Iipolyps zekholoni zizifo eziqhelekileyo nezihlala zenzeka kwi-gastroenterology. Zibhekisa kwiiprotrusions zangaphakathi eziphezulu kune-mucosa yamathumbu. Ngokubanzi, i-colonoscopy inezinga lokufunyaniswa okungenani eli-10% ukuya kwi-15%. Izinga lokuvela kwesifo lidla ngokwanda ngokukhula. Ekubeni ngaphezulu kwe-90% yomhlaza we-colorectal ibangelwa kukuguquka okunobuthi kweepolyps, unyango oluqhelekileyo kukwenza i-endoscopic resection ngokukhawuleza nje ukuba iipolyps zibonwe.
Kwi-colonoscopy yemihla ngemihla, i-80% ukuya kwi-90% yee-polyps zingaphantsi kwe-1 cm. Kwi-adenomatous polyps okanye ii-polyps ezinobude obuyi-≥ 5 mm (nokuba zi-adenomatous okanye azinjalo), kucetyiswa ukususwa kwe-endoscopic resection. Amathuba okuba ii-colon micropolyps (ubude obuyi-≤5mm) eziqulethe izinto ze-tumor aphantsi kakhulu (0~0.6%). Kwi-micropolyps kwi-rectum nakwi-sigmoid colon, ukuba i-endoscopist inokufumanisa ngokuchanekileyo ukuba azizi-polyps ezingezizo eze-adenomatous, akukho mfuneko yokususwa, kodwa le mbono ingasentla ayisetyenziswa rhoqo kwiklinikhi eTshayina.
Ukongeza, i-5% yee-polyps zithe tyaba okanye zikhula ecaleni, zinobubanzi obungaphezulu kwe-2 cm, zine okanye azinazo izinto ezinobungozi. Kule meko, kufuneka ezinye iindlela zokususa ii-polyps eziphucukileyo, ezinjeI-EMRkwayeI-ESDMakhe sijonge amanyathelo aneenkcukacha zokususa iipolyp.
Inkqubo yotyando
Isigulana sigqibe uvavanyo lwe-anesthesia ngaphambi kotyando, sabekwa kwindawo yasekhohlo ye-decubitus, saza sanikwa i-anesthesia efakwa kwi-intravenous ene-propofol. Uxinzelelo lwegazi, isantya sentliziyo, i-electrocardiogram, kunye nokwanda kwe-oxygen egazini kwajongwa ngexesha lotyando.
1 Ibanda/IshushuIiForceps zeBiopsyIcandelo
Ifanelekile ekususweni kwee-polyps ezincinci ≤5mm, kodwa kunokubakho ingxaki yokususwa okungaphelelanga kwee-polyps ezi-4 ukuya kwi-5mm. Ngokusekelwe kwi-biopsy ebandayo, i-thermal biopsy ingasebenzisa i-high-frequency current ukubola izilonda eziseleyo kwaye yenze unyango lwe-hemostasis kwinxeba. Nangona kunjalo, kufuneka kuthathwe unonophelo ukuze kuthintelwe ukonakala komaleko we-serosa wodonga lwamathumbu ngenxa ye-electrocoagulation egqithisileyo.
Ngexesha lotyando, intloko ye-polyp kufuneka ibotshwe, iphakanyiswe ngokufanelekileyo (ukuthintela ukonakala komaleko wemisipha), kwaye igcinwe kumgama ofanelekileyo ukusuka eludongeni lwamathumbu. Xa i-polyp pedicle ijika ibe mhlophe, yeka umbane kwaye ubambe isilonda. Kufuneka kuqatshelwe ukuba akulula ukususa i-polyp enkulu kakhulu, kungenjalo iya kwandisa ixesha lokufakelwa kombane kwaye yonyuse umngcipheko wokonakala kobukhulu obupheleleyo (Umfanekiso 1).
2 Kubanda/kushushuumgibe wokususwa kwe-polypectomyindlela yokususa
Ifanelekile kwizilonda eziphakamileyo zobukhulu obahlukeneyo uhlobo lwe-p, uhlobo lwe-I sp kunye noluncinci (<2cm) uhlobo lwe-I s (imigangatho ethile yokwahlulahlula ingabhekisa ekufumaneni umhlaza wendlela yokugaya ukutya nge-endoscopic. Zininzi kakhulu iintlobo kwaye andazi ukuba ndingagweba njani? Eli nqaku Yenza kucace) Ukususwa kwezilonda. Kwizilonda ezincinci ze-Ip, ukususwa kwe-snare kulula kakhulu. Ii-snare ezibandayo okanye ezishushu zingasetyenziselwa ukususwa. Ngexesha lokususwa, ubude obuthile be-pedicle kufuneka bugcinwe okanye umgama othile ukusuka eludongeni lwamathumbu ngelixa kuqinisekiswa ukususwa ngokupheleleyo kwesilonda. Emva kokuqinisa i-snare, kufuneka ishukunyiswe i-Snare, jonga ukuba kukho i-mucosa yamathumbu eqhelekileyo ejikeleze kwaye uyifake kunye ukuthintela umonakalo eludongeni lwamathumbu.
Umfanekiso 1 Umzobo wesicwangciso sokususwa kwe-forceps ye-thermal biopsy, u-A ngaphambi kokususwa kwe-forceps, u-B inxeba emva kokususwa kwe-forceps. I-CD: Amanyathelo okhuseleko kwi-thermali-biopsy forcepsukususwa. Ukuba i-polyp inkulu kakhulu, iya kwandisa ixesha le-electrocoagulation kwaye ibangele umonakalo we-transmural.
Umfanekiso 2 Umzobo weskimu wokususwa kwe-thermal snare yezilonda ezincinci zohlobo lwe-I sp
3 I-EMR
■Izilonda ze-I p
Kwizilonda ezinkulu ze-Ip, ukongeza kumanyathelo okhuseleko angentla, kufuneka kusetyenziswe imigibe yobushushu ukuze kunqunyulwe. Ngaphambi kokususwa, kufuneka kwenziwe inaliti eyaneleyo ye-submucosal ezantsi kwe-pedicle (2 ukuya kwi-10 mL yeeyunithi ezili-10,000 ze-epinephrine + i-methylene blue + physiological. Umxube we-saline ufakwa phantsi kwe-mucosa (ufake inaliti ngelixa ukhupha inaliti), ukuze i-pedicle iphakame ngokupheleleyo kwaye kube lula ukuyisusa (Umfanekiso 3). Ngexesha lenkqubo yokususwa, isilonda kufuneka siphephe ukudibana nodonga lwamathumbu ukuze kuthintelwe ukwenza iluphu evaliweyo kunye nokutshisa udonga lwamathumbu.
Umfanekiso 3 Umzobo wesicwangcisoI-EMRunyango lwezilonda zohlobo lwe-LP
Kufuneka kuqatshelwe ukuba ukuba uhlobo olukhulu lwe-I p polyp lune-pedicle etyebileyo, lunokuba ne-vasa vasorum enkulu, kwaye luya kopha ngokulula emva kokususwa. Ngexesha lenkqubo yokususwa, indlela ye-coagulation-cut-coagulation ingasetyenziselwa ukunciphisa umngcipheko wokopha. Ezinye ii-polyp ezinkulu zinokunqunyulwa zibe ziingceba ukunciphisa ubunzima botyando, kodwa le ndlela ayilungelanga uvavanyo lwe-pathological.
■izilonda zohlobo lwe-lla-c
Kwizilonda zohlobo lwe-Ila-c kunye nezinye izilonda ze-Is ezinobubanzi obukhulu, ukususwa kwe-snare ngqo kunokubangela umonakalo omkhulu. Ukufakwa kolwelo kwi-submucosal kunokunyusa ukuphakama kwesilonda kwaye kunciphise ubunzima be-snare kunye ne-resection. Nokuba kukho ukuvela ngexesha lotyando sisiseko esibalulekileyo sokufumanisa ukuba i-adenoma ayinabungozi okanye inobungozi kwaye nokuba kukho iimpawu zonyango lwe-endoscopic. Le ndlela inokunyusa izinga elipheleleyo lokususwa kwe-adenomas<2cm ububanzi.
Umfanekiso 4I-EMRitshathi yokuhamba konyango lwe-type Il a polyps
4 I-ESD
Kwi-adenomas enobubanzi obungaphezulu kwe-2cm ezifuna ukususwa kube kanye kunye nesibonakaliso sokuphakanyiswa okungalunganga, kunye nezinye iintlobo zomhlaza zakuqala,I-EMRiintsalela okanye ukuphinda-phinda okunzima ukuzinyanga,I-ESDunyango lunokwenziwa. Amanyathelo aqhelekileyo ngala:
1. Emva kokufaka idayi endoscopic, umda wesilonda uchazwa ngokucacileyo kwaye umjikelezo uphawulwe (isilonda asinakuphawulwa ukuba umda wesilonda ucacile).
2. Tofa nge-submucosally ukuze izilonda zibonakale ziphakanyisiwe.
3. Ukusika i-mucosa kancinci okanye ngokuyinxenye ukuze kubonakale i-submucosa.
4. Khulula izicubu ezidityanisiweyo ecaleni kwe-submucosa uze ukhulule kancinci kancinci izicubu ezinesifo.
5. Jonga inxeba ngononophelo kwaye unyange imithambo yegazi ukuthintela iingxaki.
6. Emva kokucubungula iisampulu ezisusiweyo, zithumele ukuze zihlolwe isifo.
Umfanekiso 5I-ESDunyango lwezilonda ezinkulu
Amanyathelo okhuseleko ngexesha lotyando
Ukususwa kwe-polyp yamathumbu amakhulu nge-endoscopic kufuna indlela efanelekileyo yokukhetha ngokusekelwe kwiimpawu ze-polyp, indawo, inqanaba lesakhono somqhubi, kunye nezixhobo ezikhoyo. Kwangaxeshanye, ukususwa kwe-polyp kukwalandela imigaqo eqhelekileyo, ekufuneka siyilandele kangangoko kunokwenzeka ukuqinisekisa ukuba inkqubo yezonyango ikhuselekile kwaye iyasebenza kwaye izigulane ziyazuza kuyo.
1. Ukuseta kwangaphambili isicwangciso sonyango yeyona nto ibalulekileyo ekugqityweni ngempumelelo konyango lwe-polyp (ingakumbi ii-polyp ezinkulu). Kwii-polyps ezintsonkothileyo, kuyimfuneko ukukhetha indlela yokususwa kwesisu efanelekileyo ngaphambi konyango, ukunxibelelana nabahlengikazi, iingcali zokubulala iintlungu kunye nabanye abasebenzi ngexesha elifanelekileyo, kunye nokulungiselela izixhobo zonyango. Ukuba iimeko ziyavuma, ingagqitywa phantsi kwesikhokelo sogqirha oyintloko wotyando ukuthintela iingozi ezahlukeneyo zotyando.
2. Ukugcina "inqanaba lenkululeko" elungileyo emzimbeni wesibuko ngexesha lonyango yimfuneko ukuqinisekisa ukuba injongo yotyando iyafezekiswa. Xa ungena kwisibuko, landela ngokungqongqo "indlela yokugcinwa kunye nokufinyeza kwe-axis" ukuze ugcine indawo yonyango ikwimeko engenalujikelezo, nto leyo enceda unyango oluchanekileyo.
3. Ukubona kakuhle ukusebenza kwenza inkqubo yonyango ibe lula kwaye ikhuselekile. Amathumbu esigulana kufuneka alungiswe ngononophelo ngaphambi konyango, indawo yesigulana kufuneka imiselwe ngaphambi kotyando, kwaye iipolyps kufuneka zibonakale ngokupheleleyo ngumxhuzulane. Kungcono ukuba isilonda sikwicala elichaseneyo lolwelo oluseleyo kumngxuma wamathumbu.
Thina, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumvelisi eTshayina ogxile kwizinto ezisetyenziswayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, umgibe we-polyp, inaliti ye-sclerotherapy, i-catheter yokutshiza, iibhrashi ze-cytology, ucingo lwesikhokelo, ibhaskithi yokuqokelela amatye, i-catheter yokukhupha amanzi empumlweninjl. ezisetyenziswa kakhulu kwiI-EMR, I-ESD, I-ERCPIimveliso zethu ziqinisekisiwe yi-CE, kwaye izityalo zethu ziqinisekisiwe yi-ISO. Iimpahla zethu zithunyelwe eYurophu, eMntla Melika, eMbindi Mpuma nakwinxalenye yeAsia, kwaye zifumana umthengi udumo nodumo!
Ixesha lokuthumela: Agasti-02-2024