuthandizidwa ndi mipeni yosiyanasiyana, mphamvu yamagetsi kapena zitsulo, komanso kudziletsa kwamitsempha yowulula zamagazi.

Kutulutsa magazi: Kutulutsa magazi kwa postoperative magazi kumawonekera ngati magazi osanza, melena, kapena magazi mu chopondapo. Milandu yoopsa, kugwedezeka kwa hemorrrgic kumatha kuchitika. Zimachitika kwambiri pasanathe sabata 1 atachitidwa opaleshoni, koma amathanso kuchitika patadutsa milungu iwiri mpaka 4 atachitidwa opaleshoni.

Kutulutsa magazi kwa postoperative nthawi zambiri kumagwirizana ndiZinthu monga zoyipa zomwe zimapangitsa magazi chifukwa chowongolera magazi ndi kutukula mitsempha yotsalira ndi chapamimba acid. Kuphatikiza apo, magazi a postoperative amagwirizananso ndi komwe kuli matenda, ndipo ndizofala kwambiri ku Antrumu ndi rectum yotsika.

Kuchedwa kusinthidwa: nthawi zambiri kumawonekera ngati kuthira kwam'mimba, kupweteka kwam'mimba, kuwoneka kwa malungo, komanso kuyerekezera kwamafuta omwe akuwonetsa kuyambiranso.

Zimagwirizana kwambiri ndi zinthu monga kusauka kokweza mabala, zamagetsi zochulukirapo, kumangokulira kwambiri kuti asunthire, kumatenganso khutu, kuwongolera magazi owuma, ndikukokolokera kwa mabala am'mimba. a. Ngati bala ndi lalikulu kapena lakuya kapena bala limakhala ndi FISZachidziwikire - monga kusintha, kama wopuma nthawi ndi nthawi yopukutira kuyenera kuchitidwa moyenera pambuyo pa opareshoni (odwala pambuyo pa opaleshoni ya m'mimba ya m'mimba) iyenera kukhala ndi ngalande ya anal. b. Odwala odwala matenda ashuga ayenera kuyang'anira shuga. Iwo omwe ali ndi zotupa zazing'ono ndi mankhwala ofatsa ndi m'mimba amayenera kupatsidwa chithandizo monga kusala, matenda, ndi mankhwala a asidi; c. Kwa iwo omwe ali ndi zokhumba, ngalande zam'manja ndi miyala yamkumino imatha kuchitidwa machubu oyenera kukwera madzi osalala; d. Ngati nthendayo singatengedwe pambuyo poti mankhwala othandizira kapena imaphatikizidwa ndi matenda oopsa a thoracoabinal, opaleshoni ya opaleshoni iyenera kuchitidwa mwachangu, ndipo kukonza zopangira komanso zotupa zam'mimba ziyenera kuchitidwa.

Zovuta zokhudzana ndi gasi: kuphatikiza subcutaNeasous emphysema, chibayotiastiastiastinam, pneumothorax ndi pneumbuperitoneum.

Hintratial Cuccutaneous Borcutaneous Borthmaron (chowonetsedwa ngati emplysema pankhope, khosi, khoma la chifuwa, ndi scrotum) ndi Mediastaphysema (sKuchulukitsa kwa epiglottis kumatha kupezeka pa gastroscopy) nthawi zambiri sikufuna chithandizo chapadera, ndipo mawu a emblysma amasintha zokhazokha.

Neumothorax imachitika dKuchita opaleshoni [Kupanikizika kwa Airway Kupitilira 20 mmhg pakuchita opareshoni

(1mmhg = 0.133kpa), spop2 <90%, adatsimikiziridwa ndi bedi ladzidzidzi X-ray], opaleshoni nthawi zambiri imatha kupitilizidwa pachifuwakusokoneza.

Kwa odwala omwe ali ndi pneumoperitoneum yoonekerayo mukamawagwira ntchito, gwiritsani ntchito singano ya chibayo kuti ipyoKumanja kotsika pamimba kuti muchepetse mpweya, ndikusiya singano yopumayo malo mpaka kumapeto kwa opareshoni, kenako ndikuchichotsa pambuyo potsimikizira kuti palibe mafuta odziwika bwino.

Gastroincastinal fistula: Madzimadzi amafa oyambitsidwa ndi opaleshoni ya endoscopic imayenda pachifuwa kapena m'mimba mwa kutaya.
Mitundu ya ESOphageal Mediassinal ndi ziphuphu za Esothagotorachic ndizofala. Kamodzi fistula imachitika, ichitatse ngalande yachifuwa kupita ku maintam'malo osalala ndikupereka chithandizo chokwanira cha kudya. Ngati ndi kotheka, zidutswa zachitsulo ndi zida zingapo zotsekera zitha kugwiritsidwa ntchito, kapena chophimba chathunthu chitha kubwezeretsedwanso. STENGO NDI Njira Zina Zimagwiritsidwa Ntchito Kuletsafistula. Milandu yayikulu imafunikira opaleshoni yoyendetsa opaleshoni.

3.Ponational oyang'anira (follow-mmwamba)

(1) Zotupa za Benugn:Matenda a sUgulu womwe umakhala ndi zotupa monga Lipoma ndi leiomyoma safuna kuvomerezedwa pafupipafupi.

(2) SMT yopanda kugwaAzichita Zotheka:Mwachitsanzo, ma oncos 2cm 2cm, ndi chapamwamba- ndi chiwopsezo chachikulu, osasunthika ayenera kuchitidwa ndi chithandizo chowonjezera (opaleshoni, mankhwala, chemotheraw) chikuyenera kuganiziridwa mwamphamvu. kuchitira). Kupanga kwa mapulani kuyenera kutengera zokambirana zingapo komanso payekha.

(3) Wotsika kwambiri SMT:Mwachitsanzo, phokoso lowopsa limafunikira kuyesedwa ndi Eus kapena kuganizira miyezi isanu ndi umodzi iliyonse mutatha kulandira chithandizo, kenako ndikumuchitira malangizo azachipatala.

(4) SMT yokhala ndi mphamvu yayikulu komanso yayikulu kwambiri:Ngati matenda a postoperative matenda atsimikizira mtundu wa nesric ukonde, ukonde ndi 2cm, komanso chiopsezo chachikulu, komanso chiopsezo chowonjezera chikuyenera kuchitidwa ndi chithandizo chowonjezera. kuchitira). Kupanga kwa mapulani kuyenera kutero[Zokhudza US 0118.docx] zokambirana zamagetsi komanso payekha.