Pakati pa chidziwitso chodziwika bwino chokhudza khansa yoyambirira ya m'mimba, pali mfundo zina zodziwika bwino za matenda zomwe zimafuna chisamaliro chapadera ndi kuphunzira. Chimodzi mwa izo ndi khansa ya m'mimba yopanda HP. Lingaliro la "zotupa za epithelial zosadwala" tsopano latchuka kwambiri. Padzakhala malingaliro osiyanasiyana pa nkhani ya dzina. Chiphunzitsochi cha zomwe zili mkati mwake chimachokera makamaka pazomwe zili zokhudzana ndi magazini ya "M'mimba ndi M'matumbo", ndipo dzinalo limagwiritsanso ntchito "khansa ya m'mimba yopanda HP".
Mtundu uwu wa zilonda uli ndi zizindikiro monga kuchepa kwa matenda, kuvutika kuzizindikira, chidziwitso chovuta cha chiphunzitso, ndipo njira yosavuta ya MESDA-G siigwira ntchito. Kuphunzira chidziwitsochi kumafuna kuthana ndi mavuto.
1. Chidziwitso choyambira cha khansa ya m'mimba yopanda HP
Mbiri
Kale, anthu ankakhulupirira kuti vuto lalikulu lomwe limayambitsa khansa ya m'mimba ndi matenda a HP, kotero njira yodziwika bwino yodziwira khansa ndi HP - kufooka kwa thupi - kusinthasintha kwa matumbo - chotupa chochepa - chotupa chachikulu - khansa. Njira yodziwika bwino nthawi zonse yakhala ikudziwika, kuvomerezedwa komanso kukhulupiriridwa mwamphamvu. Zotupa zimakula pamodzi chifukwa cha kufooka kwa thupi komanso chifukwa cha mphamvu ya HP, kotero khansa nthawi zambiri imakula m'matumbo a atrophic komanso m'matumbo a non-atrophic omwe sali abwinobwino.
Pambuyo pake, madokotala ena adapeza kuti khansa ya m'mimba imatha kuchitika ngakhale palibe matenda a HP. Ngakhale kuti kuchuluka kwa matendawa ndi kochepa kwambiri, n'zotheka. Mtundu uwu wa khansa ya m'mimba umatchedwa khansa ya m'mimba yopanda HP.
Ndi kumvetsetsa pang'onopang'ono kwa mtundu uwu wa matenda, kufufuza mozama ndi chidule kwayamba, ndipo mayina akusintha nthawi zonse. Panali nkhani mu 2012 yotchedwa "Gastric Cancer after Sterilization", nkhani mu 2014 yotchedwa "HP-negative Gastric Cancer", ndi nkhani mu 2020 yotchedwa "Epithelial Tumors Not Infected with Hp". Kusintha kwa dzina kukuwonetsa kumvetsetsa kwakukulu komanso kokwanira.
Mitundu ya Tizilombo ndi Mapangidwe a Kukula
Pali mitundu iwiri ikuluikulu ya ma fungus ndi ma pyloric glands m'mimba:
Ma fungus (ma oxyntic glands) amagawidwa mu fundus, thupi, ngodya, ndi zina zotero m'mimba. Ndi ma globs a mzere umodzi. Amapangidwa ndi maselo a mucous, maselo akuluakulu, maselo a parietal ndi maselo a endocrine, omwe aliyense amachita ntchito zake. Pakati pawo, maselo akuluakulu Madontho a PGI ndi MUC6 omwe amatulutsidwa anali abwino, ndipo maselo a parietal adatulutsa hydrochloric acid ndi intrinsic factor;
Ma pyloric glands amapezeka m'dera la m'mimba ndipo amapangidwa ndi maselo a mucus ndi maselo a endocrine. Maselo a mucus ali ndi MUC6 positive, ndipo maselo a endocrine akuphatikizapo maselo a G, D ndi maselo a enterochromaffin. Maselo a G amatulutsa gastrin, maselo a D amatulutsa somatostatin, ndi maselo a enterochromaffin amatulutsa 5-HT.
Maselo abwinobwino a mucous membrane wa m'mimba ndi maselo otupa amatulutsa mitundu yosiyanasiyana ya mapuloteni a mucus, omwe amagawidwa m'mapuloteni a mucus "a m'mimba", "a m'matumbo" ndi "osakanikirana". Kuwonekera kwa mucins wa m'mimba ndi m'matumbo kumatchedwa phenotype osati malo enieni a m'mimba ndi m'matumbo.
Pali mitundu inayi ya maselo a zotupa za m'mimba: zotupa za m'mimba zonse, zosakaniza m'mimba zonse, zosakaniza m'matumbo zonse, ndi zotupa za m'mimba zonse. Zotupa zomwe zimachitika chifukwa cha metaplasia ya m'matumbo nthawi zambiri zimakhala zotupa za m'mimba zonse. Khansa zosiyanasiyana zimawonetsa mtundu wa m'matumbo (MUC2+), ndipo khansa yofalikira imawonetsa mtundu wa m'mimba zonse (MUC5AC+, MUC6+).
Kuzindikira Hp negative kumafuna kuphatikiza kwapadera kwa njira zingapo zodziwira matenda kuti mudziwe bwino. Khansa ya m'mimba yopanda HP ndi khansa ya m'mimba yopangidwa pambuyo poyeretsedwa ndi malingaliro awiri osiyana. Kuti mudziwe zambiri za mawonekedwe a X-ray a khansa ya m'mimba yopanda HP, chonde onani gawo loyenera la magazini ya "M'mimba ndi M'matumbo".
2. Mawonekedwe a endoscopic a khansa ya m'mimba yopanda HP
Kuzindikira matenda a endoscopic ndi komwe kumayambitsa khansa ya m'mimba yopanda HP. Kumaphatikizapo makamaka khansa ya m'mimba ya mtundu wa fundic gland, khansa ya m'mimba ya mtundu wa fundic gland mucosal, adenoma ya m'mimba, chotupa cha raspberry foveolar epithelial, khansa ya cell ya signalet ring, ndi zina zotero. Nkhaniyi ikuyang'ana kwambiri pa zizindikiro za khansa ya m'mimba yopanda HP mu endoscopic.
1) Fundi gland khansa ya m'mimba
-Zilonda zoyera zokwezeka
fundic gland mtundu wa khansa ya m'mimba
◆Mlandu 1: Zilonda zoyera, zokwezeka
Kufotokozera:Kupindika kwa cardia m'mimba, 10 mm, koyera, mtundu wa O-lia (wofanana ndi SMT), popanda kufooka kapena kufalikira kwa matumbo kumbuyo. Mitsempha yamagazi yonga arbor imawoneka pamwamba (NBI ndi kukula pang'ono)
Kuzindikira (kuphatikiza ndi matenda):U, O-1la, 9mm, fundic gland mtundu wa khansa ya m'mimba, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Zilonda zoyera zathyathyathya
fundic gland mtundu wa khansa ya m'mimba
◆Mlandu 2: Zilonda zoyera, zathyathyathya/zosakhazikika
Kufotokozera:Khoma lakunja la gastric fundic fornix-cardia greater curvature, 14 mm, loyera, mtundu wa 0-1lc, lopanda kufooka kapena metaplasia ya m'mimba kumbuyo, malire osamveka bwino, ndi mitsempha yamagazi ya dendritic yomwe imawoneka pamwamba. (NBI ndi amplification mwachidule)
Kuzindikira (kuphatikiza ndi matenda):U, 0-Ilc, 14mm, fundic gland mtundu wa khansa ya m'mimba, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Zilonda zofiira zokwezeka
fundic gland mtundu wa khansa ya m'mimba
◆Mlandu 3: Zilonda zofiira komanso zokwezeka
Kufotokozera:Khoma lakutsogolo la kupindika kwakukulu kwa cardia ndi 12 mm, moonekeratu kuti ndi lofiira, mtundu wa 0-1, lopanda kufooka kapena kufalikira kwa matumbo kumbuyo, malire omveka bwino, ndi mitsempha yamagazi ya dendritic pamwamba (NBI ndi kukula pang'ono)
Kuzindikira (kuphatikiza ndi matenda):U, 0-1, 12mm, fundic gland mtundu wa khansa ya m'mimba, pT1b/SM1 (200μm), ULO, LYO, VO, HMO, VMO
-Chilonda chofiira, chathyathyathya, komanso chofookas
fundic gland mtundu wa khansa ya m'mimba
◆Mlandu 4: Zilonda zofiira, zathyathyathya/zosakhazikika
Kufotokozera:Khoma lakumbuyo la kupindika kwakukulu kwa gawo lapamwamba la thupi la m'mimba, 18mm, lofiira pang'ono, mtundu wa O-1Ic, palibe kufooka kapena kufalikira kwa matumbo kumbuyo, malire osamveka bwino, palibe mitsempha yamagazi ya dendritic pamwamba, (NBI ndi kukula kwachotsedwa)
Kuzindikira (kuphatikiza ndi matenda):U, O-1lc, 19mm, fundic gland type gastric cancer, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
kambiranani
Amuna omwe ali ndi matendawa ndi okalamba kuposa akazi, ndipo zaka zawo zapakati zimakhala zaka 67.7. Chifukwa cha makhalidwe a nthawi imodzi ndi heterochrony, odwala omwe amapezeka ndi khansa ya m'mimba ya mtundu wa fundic gland ayenera kuwunikidwanso kamodzi pachaka. Malo ofala kwambiri ndi dera la fundic gland pakati ndi pamwamba pa mimba (fundus ndi pakati ndi pamwamba pa thupi la m'mimba). Zilonda zoyera zooneka ngati SMT zimapezeka kwambiri mu kuwala koyera. Chithandizo chachikulu ndi EMR/ESD yozindikira.
Palibe kufalikira kwa mitsempha ya m'magazi kapena kufalikira kwa mitsempha yamagazi komwe kwawonedwa mpaka pano. Pambuyo pa chithandizo, ndikofunikira kudziwa ngati pakufunika opaleshoni yowonjezera ndikuwunikira ubale womwe ulipo pakati pa matenda oopsa ndi HP. Si khansa zonse za m'mimba zamtundu wa fundic gland zomwe zilibe HP.
1) Khansa ya m'mimba ya mucosal gland
Khansa ya m'mimba ya mucosal gland
◆Mlandu 1
Kufotokozera:Chilondacho chakwera pang'ono, ndipo RAC non-atrophic gastric mucosa imawoneka mozungulira. Kapangidwe ka microstructure ndi microvessels zomwe zimasintha mwachangu zitha kuwoneka m'gawo lokwezedwa la ME-NBI, ndipo DL imawoneka.
Kuzindikira (kuphatikiza ndi matenda):Fundic gland mucosal gastric cancer, U zone, 0-1la, 47 * 32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Khansa ya m'mimba ya mucosal gland
◆Mlandu 2
Kufotokozera: Chilonda chathyathyathya pakhoma lakutsogolo la kupindika kochepa kwa cardia, ndi kusintha kwa mtundu ndi kufiira kosakanikirana, mitsempha yamagazi ya dendritic imatha kuwoneka pamwamba, ndipo chilondacho chimakwezedwa pang'ono.
Kuzindikira (kuphatikiza ndi matenda): Fundic gland mucosal gastric cancer, 0-lla, pT1a/M, ULO, LyOV0,HM0,VMO
kambiranani
Dzina la "gastric gland mucosal adenocarcinoma" ndi lovuta kulitchula, ndipo kuchuluka kwa matendawa ndi kochepa kwambiri. Zimafunika khama lalikulu kuti lizindikire ndikulimvetsa. Fundic gland mucosal adenocarcinoma ili ndi zizindikiro za khansa yambiri.
Pali zinthu zinayi zazikulu zomwe zimapangitsa kuti endoscopy ya kuwala koyera ikhalepo: ① zilonda zomwe zimafa pang'onopang'ono; ② subepithelial tumor SMT; ③ mitsempha yamagazi ya dendritic yotambasuka; ④ tinthu tating'onoting'ono ta m'deralo. Kugwira ntchito kwa ME: DL(+)IMVP(+)IMSP(+)MCE imakulitsa IP ndikuwonjezeka. Pogwiritsa ntchito njira yolimbikitsidwa ndi MESDA-G, 90% ya khansa ya m'mimba ya fundic gland imakwaniritsa zofunikira zodziwira matenda.
3) Gastric adenoma (adenoma ya pyloric gland PGA)
adenoma ya m'mimba
◆Mlandu 1
Kufotokozera:Chilonda choyera chokwera chathyathyathya chinaoneka pakhoma lakumbuyo la gastric fornix lopanda malire omveka bwino. Madontho a Indigo carmine sanawonetse malire omveka bwino, ndipo mawonekedwe ofanana ndi a LST-G a matumbo akuluakulu adawoneka (akukula pang'ono).
Kuzindikira (kuphatikiza ndi matenda):khansa ya atypia yochepa, O-1la, 47*32mm, adenocarcinoma ya tubular yosiyana bwino, pT1a/M, ULO, Ly0, VO, HMO, VMO
adenoma ya m'mimba
◆Mlandu 2
Kufotokozera: Chilonda chokwezeka chokhala ndi timibulu pakhoma lakunja la gawo lapakati la thupi la m'mimba. Gastritis yogwira ntchito imawoneka kumbuyo. Indigo carmine imawoneka ngati malire. (NBI ndi kukula pang'ono)
Matenda: Kuwonekera kwa MUC5AC kunaoneka mu epithelium yapamwamba, ndipo kuonekera kwa MUC6 kunaoneka mu epithelium yapamwamba. Kuzindikira komaliza kunali PGA.
kambiranani
Ma adenoma a m'mimba kwenikweni ndi ma mucinous glands omwe amalowa mu stroma ndipo amaphimbidwa ndi foveolar epithelium. Chifukwa cha kuchuluka kwa ma glandular protrusions, omwe ndi hemispherical kapena nodular, ma adenoma a m'mimba omwe amawonedwa ndi endoscopic white light onse ndi ma nodular ndipo amatuluka. Ndikofunikira kulabadira magulu anayi a Jiu Ming pansi pa endoscopic test. ME-NBI imatha kuwona mawonekedwe a papillary/villous a PGA. PGA si HP negative kwenikweni komanso si atrophic, ndipo ili ndi chiopsezo china cha khansa. Kuzindikira msanga ndi chithandizo choyambirira kumalimbikitsidwa, ndipo mutapeza, active en bloc resection ndi kafukufuku wina watsatanetsatane akulimbikitsidwa.
4) (yofanana ndi rasipiberi) khansa ya m'mimba ya foveolar epithelial
khansa ya m'mimba ya rasiberi foveolar epithelial
◆Mlandu 2
Kufotokozera:(siyidwa)
Kuzindikira (kuphatikiza ndi matenda): khansa ya m'mimba ya foveolar epithelial
khansa ya m'mimba ya rasiberi foveolar epithelial
◆Mlandu 3
Kufotokozera:(siyidwa)
Kuzindikira (kuphatikiza ndi matenda):khansa ya m'mimba ya foveolar epithelial
kambiranani
Rasipiberi, wotchedwa "Tuobai'er" m'mudzi mwathu, ndi chipatso chakuthengo chomwe chimapezeka m'mbali mwa msewu pamene tinali ana. Epithelium ya glandular ndi glands zimalumikizana, koma sizili zofanana. Ndikofunikira kumvetsetsa kukula ndi chitukuko cha maselo a epithelial. Khansa ya m'mimba ya epithelial ya rasipiberi ndi yofanana kwambiri ndi ma polyps am'mimba ndipo imatha kusokonezedwa mosavuta ndi ma polyps am'mimba. Chizindikiro chachikulu cha foveolar epithelium ndi mawonekedwe akuluakulu a MUC5AC. Chifukwa chake foveolar epithelial carcinoma ndi mawu wamba amtunduwu. Ikhoza kukhalapo mu HP negative, positive, kapena pambuyo pa sterilization. Mawonekedwe a Endoscopic: bulge yozungulira yofiira ngati sitiroberi, nthawi zambiri yokhala ndi malire omveka bwino.
5) Khansa ya m'maselo a mphete ya Signet
Khansa ya selo la mphete ya Signet: mawonekedwe oyera a kuwala
Khansa ya selo la mphete ya Signet: mawonekedwe oyera a kuwala
khansa ya m'maselo a mphete ya chizindikiro
◆Mlandu 1
Kufotokozera:Chilonda chathyathyathya pakhoma lakumbuyo kwa khonde la m'mimba, 10 mm, chofooka, mtundu wa O-1Ib, palibe kufooka kumbuyo, malire owoneka poyamba, malire osadziwika bwino akayang'aniridwanso, ME-NBI: gawo lokhalo la pakati pa mphuno limakhala loyera, IMVP(-)IMSP (-)
Kuzindikira (kuphatikiza ndi matenda):Zitsanzo za ESD zimagwiritsidwa ntchito pozindikira khansa ya m'maselo a mphete ya chizindikiro.
Mawonetseredwe a matenda
Khansa ya mphete ya Signet ndiyo mtundu woopsa kwambiri. Malinga ndi gulu la Lauren, khansa ya mphete ya mphete ya m'mimba imagawidwa ngati mtundu wa khansa yofalikira ndipo ndi mtundu wa khansa yosasinthika. Imapezeka nthawi zambiri m'mimba, ndipo imapezeka kwambiri m'zilonda zathyathyathya komanso zolowa m'madzi zokhala ndi mitundu yosiyana. Zilonda zokwezeka zimakhala zochepa kwambiri ndipo zimatha kuonekeranso ngati kukokoloka kapena zilonda. N'zovuta kuzizindikira panthawi yofufuza endoscopic kumayambiriro. Chithandizo chingakhale chochotsa mabala monga endoscopic ESD, ndi kutsatira mosamala pambuyo pa opaleshoni ndikuwunika ngati opaleshoni yowonjezera iyenera kuchitika. Kuchotsa mabala popanda machiritso kuyenera kufunikira opaleshoni yowonjezera, ndipo njira yochitira opaleshoni imasankhidwa ndi dokotala wa opaleshoni.
Chiphunzitso ndi zithunzi zomwe zili pamwambapa zimachokera ku "Mimba ndi Matumbo"
Kuphatikiza apo, chisamaliro chiyenera kuperekedwanso ku khansa ya esophagogastric junction, khansa ya mtima, ndi adenocarcinoma yodziwika bwino yomwe imapezeka mu HP-negative background.
3. Chidule
Lero ndaphunzira chidziwitso chofunikira komanso mawonekedwe a endoscopic a khansa ya m'mimba yopanda HP. Makamaka izi zikuphatikizapo: khansa ya m'mimba ya mtundu wa fundic gland, khansa ya m'mimba ya mtundu wa fundic gland, adenoma ya m'mimba, chotupa cha foveolar epithelial (chofanana ndi rasiberi) ndi khansa ya cell ya signet ring.
Kuchuluka kwa khansa ya m'mimba yopanda HP m'thupi n'kochepa, n'kovuta kuweruza, ndipo n'kosavuta kuphonya matenda. Chovuta kwambiri ndi mawonekedwe a endoscopy a matenda ovuta komanso osowa. Iyeneranso kumvedwa kuchokera ku endoscopy, makamaka chidziwitso cha chiphunzitso chomwe chili kumbuyo kwake.
Ngati mukuyang'ana ma polyps am'mimba, kukokoloka, ndi malo ofiira ndi oyera, muyenera kuganizira za kuthekera kwa khansa ya m'mimba yopanda Hp. Kuweruza kwa HP negative kuyenera kutsatira miyezo, ndipo chisamaliro chiyenera kuperekedwa ku zolakwika zabodza zomwe zimachitika chifukwa chodalira kwambiri zotsatira za mayeso opuma. Madokotala odziwa bwino ntchito ya endoscopist amadalira maso awo kwambiri. Poyang'ana chiphunzitso chatsatanetsatane cha khansa ya m'mimba yopanda HP, tiyenera kupitiriza kuphunzira, kumvetsetsa ndikuchita kuti tidziwe bwino.
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 wa mphuno ya ndulu ndi zina zoterozomwe zimagwiritsidwa ntchito kwambiri muEMR,ESD,ERCP.Zogulitsa 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: Julayi-12-2024