Pakati pa chidziwitso chodziwika bwino chokhudza khansa ya m'mimba yoyambirira, pali mfundo zina zodziwika bwino za matenda zomwe zimafunikira chidwi komanso kuphunzira.Chimodzi mwa izo ndi khansa ya m'mimba ya HP.Lingaliro la "zotupa za epithelial zopanda kachilombo" tsopano ndi lodziwika kwambiri.Padzakhala maganizo osiyanasiyana pa nkhani ya dzina.Chiphunzitso ichi chimachokera ku zomwe zili m'magazini "M'mimba ndi M'mimba", ndipo dzinali limagwiritsanso ntchito "khansa ya m'mimba ya HP-negative".
Zilonda zamtunduwu zimakhala ndi zizindikiro zochepa, zovuta kuzizindikiritsa, chidziwitso chovuta cha chiphunzitso, ndi njira yosavuta ya MESDA-G sikugwira ntchito.Kuphunzira chidziwitso kumafuna kuthana ndi zovuta.
1. Chidziwitso choyambirira cha khansa ya m'mimba ya HP-negative
Mbiri
M'mbuyomu, ankakhulupirira kuti wopalamula limodzi mu zochitika ndi chitukuko cha khansa chapamimba anali HP matenda, kotero tingachipeze powerenga khansa chitsanzo HP - atrophy - m`mimba metaplasia - otsika chotupa - mkulu chotupa - khansa.Chitsanzo chachikale nthawi zonse chakhala chodziwika bwino, chovomerezeka komanso chotsimikizika.Zotupa kukhala pamodzi pa maziko a atrophy ndi pansi zochita za HP, kotero khansa makamaka kukula mu atrophic m`mimba thirakiti ndi zochepa yachibadwa sanali atrophic chapamimba mucosa.
Pambuyo pake, madokotala ena adapeza kuti khansa ya m'mimba imatha kuchitika ngakhale palibe matenda a HP.Ngakhale kuti chiwerengero cha zochitika ndizochepa kwambiri, n'zothekadi.Khansa ya m'mimba yamtunduwu imatchedwa HP-negative gastric cancer.
Ndi kumvetsetsa kwapang'onopang'ono kwa matenda amtunduwu, kuyang'ana mozama mwadongosolo ndi mwachidule zayamba, ndipo mayina akusintha nthawi zonse.Panali nkhani mu 2012 yotchedwa "Cancer Gastric After Sterilization", nkhani mu 2014 yotchedwa "HP-negative Gastric Cancer", komanso nkhani mu 2020 yotchedwa "Epithelial Tumors Not Infected with Hp".Kusintha kwa dzina kukuwonetsa kumvetsetsa kozama komanso kokwanira.
Mitundu ya Gland ndi Njira Zakukulira
Pali mitundu iwiri ikuluikulu ya tiziwalo timene timatulutsa timadzi ta pyloric m'mimba:
Fundic glands (oxyntic glands) amagawidwa mu fundus, thupi, ngodya, ndi zina zotero za m'mimba.Ndi zowawa za tubular zozungulira.Amapangidwa ndi maselo a mucous, maselo akuluakulu, maselo a parietal ndi maselo a endocrine, omwe amagwira ntchito zawo.Pakati pawo, maselo akuluakulu Madontho obisika a PGI ndi MUC6 anali abwino, ndipo maselo a parietal amatulutsa hydrochloric acid ndi intrinsic factor;
Zilonda za pyloric zili m'dera la m'mimba ndipo zimakhala ndi maselo a ntchentche ndi maselo a endocrine.Maselo a ntchentche ali ndi MUC6 zabwino, ndipo maselo a endocrine amaphatikizapo ma cell a G, D ndi ma cell a enterochromaffin.Maselo a G amatulutsa gastrin, D maselo amatulutsa somatostatin, ndipo maselo a enterochromaffin amatulutsa 5-HT.
Normal chapamimba mucosal maselo ndi chotupa maselo amatulutsa zosiyanasiyana mitundu yosiyanasiyana ya ntchofu mapuloteni, amene anawagawa "chapamimba", "m'mimba" ndi "osakaniza" ntchofu mapuloteni.Mawu a m'mimba ndi matumbo mucins amatchedwa phenotype osati enieni anatomical malo m'mimba ndi matumbo.
Pali ma cell phenotypes a zotupa zam'mimba: chapamimba kwathunthu, chapamimba chachikulu chosakanikirana, chosakanikirana ndi matumbo, komanso m'mimba kwathunthu.Zotupa zimene zimachitika pamaziko a m`matumbo metaplasia makamaka m`mimba osakaniza phenotype zotupa.Makhansa osiyana makamaka amawonetsa mtundu wa m'matumbo (MUC2+), ndipo khansa yofalikira imawonetsa mtundu wa m'mimba (MUC5AC+, MUC6+).
Kuzindikira kuti Hp alibe kumafuna kuphatikizika kwapadera kwa njira zingapo zodziwira kuti mutsimikizire momveka bwino.Khansara ya m'mimba ya HP-negative ndi khansa ya m'mimba ya post-sterilization ndi malingaliro awiri osiyana.Kuti mudziwe zambiri za mawonetseredwe a X-ray a khansa ya m'mimba ya HP, chonde onani gawo loyenera la magazini ya "M'mimba ndi M'mimba".
2. Mawonetseredwe a Endoscopic a khansa ya m'mimba ya HP-negative
Endoscopic matenda ndiye cholinga cha khansa ya m'mimba ya HP-negative.Makamaka zikuphatikizapo fundic gland mtundu chapamimba khansa, fundic gland mucosal mtundu chapamimba khansa, chapamimba adenoma, rasipiberi foveolar epithelial chotupa, chizindikiro mphete cell carcinoma, etc. Nkhaniyi ikufotokoza za endoscopic mawonetseredwe a khansa chapamimba HP-negative.
1) Fundi gland khansa ya m'mimba
-Zotupa zoyera zokwezeka
fundic gland mtundu wa khansa ya m'mimba
◆Mlandu 1: Zoyera zoyera, zokwezeka
Kufotokozera:Gastric fundic fornix-kupindika kwakukulu kwa cardia, 10 mm, yoyera, mtundu wa O-lia (SMT-ngati), wopanda atrophy kapena metaplasia yamatumbo kumbuyo.Mitsempha yamagazi ngati Arbor imatha kuwoneka pamtunda (NBI ndikukulitsa pang'ono)
Kuzindikira (kuphatikiza ndi pathology):U, O-1la, 9mm, fundic gland mtundu wa khansa ya m'mimba, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Zotupa zoyera
fundic gland mtundu wa khansa ya m'mimba
◆Mlandu 2: Zoyera, zotupa / zopsinjika maganizo
Kufotokozera:Khoma lakutsogolo la gastric fundic fornix-cardia kupindika kwakukulu, 14 mm, loyera, mtundu wa 0-1lc, wopanda atrophy kapena metaplasia yamatumbo kumbuyo, malire osadziwika bwino, ndi mitsempha yamagazi ya dendritic yomwe imawoneka pamwamba.(NBI ndi kukulitsa chidule)
Kuzindikira (kuphatikiza ndi pathology):U, 0-Ilc, 14mm, fundic gland mtundu wa khansa ya m'mimba, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Zotupa zofiira
fundic gland mtundu wa khansa ya m'mimba
◆ Mlandu wa 3: Zilonda zofiira ndi zokwezeka
Kufotokozera:Khoma lakutsogolo la kupindika kwakukulu kwa cardia ndi 12 mm, mwachiwonekere wofiira, mtundu wa 0-1, wopanda atrophy kapena metaplasia yamatumbo kumbuyo, malire omveka bwino, ndi mitsempha yamagazi ya dendritic pamwamba (NBI ndi kukulitsa pang'ono)
Kuzindikira (kuphatikiza ndi pathology):U, 0-1, 12mm, fundic gland mtundu wa khansa ya m'mimba, pT1b/SM1 (200μm), ULO, LYO, VO, HMO, VMO
-Zofiyira, zosalala, zopsinjikas
fundic gland mtundu wa khansa ya m'mimba
◆ Mlandu wa 4: Zilonda zofiira, zowonongeka / zowonongeka
Kufotokozera:Khoma lakumbuyo la kupindika kwakukulu kumtunda kwa chapamimba thupi, 18mm, ofiira owala, mtundu wa O-1Ic, palibe atrophy kapena metaplasia yamatumbo kumbuyo, malire osadziwika bwino, palibe mitsempha yamagazi ya dendritic pamtunda, (NBI ndi kukulitsa sikunasiyidwe). )
Kuzindikira (kuphatikiza ndi pathology):U, O-1lc, 19mm, fundic gland type gastric cancer, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
kambiranani
Amuna omwe ali ndi matendawa ndi aakulu kuposa akazi, ndipo zaka zambiri zimakhala zaka 67.7.Chifukwa cha mawonekedwe anthawi imodzi ndi heterochrony, odwala omwe ali ndi khansa yapamimba ya fundic gland ayenera kuwunikiridwa kamodzi pachaka.Malo odziwika kwambiri ndi malo a fundic gland pakati ndi kumtunda kwa m'mimba (fundus ndi gawo lapakati ndi lapamwamba la m'mimba).Zotupa zowoneka ngati zoyera za SMT ndizofala kwambiri pakuwala koyera.Chithandizo chachikulu ndi matenda a EMR/ESD.
Palibe ma lymphatic metastasis kapena vascular invasion yomwe yawonedwa mpaka pano.Pambuyo pa chithandizo, m'pofunika kudziwa ngati mukuchita opaleshoni yowonjezera ndikuwunika mgwirizano pakati pa mkhalidwe woipa ndi HP.Sikuti mitundu yonse ya khansa ya m'mimba ya fundic yomwe ili ndi HP negative.
1) Fundic gland mucosal chapamimba khansa
Fundic gland mucosal gastric cancer
◆ Mlandu 1
Kufotokozera:Chotupacho chimakwezedwa pang'ono, ndipo RAC non-atrophic gastric mucosa imatha kuwoneka mozungulira.Kusintha kwachangu kwa ma microstructure ndi ma microvessel amatha kuwoneka mu gawo lokwezeka la ME-NBI, ndipo DL imatha kuwoneka.
Kuzindikira (kuphatikiza ndi pathology):Fundic gland mucosal gastric cancer, U zone, 0-1la, 47 * 32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Fundic gland mucosal gastric cancer
◆Mlandu 2
Kufotokozera: Chotupa chathyathyathya pakhoma lakumbuyo la chopindika chocheperako cha cardia, chokhala ndi mabala osakanikirana ndi ofiira, mitsempha yamagazi ya dendritic imatha kuwoneka pamwamba, ndipo chotupacho chimakwezedwa pang'ono.
Kuzindikira (kuphatikiza ndi pathology): Fundic gland mucosal gastric cancer, 0-lla, pT1a/M, ULO, LyOV0,HM0,VMO
kambiranani
Dzina la "gastric gland mucosal adenocarcinoma" ndilovuta kutchula, ndipo chiwerengero cha zochitika ndizochepa kwambiri.Pamafunika khama lowonjezereka kuti muzindikire ndi kulimvetsa.Fundic gland mucosal adenocarcinoma ili ndi mawonekedwe owopsa kwambiri.
Pali zinthu zinayi zazikuluzikulu za endoscope ya kuwala koyera: ① zotupa za homochromatic-zinazimiririka;② chotupa cha subpithelial SMT;③ dilated dendritic mitsempha;④ zigawo zazing'ono.Kuchita kwa ME: DL(+)IMVP(+)IMSP(+)MCE imakulitsa IP ndikuwonjezeka.Pogwiritsa ntchito njira yolimbikitsira ya MESDA-G, 90% ya khansa ya m'mimba ya fundic gland mucosal imakwaniritsa njira zowunikira.
3) Gastric adenoma (pyloric gland adenoma PGA)
m'mimba adenoma
◆ Mlandu 1
Kufotokozera:Chotupa choyera chathyathyathya chinawoneka pakhoma lakumbuyo la m'mimba fornix ndi malire osadziwika bwino.Kupaka utoto wa Indigo carmine sikunawonetse malire omveka bwino, ndipo mawonekedwe a LST-G a matumbo akulu adawoneka (atakulitsidwa pang'ono).
Kuzindikira (kuphatikiza ndi pathology):low atypia carcinoma, O-1la, 47 * 32mm, adenocarcinoma yodziwika bwino, pT1a/M, ULO, Ly0, VO, HMO, VMO
m'mimba adenoma
◆Mlandu 2
Kufotokozera: Kutupa kokwezeka kokhala ndi tinatake tozungulira pakhoma lakutsogolo la gawo lapakati pamimba.Yogwira gastritis Tingaone chapansipansi.Indigo carmine imatha kuwoneka ngati malire.(NBI ndi kukulitsa pang'ono)
Matenda: Mawu a MUC5AC adawonedwa mu epithelium yapamwamba, ndipo mawu a MUC6 adawonedwa mu epithelium yapamwamba.Matenda omaliza anali PGA.
kambiranani
Gastric adenomas kwenikweni ndi tiziwalo timene timatulutsa timadzi tomwe timalowa mu stroma ndikukutidwa ndi foveolar epithelium.Chifukwa cha kuchuluka kwa ma glandular protrusions, omwe amakhala a hemispherical kapena nodular, adenomas am'mimba omwe amawonedwa ndi kuwala koyera kwa endoscopic onse amakhala ozungulira komanso otuluka.Ndikofunikira kulabadira magulu 4 a Jiu Ming poyesedwa endoscopic.ME-NBI imatha kuwona mawonekedwe a papillary/woyipa a PGA.PGA si mwamtheradi HP zoipa ndi sanali atrophic, ndipo ali pachiwopsezo cha khansa.Kuzindikira koyambirira ndi chithandizo chamankhwala msanga kumalimbikitsidwa, ndipo pambuyo pozindikira, kutulutsa mwachangu kwa en bloc ndi kuphunzira mwatsatanetsatane kumalimbikitsidwa.
4) (ngati rasipiberi) foveolar epithelial khansa ya m'mimba
rasipiberi foveolar epithelial chapamimba khansa
◆Mlandu 2
Kufotokozera:(yosiyidwa)
Kuzindikira (kuphatikiza ndi pathology): khansa ya m'mimba ya foveolar epithelial
rasipiberi foveolar epithelial chapamimba khansa
◆Mlandu 3
Kufotokozera:(yosiyidwa)
Kuzindikira (kuphatikiza ndi pathology):foveolar epithelial khansa ya m'mimba
kambiranani
Rasipiberi, wotchedwa "Tuobai'er" m'mudzi mwathu, ndi chipatso chakutchire m'mphepete mwa msewu pamene tinali ana.Epithelium ya glandular ndi glands zimalumikizidwa, koma sizili zofanana.Ndikofunika kumvetsetsa kukula ndi kukula kwa maselo a epithelial.Rasipiberi epithelial khansa ya m'mimba ndi yofanana kwambiri ndi ma polyps a m'mimba ndipo amatha kuganiziridwa molakwika ngati ma polyps am'mimba.Chodziwika bwino cha foveolar epithelium ndikuwonetsa kwakukulu kwa MUC5AC.Choncho foveolar epithelial carcinoma ndi mawu ambiri a mtundu uwu.Itha kukhalapo mu HP negative, positive, kapena pambuyo potseketsa.Maonekedwe a Endoscopic: chozungulira chofiira chofiira ngati sitiroberi, nthawi zambiri chokhala ndi malire omveka bwino.
5) Chizindikiro cha mphete cell carcinoma
Sigineti mphete cell carcinoma: kuwala koyera mawonekedwe
Sigineti mphete cell carcinoma: kuwala koyera mawonekedwe
chizindikiro cha mphete cell carcinoma
◆ Mlandu 1
Kufotokozera:Chotupa chathyathyathya pakhoma lakumbuyo la chipinda chapamimba, 10 mm, chinazimiririka, mtundu wa O-1Ib, palibe atrophy kumbuyo, malire owonekera poyamba, malire osadziwika poyang'ananso, ME-NBI: gawo lokhalo la interfoveal limakhala loyera, IMVP (-) MSP (-)
Kuzindikira (kuphatikiza ndi pathology):Zitsanzo za ESD zimagwiritsidwa ntchito pozindikira signet ring cell carcinoma.
Mawonekedwe a pathological
Sigineti ring cell carcinoma ndi mtundu wowopsa kwambiri.Malinga ndi gulu la Lauren, gastric signet ring cell carcinoma imagawidwa ngati mtundu wa carcinoma ndipo ndi mtundu wa carcinoma wosadziwika.Nthawi zambiri amapezeka m'mimba, ndipo amapezeka m'mabala athyathyathya komanso omira ndi ma toni osinthika.Zilonda zokulirapo ndizosowa kwambiri ndipo zimatha kuwoneka ngati kukokoloka kapena zilonda.Ndizovuta kuzindikira pakuwunika kwa endoscopic koyambirira.Kuchiza kumatha kukhala kuchiritsa kwapang'onopang'ono monga endoscopic ESD, ndikutsata mosamalitsa pambuyo pa opaleshoni ndikuwunika ngati angachite opaleshoni yowonjezera.Kuchotsa osachiritsika kuyenera kuchitidwa opaleshoni yowonjezera, ndipo njira ya opaleshoni imasankhidwa ndi dokotala wa opaleshoni.
Chiphunzitso ndi zithunzi zomwe zili pamwambapa zimachokera ku "M'mimba ndi M'mimba"
Kuphatikiza apo, chidwi chiyenera kuperekedwanso ku khansa ya esophagogastric junction, khansa ya cardia, ndi adenocarcinoma yodziwika bwino yomwe imapezeka mu HP-negative background.
3. Mwachidule
Lero ndaphunzira chidziwitso chofunikira komanso mawonetsedwe a endoscopic a khansa ya m'mimba ya HP-negative.Zimaphatikizapo: fundic gland mtundu wa khansa ya m'mimba, fundic gland mucosal mtundu wa khansa ya m'mimba, gastric adenoma, (raspberry-like) foveolar epithelial chotupa ndi signet ring cell carcinoma.
Matenda a khansa ya m'mimba ya HP-negative ndi yochepa, ndizovuta kuweruza, ndipo n'zosavuta kuphonya matenda.Chomwe chimakhala chovuta kwambiri ndi mawonekedwe a endoscopic a matenda ovuta komanso osowa.Iyeneranso kumveka kuchokera kumalingaliro a endoscopic, makamaka chidziwitso chamalingaliro kumbuyo kwake.
Mukayang'ana chapamimba polyps, kukokoloka, ndi madera ofiira ndi oyera, muyenera kuganizira kuthekera kwa Hp-negative chapamimba khansa.Chigamulo cha HP chopanda pake chiyenera kutsatizana ndi miyezo, ndipo chidwi chiyenera kuperekedwa ku zolakwika zabodza zomwe zimadza chifukwa chodalira kwambiri zotsatira zoyesa mpweya.Odziwa endoscopists amakhulupirira maso awo kwambiri.Poyang'anizana ndi chiphunzitso chatsatanetsatane cha khansa ya m'mimba ya HP-negative, tiyenera kupitiliza kuphunzira, kumvetsetsa ndikuchita kuti tidziwe bwino.
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Nthawi yotumiza: Jul-12-2024