Iipolyps zekholoni sisifo esiqhelekileyo kwaye sihlala sisenzeka rhoqo kwi-gastroenterology. Babhekisela kwi-intraluminal protrusions ephezulu kune-intestinal mucosa. Ngokuqhelekileyo, i-colonoscopy inezinga lokufumanisa ubuncinane ubuncinane be-10% ukuya kwi-15%. Izinga lezehlo lidla ngokunyuka ngokukhula. ukuphakama. Ekubeni ngaphezu kwe-90% ye-cancer ye-colorectal ibangelwa utshintsho olubi lwe-polyps, unyango oluqhelekileyo kukwenza i-endoscopic resection ngokukhawuleza xa i-polyps ibonwa.
Kwi-colonoscopy yemihla ngemihla, i-80% ukuya kwi-90% yeepolyps ingaphantsi kwe-1 cm. Kwiipolyps okanye iipolyps ezinobude ≥ 5 mm (nokuba i-adenomatous okanye ayikho), i-elective endoscopic resection iyacetyiswa. Ukuba nokwenzeka kwekholoni micropolyps (ubude ububanzi ≤5mm) equlethe amacandelo ithumba liphantsi kakhulu (0~0.6%). Kwi-micropolyps kwikholoni ye-rectum kunye ne-sigmoid, ukuba i-endoscopist inokugqiba ngokuchanekileyo ukuba i-polyps non-adenomatous, akukho mfuneko yokuResection, kodwa le mbono ingasentla ayifane iphunyezwe kwiiklinikhi zaseChina.
Ukongezelela, i-5% ye-polyps i-flat okanye ikhule emacaleni, kunye nobubanzi obungaphezulu kwe-2 cm, kunye okanye ngaphandle kwezinto ezinobungozi. Kule meko, ezinye iindlela eziphambili zokususa i-polyp endoscopic ziyafuneka, njengeI-EMRkwayeESD. Makhe sijonge amanyathelo aneenkcukacha zokususwa kwe-polyp.
Inkqubo yotyando
Isigulana sagqiba uvavanyo lwe-anesthesia yangaphambili, yafakwa kwindawo ye-decubitus ye-lateral yasekhohlo, kwaye yanikwa i-anesthesia ye-intravenous kunye ne-propofol. Uxinzelelo lwegazi, ukubetha kwentliziyo, i-electrocardiogram, kunye ne-peripheral blood saturation ye-oxygen yajongwa ngexesha lotyando.
1 Kubanda/KushushuBiopsy ForcepsUkwahlula
Kufanelekile ukususwa kweepolyps ezincinci ≤5mm, kodwa kunokubakho ingxaki yokukhutshwa okungaphelelanga kweepolyps 4 ukuya ku-5mm. Ngokwesiseko se-biopsy ebandayo, i-thermal biopsy inokusebenzisa i-high-frequency current ukuze i-cauterize izilonda ezishiyekileyo kunye nokwenza unyango lwe-hemostasis enxebeni. Nangona kunjalo, kufuneka kuthathwe unonophelo ukuze kuthintelwe umonakalo kumgangatho we-serosa wodonga lwamathumbu ngenxa ye-electrocoagulation egqithisileyo.
Ngethuba lokusebenza, isiphelo sentloko se-polyp kufuneka sinyanzeliswe, siphakanyiswe ngokufanelekileyo (ukuphepha ukulimaza i-muscle layer), kwaye igcinwe kumgama ofanelekileyo ukusuka kudonga lwamathumbu. Xa i-polyp pedicle ijika ibe mhlophe, yeka i-electrocoagulation kwaye ubambe isilonda. Kufuneka kuqatshelwe ukuba akulula ukususa i-polyp enkulu kakhulu, ngaphandle koko kuya kwandisa ixesha lokufakelwa kombane kwaye kwandise umngcipheko womonakalo ogcweleyo (Umfanekiso 1).
2 Kuyabanda/kushushupolypectomy umgibeindlela yokususa
Ifanelekile izilonda eziphakanyisiweyo zobukhulu obuhlukeneyo I p uhlobo, uhlobo lwe-sp kunye nencinci (<2cm) I s uhlobo (imigangatho yokwahlula ngokuthe ngqo ingabhekisela ekubonweni kwe-endoscopic yomhlaza wokuqala wendlela yokugaya ukutya. Kukho iintlobo ezininzi kakhulu kwaye andiyazi indlela yokugweba? Eli nqaku Yenza kucace) Ukutshatyalaliswa kwakhona kwezilonda. Kuhlobo oluncinci lwezilonda ze-Ip, ukuchithwa komgibe kulula. Imigibe ebandayo okanye eshushu ingasetyenziselwa ukuhluma. Ngethuba lokuqhawula, ubude obuthile be-pedicle kufuneka bugcinwe okanye umgama othile ukusuka eludongeni lwamathumbu ngelixa uqinisekisa ukususwa ngokupheleleyo kwesilonda. Emva kokuqinisa umgibe, kufuneka kugungqiswe Umgibe, jonga ukuba kukho i-mucosa yamathumbu ejikelezayo aqhelekileyo kwaye uyifake kunye nokukhusela umonakalo kwindonga yamathumbu.
Umzobo 1 Umzobo weSchematic wokususwa kwe-thermal biopsy forceps, A phambi kokususwa kweforcep, B inxeba emva kokususwa kwenkani. I-CD: Izilumkiso ze-thermali-biopsy forcepsukususwa. Ukuba i-polyp inkulu kakhulu, iya kwandisa ixesha le-electrocoagulation kwaye ibangele umonakalo we-transmural.
Umzobo 2 Umzobo ocwangcisiweyo wokususwa kwe-thermal yomgibe wezilonda ezincinci ze-I sp
3 I-EMR
■ I p izilonda
Kwizilonda ezinkulu ze-I, ngaphezu kwezi zilumkiso zingentla, izibatha ze-thermal kufuneka zisetyenziswe ukutshatyalaliswa. Ngaphambi kokutshatyalaliswa, i-injection ye-submucosal eyaneleyo kufuneka yenziwe kwisiseko se-pedicle (i-2 ukuya kwi-10 mL yeeyunithi ze-10,000 ze-epinephrine + i-methylene blue + ye-physiological Umxube we-saline ujojowe phantsi kwe-mucosa (i-injection ngelixa ihoxisa inaliti), ukwenzela ukuba i-pedicle iphakanyiswe ngokupheleleyo kwaye kulula ukuyisusa (Umfanekiso kufuneka ugweme ukudibanisa nodonga, ngexesha lokuthintela ukudibanisa nodonga). ukwenza i-loop evaliweyo kunye nokutshisa udonga lwamathumbu.
Umfanekiso 3 Umzobo weSchematic weI-EMRunyango lwezilonda zohlobo lwe-lp
Kufuneka kuqatshelwe ukuba ukuba uhlobo olukhulu lwe-polyp lune-pedicle engqingqwa, lunokuthi lube ne-vasorum enkulu, kwaye luya kuphuma ngokukhawuleza emva kokususwa. Ngethuba lenkqubo yokubuyisela, indlela ye-coagulation-cut-coagulation ingasetyenziselwa ukunciphisa umngcipheko wokuphuma kwegazi. Ezinye iipolyps ezinkulu zinokuphinda zifakwe kwiziqwenga ukunciphisa ubunzima bokusebenza, kodwa le ndlela ayilungele uvavanyo lwe-pathological.
■ lla-c uhlobo lwezilonda
Kwizilonda zohlobo lwe-Ila-c kunye nezinye Ngaba izilonda ezinobubanzi obukhulu, ukutshatyalaliswa ngokuthe ngqo komgibe kunokubangela umonakalo ogcweleyo. Inaliti ye-submucosal yolwelo inokunyusa ukuphakama kwesilonda kunye nokunciphisa ubunzima bomgibe kunye nokususwa. Ingaba kukho i-protrusion ngexesha lotyando sisiseko esibalulekileyo sokugqiba ukuba i-adenoma inobungozi okanye iyingozi kwaye ingaba kukho izibonakaliso zonyango lwe-endoscopic. Le ndlela inokunyusa izinga lokutshatyalaliswa ngokupheleleyo kwe-adenomas<2cm ububanzi.
Umzobo 4I-EMRitshati flow unyango uhlobo Il a polyps
4 ESD
Kwi-adenomas enobubanzi obungaphezulu kwe-2cm efuna ukuphinda kuphinde kuphinde kuphinde kuphawulwe uphawu olungalunganga, kunye nomhlaza wokuqala,I-EMRintsalela okanye ukuvela kwakhona ekunzima ukunyanga,ESDunyango lunokwenziwa. Amanyathelo ngokubanzi ngala:
1. Emva kokutshatyalaliswa kwe-endoscopic, umda we-lesion uchazwe ngokucacileyo kwaye i-circumference imakishwa (i-lesion ayinakuphawulwa ukuba umda we-lesion ucacile).
2. Tofa i-submucosally ukwenza izilonda ziphakanyiswe ngokucacileyo.
3. Ngokuyinxenye okanye circumferentially incise i-mucosa ukuveza i-submucosa.
4. Khulula i-tissue edibeneyo kunye ne-submucosa kwaye ngokukhawuleza ukhuphe izicubu ezigulayo.
5. Qwalasela inxeba ngononophelo kwaye uphathe imithambo yegazi ukuthintela iingxaki.
6. Emva kokucubungula iisampulu ezihlaziyiweyo, zithumele kuviwo lwe-pathological.
Umfanekiso wesi-5ESDunyango lwezilonda ezinkulu
Ukhuseleko lwangaphakathi
I-Endoscopic colon polyp resection ifuna indlela efanelekileyo yokukhethwa ngokusekelwe kwiimpawu ze-polyp, indawo, inqanaba lezakhono zomqhubi, kunye nezixhobo ezikhoyo. Ngelo xesha, ukususwa kwe-polyp kwakhona kulandela imigaqo eqhelekileyo, ekufuneka siyilandele kangangoko sinakho ukuqinisekisa ukuba inkqubo yonyango ikhuselekile kwaye iyasebenza kwaye izigulane ziyazuza kuyo.
1. Ukumiselwa kwangaphambili kwesicwangciso sonyango sisitshixo sokugqitywa ngempumelelo kwonyango lwe-polyp (ingakumbi iipolyps ezinkulu). Kwii-polyps eziyinkimbinkimbi, kuyimfuneko ukukhetha indlela ehambelanayo yokutshatyalaliswa ngaphambi kokuba unyango, uqhagamshelane nabongikazi, i-anesthesiologists kunye nabanye abasebenzi ngexesha elifanelekileyo, kwaye ulungiselele izixhobo zonyango. Ukuba iimeko zivuma, inokugqityezelwa phantsi kwesikhokelo sogqirha ophezulu ukukhusela iingozi ezahlukeneyo zotyando.
2. Ukugcina "iqondo lenkululeko" elungileyo kumzimba wesibuko ngexesha lonyango kuyimfuneko yokuqinisekisa ukuba injongo yokusebenza iyafezekiswa. Xa ungena kwisibuko, landela ngokungqongqo "ukugcinwa kwe-axis kunye nendlela yokunciphisa" ukugcina indawo yonyango kwi-loop-free state, ehambelana nonyango oluchanekileyo.
3. Umbono wokusebenza kakuhle wenza inkqubo yonyango ibe lula kwaye ikhuselekile. Amathumbu esigulane kufuneka alungiswe ngononophelo ngaphambi kokuba unyango, indawo yesigulane kufuneka igqitywe ngaphambi kokuhlinzwa, kwaye i-polyps kufuneka ibonakaliswe ngokupheleleyo ngumxhuzulane. Kudla ngokuba ngcono ukuba isilonda sibekwe kwicala elichasene nolwelo oluseleyo kumqolo wamathumbu.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ngumvelisi e-China ogxile kwizinto ezityiwayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, polyp umgibe, inaliti ye-sclerotherapy, fafaza i-catheter, iibrashi zecytology, guidewire, ibhasikithi yokubuyiswa kwamatye, i-catheter ye-biliary drainage yeempumlonjl ezisetyenziswa ngokubanzi kwiI-EMR, ESD, I-ERCP. Iimveliso zethu ziqinisekisiwe nge-CE, kwaye izityalo zethu ziqinisekisiwe nge-ISO. Impahla yethu ithunyelwe eYurophu, kuMntla Melika, kuMbindi Mpuma kunye nenxalenye yeAsia, kwaye ifumana ngokubanzi umthengi wokuqatshelwa kunye nendumiso!
Ixesha lokuposa: Aug-02-2024