Ma polyps a m'matumbo ndi matenda ofala komanso omwe amapezeka kawirikawiri mu gastroenterology. Amatchula kutuluka kwa intraluminal komwe kumakhala kokwera kuposa mucosa ya m'matumbo. Kawirikawiri, colonoscopy imakhala ndi kuchuluka kwa kuzindikira kwa osachepera 10% mpaka 15%. Kuchuluka kwa matendawa nthawi zambiri kumawonjezeka ndi ukalamba. Popeza khansa yoposa 90% ya m'matumbo imayamba chifukwa cha kusintha kwa ma polyps, chithandizo chachikulu ndikuchita opaleshoni ya endoscopic akangowona ma polyps.
Mu colonoscopy ya tsiku ndi tsiku, 80% mpaka 90% ya ma polyps ndi ochepera 1 cm. Pa ma polyps a adenomatous kapena ma polyps okhala ndi kutalika kwa ≥ 5 mm (kaya adenomatous kapena ayi), njira yosankha yochotsera ma endoscopic resection imalimbikitsidwa. Kuthekera kwa ma micropolyps a m'matumbo (kutalika kwa mainchesi ≤5mm) okhala ndi zigawo za chotupa ndi kochepa kwambiri (0 ~ 0.6%). Pa ma micropolyps omwe ali mu rectum ndi sigmoid colon, ngati endoscopist angadziwe molondola kuti ndi ma polyps omwe si adenomatous, palibe chifukwa chochotsera ma endoscope, koma malingaliro omwe ali pamwambapa sagwiritsidwa ntchito kawirikawiri m'machitidwe azachipatala ku China.
Kuphatikiza apo, 5% ya ma polyp ndi athyathyathya kapena amakula m'mbali, okhala ndi mainchesi opitilira 2 cm, okhala ndi kapena opanda zigawo zoyipa. Pankhaniyi, njira zina zapamwamba zochotsera ma polyp endoscopic ndizofunikira, mongaEMRndiESDTiyeni tiwone njira zatsatanetsatane zochotsera ma polyp.
Njira yochitira opaleshoni
Wodwalayo anamaliza kuyezetsa opaleshoni asanachite opaleshoni, anaikidwa kumanzere kwa decubitus, ndipo anapatsidwa mankhwala oletsa ululu m'mitsempha ndi propofol. Kuthamanga kwa magazi, kugunda kwa mtima, electrocardiogram, ndi kuchuluka kwa mpweya m'magazi kunayang'aniridwa panthawi ya opaleshoni.
1 Wozizira/WotenthaMphamvu za BiopsyGawo
Ndi yoyenera kuchotsa ma polyps ang'onoang'ono ≤5mm, koma pakhoza kukhala vuto la kuchotsa ma polyps osakwanira 4 mpaka 5mm. Pogwiritsa ntchito biopsy yozizira, biopsy yotenthetsera ingagwiritse ntchito mphamvu yamagetsi yapamwamba kuti iwononge zilonda zotsala ndikuchita chithandizo cha hemostasis pabala. Komabe, muyenera kusamala kuti mupewe kuwonongeka kwa serosa wosanjikiza wa khoma la m'mimba chifukwa cha electrocoagulation yambiri.
Pa opaleshoni, mutu wa polyp uyenera kumangidwa, kukwezedwa moyenera (kuti usawononge minofu), ndikusungidwa patali ndi khoma la m'mimba. Pamene pedicle ya polyp ikhala yoyera, siyani kuuma kwa electrocoagulation ndikutseka chotupacho. Dziwani kuti sikophweka kuchotsa polyp yayikulu kwambiri, apo ayi idzawonjezera nthawi yogwiritsa ntchito magetsi ndikuwonjezera chiopsezo cha kuwonongeka kwathunthu (Chithunzi 1).
2 Wozizira/wotenthamsampha wochotsa polypectomynjira yochotsera
Yoyenera zilonda zokwezeka za kukula kosiyanasiyana I p mtundu, I sp mtundu ndi zazing'ono (<2cm) I s mtundu (miyezo yeniyeni yogawa ikhoza kutanthauza kuzindikira khansa yoyambirira ya m'mimba. Pali mitundu yambiri ndipo sindikudziwa momwe ndingaweruze? Nkhaniyi Fotokozani momveka bwino) Kuchotsa zilonda. Pa zilonda zazing'ono za Ip mtundu, kuchotsa snare resep ndi kosavuta. Zitsulo zozizira kapena zotentha zingagwiritsidwe ntchito pochotsa snare resep. Pakuchotsa snare resep, kutalika kwina kwa pedicle kuyenera kusungidwa kapena mtunda wina kuchokera pakhoma la m'mimba pamene mukuonetsetsa kuti chilondacho chachotsedwa kwathunthu. Mukamaliza kulimbitsa snare, iyenera kugwedezeka Snare, yang'anani ngati pali mucosa wabwinobwino wa m'mimba ndikuyiyika pamodzi kuti mupewe kuwonongeka kwa khoma la m'mimba.
Chithunzi 1 Chithunzi cha chidule cha kuchotsa forceps pogwiritsa ntchito kutentha, A asanachotse forceps, B bala litachotsedwa pogwiritsa ntchito forceps. CD: Malangizo pa kutenthamphamvu ya biopsykuchotsa. Ngati polyp ndi yayikulu kwambiri, idzawonjezera nthawi ya electrocoagulation ndikuyambitsa kuwonongeka kwa transmural.
Chithunzi 2 Chithunzi cha Schematic cha thermal snare resection ya zilonda zazing'ono za mtundu wa I sp
3 EMR
■Zilonda za I p
Pa zilonda zazikulu za Ip, kuwonjezera pa njira zodzitetezera zomwe zili pamwambapa, misampha yotenthetsera iyenera kugwiritsidwa ntchito pochotsa. Musanachotse, jakisoni wokwanira wa submucosal uyenera kupangidwa pansi pa pedicle (2 mpaka 10 mL ya mayunitsi 10,000 a epinephrine + methylene blue + physiological. Chosakaniza cha saline chimabayidwa pansi pa mucosa (bayani pamene mukutulutsa singano), kuti pedicle ikhale yokwezeka mokwanira komanso yosavuta kuchotsa (Chithunzi 3). Panthawi yochotsa, chotupacho chiyenera kupewa kukhudzana ndi khoma la m'mimba kuti chisapange kuzungulira kotsekedwa ndikuwotcha khoma la m'mimba.
Chithunzi 3 Chithunzi cha ndondomeko yaEMRchithandizo cha zilonda zamtundu wa lp
Tiyenera kudziwa kuti ngati polyp yayikulu ya mtundu wa I p ili ndi pedicle yokhuthala, ikhoza kukhala ndi vasa vasorum yayikulu, ndipo imatha kutuluka magazi mosavuta ikachotsedwa. Panthawi yochotsa, njira yolumikizirana-yodula-yolumikizirana ingagwiritsidwe ntchito kuchepetsa chiopsezo cha kutuluka magazi. Polyp zina zazikulu zimatha kuchotsedwa m'zidutswa kuti zichepetse kuvutika kwa opaleshoni, koma njira iyi siyothandiza pakuwunikira matenda.
■zilonda za mtundu wa lla-c
Pa zotupa za mtundu wa Ila-c ndi zina za Is zokhala ndi mainchesi akuluakulu, kudula strap resection mwachindunji kungayambitse kuwonongeka kwakukulu. Kuika madzi m'thupi kungathe kuwonjezera kutalika kwa chotupa ndikuchepetsa kuuma kwa snare ndi resection. Kaya pali kutuluka kwa strare panthawi ya opaleshoni ndi maziko ofunikira podziwa ngati adenoma ndi yabwino kapena yoyipa komanso ngati pali zizindikiro za chithandizo cha endoscopic. Njirayi ikhoza kuwonjezera kuchuluka kwa resection ya adenomas.<2cm m'mimba mwake.
Chithunzi 4EMRTchati cha njira yochizira matenda a mtundu wa Il a polyps
4 ESD
Kwa adenomas okhala ndi mainchesi opitilira 2cm omwe amafunika kuchotsedwa kamodzi kokha komanso chizindikiro chokweza bwino, komanso khansa zina zoyambirira,EMRzotsalira kapena kubwereranso komwe kumakhala kovuta kuchiza,ESDchithandizo chingathe kuchitika. Njira zonse ndi izi:
1. Pambuyo popaka utoto wa endoscopic, malire a chotupacho amafotokozedwa bwino ndipo kuzungulira kwake kumalembedwa (chotupacho sichingalembedwe ngati malire a chotupacho ali omveka bwino).
2. Jambulani jekeseni wa submucosally kuti zilonda ziwonekere kuti zatha.
3. Kudula pang'ono kapena mozungulira mucosa kuti muwonetse submucosa.
4. Masulani minofu yolumikizana m'mbali mwa submucosa ndipo pang'onopang'ono chotsani minofu yodwalayo.
5. Yang'anirani bala mosamala ndipo chizani mitsempha yamagazi kuti mupewe mavuto.
6. Mukamaliza kukonza zitsanzo zomwe zachotsedwa, zitumizeni kuti zikaunikidwe.
Chithunzi 5ESDchithandizo cha zilonda zazikulu
Malangizo Oteteza Pa Nthawi ya Opaleshoni
Kuchotsa ma polyp m'matumbo kumafuna njira yoyenera yosankhidwira kutengera mawonekedwe a ma polyp, malo, luso la wogwiritsa ntchito, ndi zida zomwe zilipo. Nthawi yomweyo, kuchotsa ma polyp kumatsatiranso mfundo zofanana, zomwe tiyenera kutsatira momwe tingathere kuti tiwonetsetse kuti njira yachipatala ndi yotetezeka komanso yothandiza komanso kuti odwala apindule nayo.
1. Kukonzekera pasadakhale dongosolo la chithandizo ndiye chinsinsi cha kumaliza bwino chithandizo cha polyp (makamaka polyps zazikulu). Pa polyps zovuta, ndikofunikira kusankha njira yoyenera yochotsera opaleshoni musanalandire chithandizo, kulankhulana ndi anamwino, akatswiri ogonetsa ndi antchito ena nthawi yake, ndikukonzekera zida zothandizira. Ngati zinthu zilola, zitha kumalizidwa motsogozedwa ndi dokotala wamkulu wa opaleshoni kuti apewe ngozi zosiyanasiyana za opaleshoni.
2. Kusunga "ufulu" wabwino pa galasi panthawi ya chithandizo ndikofunikira kuti cholinga cha opaleshoni chikwaniritsidwe. Mukalowa mu galasi, tsatirani mosamala "njira yosamalira ndi kufupikitsa axis" kuti malo ochizira asasunthike, zomwe zimathandiza kuti chithandizo chichitike molondola.
3. Kuona bwino opaleshoni kumapangitsa kuti njira yochizira ikhale yosavuta komanso yotetezeka. Matumbo a wodwalayo ayenera kukonzedwa mosamala asanalandire chithandizo, malo a wodwalayo ayenera kudziwika bwino asanachite opaleshoni, ndipo ma polyps ayenera kuonekera bwino ndi mphamvu yokoka. Nthawi zambiri zimakhala bwino ngati chotupacho chili mbali ina ya madzi otsala m'mimba.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China omwe amagwira ntchito kwambiri pazinthu zogwiritsidwa ntchito m'ma endoscopic, mongamphamvu ya biopsy, hemoclip, msampha wa polyp, singano ya sclerotherapy, katheta wopopera, maburashi a cytology, waya wotsogolera, dengu lotengera miyala, katheta yotulutsira madzi m'mphunondi zina zotero zomwe zimagwiritsidwa ntchito kwambiri muEMR, ESD, ERCPZogulitsa zathu zili ndi satifiketi ya CE, ndipo mafakitale athu ali ndi satifiketi ya ISO. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi mbali ina ya Asia, ndipo makasitomala ambiri amalandira ulemu ndi kutamandidwa!
Nthawi yotumizira: Ogasiti-02-2024