I-Endoscopic inyameko yamathumba e-submucosal yeThuthi yeDict yokugaya: 3 Amanqaku ama-3 amanqaku ashwankathiweyo kwinqaku elinye

I-Submucosal Tumuurs (SMT) yephecana le-gestrointenal zizinto eziphakamileyo zivela kwi-Muscrouse Mucosa, i-Sugucosa, i-ProCulis ProCria, kwaye inokubakho kwezilonda zangaphandle. Ngophuhliso lwetekhnoloji yezonyango, iindlela zonyango zemveli zonyango ziye zangena kancinci ixesha lonyango oluncinci oluncinci, njenge-lutyando lwe-Aparoscopic kunye nonyango lwerobhothi. Nangona kunjalo, kwisenzo sekliniki, inokufunyanwa ukuba "utyando" alifanelekanga kubo bonke abaguli. Kwiminyaka yakutshanje, ixabiso le-Endoscopic ithathele ingqalelo ngokuthe ngcembe. Inguqulelo yakutshanje ye-Chinese Chineses iSivumelwano sokuxilongwa kwe-endoscopic kunye nonyango lwe-SMT lukhutshiwe. Eli nqaku liza kufunda ngokufutshane ulwazi olufanelekileyo.

1.Smt Epidemic Carecteizifundo

(1) Imeko ye-smI-T ayilingani kwiindawo ezahlukeneyo zephecana lokugaya, kwaye isisu sesona ndawo siqhelekileyo se-SMT.

Imeko ye-variouIinxalenye zephecana lokugaya alilingani, kunye nephecana eliphezulu lokugaya lixhaphake ngakumbi. Kwezi, 2/3 zenzeka esiswini, elandelwa ngu-Esophagus, Duodenum, kunye noColon.

(2) I-HidtoptoloLogitaIindidi ze-SMT zintsonkothile, kodwa uninzi lwe-SMT luzincama izilonda, kwaye zimbalwa kuphela ezinamandla.

A.SMT ibandakanyaI-N-Neoplastic izilonda ezinje nge-ectopic tisceric tishu kunye ne-neopistic lesions.

B.among i-neoplastic lesshonS, i-gastrointentinal leomyomas, i-lipomas, i-Brucellasa Adonosa, i-SchwaSnosa iselfowuni, kunye ne-tumumper zeselfowuni, kwaye zingaphantsi kwe-15% zinokuvela njengezicubu zifunda ububi.

I-C.gastrointenal stromaI-L TIMIRS (GIT) kunye ne-Neuroendorne Tumors (NET) kwi-SMT ngamathungo anokubakho okuthile, kodwa oku kuxhomekeke kubungakanani bayo, indawo kunye nohlobo.

D.I-SMT ihambelanaKwindawo yokuhlelwa kwendalo: a. I-Leiomymas iluhlobo oluqhelekileyo lwe-tsophagus, i-accounting i-60% ukuya kwi-80% ye-smts ye-esophageal, kwaye kunokwenzeka ukuba zenzeke kumacandelo ase-Esophagus; I-B.Indidi-ntlobo ze-guricric smt zintsonkothileyo, nge-gin, leomyoI-MA kunye ne-ectopic pancreas yeyona ixhaphakileyo. Phakathi kwe-Gastric SMT, i-Git idla ngokufumaneka kwi-cussus kunye nomzimba wesisu, uLeomyma uhlala esikhona kwi-Cardia kunye ne-Carpic Pancreas kunye ne-ectopic pancreas exhaphakileyo. I-Lipomas ixhaphake kakhulu kwi-antrum ye-gastric; c. I-Lipos kunye ne-cysts zixhaphake kakhulu ekwehweni nasezintlungwini ze-duedonum; d. Kwi-SMT yephecana elisezantsi le-gestrointenal, i-lipomas iphambili kwi-colon, ngelixa iminatha iphambili kwi-rectum.

(3) Sebenzisa i-CT kunye ne-MRI ukuya kwiBanga, phatha, kwaye uvavanye amathumba. Nge-smts ekrokrelwa ukuba inokwenzeka okanye ibe namathumba amakhulu (ixesha elideUbubanzi> 2 cm), i-CT kunye neMRI iyacetyiswa.

Ezinye iindlela ezicinga, kubandakanya i-CT ne-MRI, zibaluleke kakhulu ekufumanekeni kwesifo se-SMT. Banokubonisa ngokuthe ngqo indawo yokwenzeka kwe-tumor, iphethini yokukhula, ubungakanani bemibuzo, ubume, ubukho, i-homogenity, isidanga, kwaye sinokufumana i-cerickUkuphuma kodonga lwe-gastrointentinal.Mold ngokubonakalayo, le mviwo ingcinga inokufumana ukuba kukho uhlaselo lwezakhiwo ezikufuphi nesikhonkwane, nokuba kukho i-metastasis kwi-peritones, i-lymph node kunye namanye amalungu. Yindlela ephambili yokuhlela kweklinikhi, unyango kunye novavanyo lokuqinisa amathumba.

(4) Isampulu yezicubu ayichaphazeliI-MMETED YOKUGQIBELA YOKUGQIBELA Enokufunyaniswa yi-Endoscopy ehlanganisiweyo kunye ne-EUS, njenge-EUPS, njengeLipomas, kunye ne-encreas.

Izilonda ekrokrelwa ukuba zizinyanya okanye xa i-Endoscopy ehlanganisiweyo idityaniswa ne-EUS ayinakuvavanya izilonda ze-EUS okanye izilonda ze-EUs, i-biopsy ekhokelayo / i-biopsy enqununuI-Eeedle Aspition / Biopsy, i-EUS-FNA / FNB), i-MUCOSY I-MUCOSY I-BIOPSY (MUCOSAL I-MUCOSY (MUCOSAL I-MUCOSY (MUCOSASICE), njly. Ngenxa yokusikelwa umda kwe-EUS-FNA kunye nefuthe elilandelayo kwi-Endoscopic, kwabo bafanelekileyo kwiToscopic utyando, kwiTekhi leTekhnoloji ye-Endoscopic eNyokoyini

Nayo nayiphi na indlela yokufumana iisampulu ze-pathowogical ngaphambi kokuba ihlaselwe kwaye iyakonakalisa i-MUCOSA okanye ibangele ukuba ubunzima bokwanda kwe-submucosal, ngaloo ndlela kunyusa ubunzima bokwaphuka, i-PERFOukusasazwa, kunye nokusasazwa kwe-tumor. Ke ngoko, i-bioPSy ye-bioPSy ayimfuneko. Kuyimfuneko, ngakumbi ii-SMT ezinokufunyanwa zidityaniswa nge-eussoscopy edityaniswe ne-EUs, ezinjengeLipomas, i-cysts, kunye nesampulu ye-ercric, akukho sampulu ye-tissic, akukho sampululi ye-esculac, akukho sampululi ye-escreas, akukho sisa-samisi se-tissie siyimfuneko.

2.SSMT Endoscopicnt

(1) Imigaqo-nkqubo yoNyango

Izilonda ezingenayo i-lymph node i-metastasis okanye umngcipheko kakhulu we-lymph node metastasis, kwaye zinokusetyenziswa ngokupheleleyo kusetyenziswa iindlela ze-endoscopic, kwaye iphinda iphinde isebenze kwi-endoscopic rection ukuba imfuneko. Ukususwa ngokupheleleyo kwethumba inciphisa i-tumor yentsalela kunye nomngcipheko wokuphinda uqalise kwakhona. IUmgaqo-nkqubo we-Tumor-free kufuneka ulandelwe ngexesha lokuqhubela phambili kwe-gososcopic, kwaye ukuthembeka kwe-turu crule kufuneka kuqinisekiswe ngexesha lokufika.

(2) Izalathiso

I.Umurumbars enamachaphaza amanqam ekrokrelwa ngoviwo lokwanela okanye oluqinisekiswe yi-biopsy pathology, ngakumbi abo bakrokrelweyo be-GII-St ngovavanyo lokukhetha ubude be-tuyolor kunye nomngcipheko ophantsi wokuphinda-phinda kunye ne-metastasis, kunye nokuba kunokwenzeka ukuba kuphinde kwesenzi, kunokubathwa ngocoselelo; I-tumuber ene-diameter ende ye-Gint esengozini ephantsi >> ukutshata.

II. Uphawu (umz. Ukopha, ukuthintela) i-SMT.

I-III.PIRTURS AMANQAKU E-III ZESIBINI I-IIIKELWE UKUZE UBELWE NGU-BHAKICHE UVIWO LOKWENZA OLUFANELEKILEYO OKANYE OKUFUNDILEYO, kodwa akakwazi ukulandelwa rhoqo okanye amathumba awo anda ngexesha lokulandelaI-e ye-endoscopic.

(3) Ukuphikisana

i. Chonga izilonda ezinamI-Testas kwi-lymph node okanye iindawo ezikude.

II. Yenye i-smt nge-lymph ecacileyonodeokanye i-metastasis ekude, i-bulk biopsy iyafuneka ukuba ifumane i-pathology, enokuthathwa njengento eyamkelweyo.

III. Emva kokuthengisa inkcukachaUvavanyo, kugqitywe ukuba imeko ngokubanzi ihlwempuzekile kwaye utyando lwe-gososcopic akunakwenzeka.

Izilonda ezibonakalayo ezinjengeLipoma kunye ne-ectopic pancreas ngokubanzi azibangeli iimpawu ezinjengeentlungu, ukopha, kunye nokuthintelwa. Xa sI-MT ibonakalisa ukhukuliseko, isilonda, okanye ukunyuka ngokukhawuleza ngexesha elifutshane, kungenzeka ukuba i-lesion yonyuka.

(4) Ukukhetha iindlela zokuqalad

I-Endoscopic DayetionI-SMT ebalaseleyo, ixhasa i-cavity njengoko kumiselwe kukuthintelwa kweemviwo ze-EUs ze-EUs kunye ne-CT, kwaye zinokutsha kwakhona ngaxeshanye kunye nomgibe, i-endoscopic tion isetyenzisiwe.

Izifundo zasekhaya nezangaphandle ziqinisekisile ukuba zikhuselekile kwaye ziyasebenza kwi-SMT FOST <2cm, ngomngcipheko we-4% ukuya kwi-13% kunye nokungahambi kakuhleUmngcipheko we-2% ukuya kwi-70%.

I-Endoscopic Submucosal Ukumbiwa, i-ESE: yeSMTS nge-SMTER ngeDiameter ye-DMETter okanye ukuba i-PM i-ofisi yengcinga ye-PM okanye i-PerOpering VM okanye i-EUPOEPE YEMICIMBIWEYO EYENZIWA NGE-EUS NE-CT uqinisekiseKwi-tumar protrudes kwi-cavity, i-ese inokwenzeka kwi-Endoscopic Sleeve yeSMTS.

Ese ngokulandela imikhwa yezobugcisa yeI-Endoscopic Submucosal Dissasation (i-ESD) kunye ne-Endoscopic Mucosal Repos, kwaye isebenzisa rhoqo i-tumation "i-Flip-Top" i-Inder Tumosa isuse i-MUCOSA igubungela i-MUCOSA egubungela i-MUCOS. , ukufezekisa injongo yokugcina ingqibelelo yethumba, ukuphucula ubuchwephesha botyando, kunye nokucutha iingxaki zobume. I-tumurs ≤1.5 cm, ireyithi yokuphela kwe-100% inokufezekiswa.

I-Submucosal Toscopic reseI-ion, i-Ster: ye-SMT iqala kwi-procria ye-muscrougus, i-hilum, i-curvature yomzimba, i-custric and cervatus, i-tectum, i-readric, i-DM, i-STE inokuba yindlela ekhethiweyo yonyango.

I-Ster yitekhnoloji entsha ephuhliswe ngokusekwe kwi-Peroral Osophagebal Sphincterotomy (i-poem) kwaye yindawo eyandisiweyo yeTekhnoloji ye-ESDI-nology. Izinga le-en Bloc Reciection Reting ye-STR yonyango lwe-SMT lifikelela kwi-84.9% ukuya kwi-97.59%.

I-Endoscopic egcweleyoI-ion, i-EFTR: Inokusetyenziselwa i-SMT apho kunzima ukuyimisela umjelo okanye apho ububanzi be-turumeter ye-tumames yi-tumameter yi-tumament yi-t3.5 cm kwaye ayifanelekanga i-ST. Ukuba i-tumar protruds phantsi kwe-membrane okanye ikhula ngaphandle kwenxalenye ye-cavity, kwaye ithumba lifunyenwe linamathele ngokuqinileyo kwi-serosa ye-serosa ngexesha lotyando kwaye ingasetyenziswa. I-EFTR yenza unyango lwe-endoscopic.

Ukupheliswa okufanelekileyo kokungalungangaIndawo emva kwe-EFFR yeyona nto iphambili kwimpumelelo ye-EFFR. Ukwenzela ukuvavanya ngokuchanekileyo umngcipheko wokuphinda-phinda kwaye unciphise umngcipheko wokutshatyalaliswa kwe-tumor, akucetyiswa ukusika kwaye ususe i-tumamen ye-tumamen ngexesha le-EFTR. Ukuba kuyimfuneko ukususa ithumba le-turumus, ukungafezeki kufuneka kulungiswe kuqala ukunciphisa umngcipheko wokutyibilika nokusasazeka. Ezinye iindlela zokutsalela zibandakanya: I-Clip Slip Scuture, Clip Scrept Sutt Pouture, "Indlela ye-Poight Patch" ye-ranges ye-pip ye-nylon idityaniswe ne-biptions, i-rake i-rake ye-nylon edibene ne-biptroure kunye nenye itekhnoloji ye-nyp.

(5) Iingxaki zeposi

I-intraoperaperation yopha: ukopha oko kubangela ukuba i-hemoglobin yesigulana ihlise ngaphezulu kwe-20 g / l.
Ukuthintela ukopha okukhulu kwegazi,Inaliti eyaneleyo ye-submucosal kufuneka yenziwe ngexesha lokusebenzisa imithambo yegazi enkulu kwaye iququzelele i-elektroccooducoloadication ukumisa ukopha. I-intraoperation Yophangezwe inokunyangwa ngeempeni ezinobungozi, i-hestical forbatic okanye izikripthi zensimbi, kwaye iziqendu ze-tenalive ze-temonasis yegazi efunyenwe ngexesha lenkqubo yokungahambi.

I-Pobstoperaperatity Enxaoling: Ukuvela kwendawo kobulala phakathi kokugabha igazi, uMelena, okanye igazi kwisitulo. Kwiimeko ezinzima, ukothuka kwe-hemorrhagic kunokwenzeka. Kakhulu senzeka kwiveki e-1 emva kotyando, kodwa inokwenzeka nakwiiveki ezi-2 emva kotyando.

I-Postoperaperative yobutsha ihlala inxulumene nayoIzinto ezifana nokungasebenzi kakuhle kulawulo lwegazi loxinzelelo lwegazi kunye nokususwa kwemithambo yegazi yegazi yi-Gastric Acid. Ukongeza, ukopha iposti ihambelana nendawo esi sifo, kwaye kuxhaphake kakhulu kwi-antrum ye-gastric and rectum.

Ukulibaziseka kwe-Artfocations: Ngokwesiqhelo bonakalisa ukungahlambuluki kwesisu, ukubulala isisu, imiqondiso ye-peritonitis, umkhuhlane, kunye nokuvavanya kubonisa ukuqokelelwa kwegesi okanye ukwanda kokuqokelelwa kwegesi xa kuthelekiswa nawo ngaphambili.

Inxulumene kakhulu nezinto ezifana nokuthuka amanxeba, i-electrocooducal egqithisileyo, ukuvuka kakhulu ukuze ujikeleze, ukutya iswekile, kunye nokukhukulisa amanxeba nge-gestric acid. a. Ukuba inxeba likhulu okanye linzulu okanye inxeba liyifayileNgokuqinisekileyo-njengotshintsho, ixesha lokuphumla kwebhedi kunye nexesha lokutya kufuneka lidluliselwe ngokufanelekileyo kunye ne-gestrointerinal decofatal yenziwa emva kotyando (izigulana emva kotyando olusezantsi lwe-gestrointentinal kufuneka zinemitha ye-anal can); b. Izigulana zesifo seswekile kufuneka zilawule ngokungqongqo iswekile yazo yegazi; Abo baneento ezincinci kunye nosulelo olusesigulweni kunye nosulelo lwesisu kufuneka banikwe unyango olunjengokuzila ukutya, ukunyanzelwa, kunye nokucinezelwa kwe-acid; c. Kwabo banomtsalane, i-cheage evaliweyo kunye nokuphononongwa kwesisu kunokwenziwa iityhubhu kufuneka zibekwe ukugcina i-drainage egudileyo; d. Ukuba usulelo alunakubakho lwasekhaya emva konyango oluqinileyo okanye ludityaniswa nosulelo oluphambili, i-sugocical laparoscopy kufuneka yenziwe ngokukhawuleza, kwaye ukulungiswa okuthe tye kufuneka kwenziwe.

Ukuhambelana ngokunxulumene negesi: kubandakanya i-subcutaI-neaus Amphymema, i-PneumomedinastInum, pneumothorax kunye ne-pneumoritoneum.

I-Intraopeed ImfyseAous Emphysema (eboniswe njenge-EMPHYEMA ebusweni, entanyeni, udonga lwesifuba, kunye ne-scrotum) kunye ne-Protum) kunye nePneatinal pneumophyma (sUkuphila kwe-Epiglottis kunokufumaneka ngexesha le-Gastroscopy) ngesiqhelo alifuni ukuba unyango olukhethekileyo, kwaye i-EMFCYSEMA iya kuzimisela ngokwakho.

I-Pneumothorax yenzekaUnyango lwe-Unyango

(1mmhgI-Ivage.

Kwizigulana ezinepneumoperaperitonogum ebonakalayo ngexesha lokusebenza, sebenzisa inaliti ye-Pneumoperitooneoneum ukubeka i-McFArland PointKwisisu esisezantsi esisezantsi sokulahla umoya, kwaye ushiye inaliti yenzwane kwindawo de kube sekupheleni komsebenzi, emva koko uyisuse emva kokukhuphela irhasi ekhutshiweyo.

I-gestrointentinal fistila: i-Gignity fluid ebangelwa ngu-Endoscopic utyando oluhamba esifubeni okanye isisu ngokuvuza.
I-EsophagegeAl Ficistal Fistinal Fistais kunye ne-Esophagoric Fistais ziqhelekile. Nje ukuba i-fistila yenzeka, yenza i-cloinage yesifuba esivaliweyo kwi-Maintakwi-drainage egudileyo kwaye unike inkxaso eyaneleyo yesondlo. Ukuba kukho imfuneko, iiklip zensimbi kunye nezixhobo ezahlukeneyo zokuvala zinokusetyenziswa, okanye isigqubuthelo esipheleleyo sinokuphinda sisebenze kwakhona. Izixa kunye nezinye iindlela zisetyenziselwa ukuvimba ifistila. Amatyala amakhulu afuna ungenelelo lotyando ngokukhawuleza.

Ulawulo lwe-TI-ORD-up)

(1) Izilonda ezibonakalayo:I-pathology sIimbuzane ezingena kwizilonda ezifana ne-lipoma kunye ne-leomyma ayifuni kunyanzeliswa.

(2) SMT ngaphandle kwe-MalignAmandla akhomba:Umzekelo, umnatha we-tecal 2cm, kunye ne-gin ephakathi kwaye inobungozi obuphezulu, isitali esipheleleyo kufuneka senziwe kwaye unyango olongezelelweyo (utyando olongezelelweyo (utyando, unyango olujolise ngokuqinileyo. phatha). Ukuqulunqwa kwesicwangciso kufuneka kusekwe kwi-themidiscliiscipliisciations kunye nomntu ngamnye.

(3) I-SMT ephantsi ephantsi ye-SMT:Umzekelo, i-gist yomngcipheko ophantsi kufuneka ivavanywe yi-EUS okanye icinge qho kwiinyanga ezi-6 ukuya kwezi-12 emva konyango, emva koko inyangwe ngokwemiyalelo yekliniki.

(4) I-SMT kunye namandla aphakathi kunye aphezulu:Ukuba i-Pottopeloperativelwano iqinisekisa i-Test 3 ye-Gastric Net, i-Coorement inobude> I-2cm, kunye ne-Gint ePhakamileyo, i-sumoradiody, i-Chemoradiotherapy, iChemoradiotherapy, i-chemoradiotherapy, i-chemoradiotherapy ithathelwe ingqalelo. phatha). Ukuqulunqwa kwesicwangciso kufuneka kusekwe kwi[Malunga ne-0118.docx] I-PropedisCIight Dissations kunye nomntu ngamnye.