Colon polyps ndi matenda ofala komanso omwe amapezeka pafupipafupi mu gastroenterology. Amatchula zotuluka m'mimba zomwe zimakhala zapamwamba kuposa matumbo a m'mimba. Kawirikawiri, colonoscopy imakhala ndi chiwerengero cha 10 mpaka 15 peresenti. Chiwerengero cha zochitika nthawi zambiri chimawonjezeka ndi zaka. kuwuka. Popeza opitilira 90% a khansa yapakhungu amayamba chifukwa cha kusintha koyipa kwa ma polyps, chithandizo chambiri ndichopanga endoscopic resection atangowona ma polyps.
Mu colonoscopy ya tsiku ndi tsiku, 80% mpaka 90% ya polyps ndi yochepera 1 cm. Kwa adenomatous polyps kapena polyps okhala ndi kutalika ≥ 5 mm (kaya adenomatous kapena ayi), elective endoscopic resection ikulimbikitsidwa. Kuthekera kwa ma micropolyps amtundu (kutalika kwa ≤5mm) okhala ndi zigawo zotupa ndi otsika kwambiri (0~0.6%). Pakuti micropolyps mu rectum ndi sigmoid m'matumbo, ngati endoscopist akhoza molondola kudziwa kuti si adenomatous polyps, sipafunika Resection, koma mfundo pamwamba pa kaonedwe sikawirikawiri akuyendera pachipatala kuchita ku China.
Komanso, 5% ya polyps ndi lathyathyathya kapena kukula cham'mbali, ndi awiri m'mimba mwake kuposa 2 cm, kapena popanda zigawo zoipa. Pankhaniyi, njira zina zapamwamba za endoscopic polyp kuchotsa zimafunikira, mongaEMRndiESD. Tiyeni tione mwatsatanetsatane njira kuchotsa polyp.
Njira ya opaleshoni
Wodwalayo adamaliza kuwunika kwa anesthesia asanayambe kuchitidwa opaleshoni, adayikidwa kumanzere kwa decubitus, ndipo adapatsidwa mankhwala oletsa ululu ndi propofol. Kuthamanga kwa magazi, kugunda kwa mtima, electrocardiogram, ndi peripheral blood saturation saturation ankayang'aniridwa panthawi ya opaleshoni.
1 Kuzizira/KutenthaBiopsy ForcepsGawo
Ndi oyenera kuchotsa tizilombo tating'onoting'ono ≤5mm, koma pangakhale vuto la kuchotsa kosakwanira kwa polyps 4 mpaka 5mm. Pamaziko a kuzizira kwa biopsy, matenthedwe a biopsy amatha kugwiritsa ntchito ma frequency apamwamba kuti achepetse zotsalira zotsalira ndikupanga chithandizo cha hemostasis pabala. Komabe, kusamala kuyenera kuchitidwa kuti mupewe kuwonongeka kwa khoma la m'mimba la serosa chifukwa cha electrocoagulation yambiri.
Panthawi ya opaleshoni, mutu wa polyp uyenera kumangirizidwa, kukwezedwa moyenera (kupewa kuwononga minofu ya minofu), ndikusungidwa pamtunda woyenera kuchokera ku khoma lamatumbo. Polyp pedicle ikasanduka yoyera, siyani electrocoagulation ndikuchepetsa chotupacho. Tiyenera kuzindikira kuti sikophweka kuchotsa polyp yaikulu kwambiri, mwinamwake idzatalikitsa nthawi yopangira magetsi ndikuwonjezera chiopsezo cha kuwonongeka kwakukulu (Chithunzi 1).
2 Kuzizira/kutenthapolypectomy msamphakuchotsa njira
Oyenera kukweza zilonda zamitundu yosiyanasiyana ya mtundu wa I p, mtundu wa I sp ndi ang'onoang'ono (<2cm) I s mtundu (miyezo yeniyeni yamagulu ingatanthauze kuzindikira kwa endoscopic ya khansa yoyambirira ya m'mimba. Pali mitundu yambiri ndipo sindikudziwa momwe ndingaweruzire? Nkhaniyi Ipangitseni momveka bwino) Kuchotsa zotupa. Kwa zilonda zamtundu wa Ip zazing'ono, kuchotsa msampha ndikosavuta. Misampha yozizira kapena yotentha ingagwiritsidwe ntchito pochotsa. Panthawi ya resection, kutalika kwa pedicle kuyenera kusungidwa kapena mtunda wina kuchokera pakhoma la matumbo ndikuwonetsetsa kuchotsedwa kwathunthu kwa chotupacho. Pambuyo kumangitsa msampha, ayenera kugwedezeka Msampha, onani ngati pali ozungulira yachibadwa matumbo mucosa ndi kuika pamodzi kuteteza kuwonongeka kwa khoma matumbo.
Chithunzi 1 Chojambula chojambula cha kuchotsedwa kwa mphamvu za biopsy, A musanachotsere zokakamiza, B chilonda pambuyo pochotsa mphamvu. CD: Njira zodzitetezera pakutenthabiopsy forcepskuchotsa. Ngati polyp ndi yayikulu kwambiri, imawonjezera nthawi ya electrocoagulation ndikuyambitsa kuwonongeka kwa transmural.
Chithunzi 2 Chithunzi chojambula cha kusungunula kwa msampha wotentha wa zilonda zazing'ono za mtundu wa I sp
3 EMR
■ I p zotupa
Kwa zilonda zazikulu za I p, kuwonjezera pa zomwe zili pamwambazi, misampha yotentha iyenera kugwiritsidwa ntchito pochotsa. Asanayambe kuchotsedwa, jekeseni yokwanira ya submucosal iyenera kupangidwa pansi pa pedicle (2 mpaka 10 mL ya 10,000 units ya epinephrine + methylene blue + physiological The saline osakaniza amabayidwa pansi pa mucosa (jekeseni pamene akuchotsa singano), kotero kuti pedicle ikwezedweratu ndi yosavuta kuchotsa (Chithunzi 3, ndi kupeŵa kukhudzana kwa restestinal, panthawi ya lesion sayenera kukhudzana ndi khoma). kupanga chipika chotsekedwa ndikuwotcha khoma lamatumbo.
Chithunzi 3 Chojambula chaEMRchithandizo cha zilonda zamtundu wa lp
Tiyenera kuzindikira kuti ngati mtundu waukulu wa I p polyp uli ndi pedicle wandiweyani, ukhoza kukhala ndi vasa vasorum yaikulu, ndipo imatuluka magazi mosavuta ikachotsedwa. Panthawi yochotsa mimba, njira ya coagulation-cut-coagulation ingagwiritsidwe ntchito kuchepetsa chiopsezo chotaya magazi. Ma polyps ena akuluakulu amatha kupangidwanso mzidutswa kuti achepetse zovuta za opareshoni, koma njirayi sithandiza kuwunika kwa ma pathological.
■ zotupa za mtundu wa lla-c
Kwa zilonda zamtundu wa Ila-c ndi zina za Is zokhala ndi mainchesi akuluakulu, kuchotsa msampha mwachindunji kungayambitse kuwonongeka kwathunthu. Jakisoni wa submucosal wamadzimadzi amatha kukulitsa kutalika kwa chotupa ndikuchepetsa zovuta za msampha ndi kuchotsa. Kaya pali kuphulika panthawi ya opaleshoni ndi maziko ofunikira kuti mudziwe ngati adenoma ndi yoopsa kapena yoopsa komanso ngati pali zizindikiro za chithandizo cha endoscopic. Njirayi imatha kuonjezera kuchuluka kwa resection kwa adenomas<2cm m'mimba mwake.
Chithunzi 4EMRmankhwala otaya tchati mtundu Il a polyps
4 ESD
Kwa adenomas omwe ali ndi mainchesi okulirapo kuposa 2cm omwe amafunikira kuchotsedwa kamodzi komanso chizindikiro chokweza choyipa, komanso makhansa ena oyambilira,EMRzotsalira kapena zobwereza zomwe zimakhala zovuta kuchiza,ESDmankhwala akhoza kuchitidwa. Masitepe onse ndi awa:
1. Pambuyo podetsa ma endoscopic, malire a zilonda amafotokozedwa momveka bwino ndipo chigawocho chimasindikizidwa (chotupacho sichingalembedwe ngati malire a zilondazo ndi omveka bwino).
2. Jekeseni submucosally kuti zotupa mwachionekere anakweza.
3. Pang'ono kapena circumferentially incise mucosa poyera submucosa.
4. Masulani minyewa yolumikizana ndi submucosa ndipo pang'onopang'ono chotsani minofu yodwalayo.
5. Yang'anani chilondacho mosamala ndikusamalira mitsempha yamagazi kuti mupewe zovuta.
6. Pambuyo pokonza zitsanzo zomwe zachotsedwa, zitumizeni kuti akafufuze matenda.
Chithunzi 5ESDchithandizo cha zilonda zazikulu
Njira zopewera ma opaleshoni
Endoscopic colon polyp resection imafuna njira yoyenera yosankhidwa potengera mawonekedwe a polyp, malo, luso la opareshoni, ndi zida zomwe zilipo. Panthawi imodzimodziyo, kuchotsa polyp kumatsatiranso mfundo zodziwika bwino, zomwe tiyenera kuzitsatira momwe tingathere kuti titsimikizire kuti njira yachipatala ndi yotetezeka komanso yothandiza ndipo odwala amapindula nayo.
1. Kukonzekera koyambirira kwa ndondomeko ya chithandizo ndi chinsinsi cha kutsiriza bwino kwa mankhwala a polyp (makamaka ma polyps aakulu). Kwa ma polyps ovuta, ndikofunikira kusankha njira yofananira ya resection musanalandire chithandizo, kuyankhulana ndi anamwino, akatswiri opha ululu ndi ogwira ntchito ena munthawi yake, ndikukonzekera zida zamankhwala. Ngati mikhalidwe ikuloleza, imatha kumalizidwa motsogozedwa ndi dokotala wamkulu kuti apewe ngozi zosiyanasiyana za opaleshoni.
2. Kukhalabe ndi "digiri yaufulu" yabwino pagalasi panthawi ya chithandizo ndikofunikira kuonetsetsa kuti cholinga cha opareshoni chikukwaniritsidwa. Mukalowa pagalasi, tsatirani mosamalitsa "kukonza ndi kufupikitsa njira" kuti musunge malo ochizira, omwe amathandizira kuwongolera bwino.
3. Masomphenya abwino opangira ntchito amapangitsa njira yochizira kukhala yosavuta komanso yotetezeka. Matumbo a wodwalayo ayenera kukonzedwa mosamala asanalandire chithandizo, malo a wodwalayo ayenera kutsimikiziridwa asanachite opaleshoni, ndipo ma polyps ayenera kuwululidwa mokwanira ndi mphamvu yokoka. Nthawi zambiri bwino ngati chotupa ili mbali ina ya madzimadzi otsala mu matumbo patsekeke.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China okhazikika pazakudya zama endoscopic, mongabiopsy forceps, hemoclip, polyp msampha, sclerotherapy singano, kupopera catheter, maburashi a cytology, guidewire, dengu lochotsa miyala, catheter ya nasal biliary drainageetc. omwe amagwiritsidwa ntchito kwambiri muEMR, ESD, ERCP. Zogulitsa zathu ndi zovomerezeka za CE, ndipo mbewu zathu ndi zovomerezeka za ISO. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi gawo la Asia, ndipo amapeza makasitomala ambiri kuzindikira ndi kutamandidwa!
Nthawi yotumiza: Aug-02-2024