Phakathi kolwazi oludumileyo malunga nomhlaza wesisu wasekuqaleni, kukho amanqaku olwazi olunqabileyo lwesifo afuna ingqalelo ekhethekileyo nokufunda. Enye yazo ngumhlaza wesisu ongengowe-HP. Ingcamango "yee-epithelial tumors ezingasulelekiyo" ngoku ithandwa kakhulu. Kuza kubakho izimvo ezahlukeneyo ngomba wegama. Le ngcamango yomxholo isekelwe kakhulu kumxholo onxulumene nemagazini ethi "Isisu kunye namathumbu", kwaye igama likwasebenzisa "umhlaza wesisu ongengowe-HP".
Olu hlobo lwezilonda luneempawu zokuba azibonakali kangako, kunzima ukuzibona, ulwazi oluntsonkothileyo lwethiyori, kwaye inkqubo elula ye-MESDA-G ayisebenzi. Ukufunda olu lwazi kufuna ukujongana nobunzima.
1. Ulwazi olusisiseko malunga nomhlaza wesisu ongenamandla e-HP
Imbali
Ngaphambili, kwakukholelwa ukuba unobangela omnye ekuveleni nasekuphuhlisweni komhlaza wesisu yayikusulelo lwe-HP, ngoko ke imodeli yomhlaza eqhelekileyo yi-HP - ukuwohloka - ukubola kwamathumbu - ithumba eliphantsi - ithumba eliphezulu - umhlaza. Le modeli yakudala ibisoloko iqatshelwa, yamkelwe kwaye ikholelwa ngokuqinileyo. Iithumba zikhula kunye ngokusekelwe kwi-atrophy naphantsi kwesenzo se-HP, ngoko ke umhlaza ukhula kakhulu kwiindawo zamathumbu ezingasebenzi kakuhle nakwi-mucosa yesisu engaqhelekanga.
Kamva, abanye oogqirha bafumanisa ukuba umhlaza wesisu unokubakho nokuba akukho ntsholongwane ye-HP. Nangona izinga lokwanda kwawo liphantsi kakhulu, kunokwenzeka ngokwenene. Olu hlobo lomhlaza wesisu lubizwa ngokuba yi-HP-negative gastric cancer.
Ngokuqonda kancinci olu hlobo lwesifo, kuye kwaqaliswa ukuqwalasela okucwangcisiweyo kunye nezishwankathelo, kwaye amagama atshintsha rhoqo. Kwakukho inqaku ngo-2012 elalibizwa ngokuba yi "Gastric Cancer after Sterilization", inqaku ngo-2014 elalibizwa ngokuba yi "HP-negative Gastric Cancer", kunye nenqaku ngo-2020 elalibizwa ngokuba yi "Epithelial Tumors Not Infected with Hp". Utshintsho lwegama lubonisa ukuqonda okunzulu nokupheleleyo.
Iintlobo zeGland kunye neePatheni zokukhula
Kukho iintlobo ezimbini eziphambili ze-fundic glands kunye ne-pyloric glands esiswini:
Ii-Fundic glands (ii-oxyntic glands) zisasazeke kwi-fundus, emzimbeni, kwiikona, njl.njl. zesisu. Zii-linear single tubular glands. Zenziwe zii-mucous cells, ii-chief cells, ii-parietal cells kunye nee-endocrine cells, nganye kuzo yenza imisebenzi yayo. Phakathi kwazo, ii-chief cells I-PGI kunye ne-MUC6 staining ezikhutshweyo bezilungile, kwaye ii-parietal cells zikhuphe i-hydrochloric acid kunye ne-intrinsic factor;
Ii-pyloric glands zikwindawo yesisu kwaye zenziwe zii-mucus cells kunye nee-endocrine cells. Ii-mucus cells zine-MUC6 positive, kwaye ii-endocrine cells ziquka ii-G, D cells kunye nee-enterochromaffin cells. Ii-G cells zikhupha i-gastrin, ii-D cells zikhupha i-somatostatin, kunye nee-enterochromaffin cells zikhupha i-5-HT.
Iiseli zesisu eziqhelekileyo kunye neeseli zethumba zikhupha iintlobo ngeentlobo zeeproteni ze-mucus, ezahlulwe zibe ziiproteni ze-mucus "zesisu", "zamathumbu" kunye "nezixutyiweyo". Ukubonakaliswa kwe-mucins zesisu kunye namathumbu kubizwa ngokuba yi-phenotype kwaye kungekhona indawo ethile yomzimba yesisu kunye namathumbu.
Kukho iintlobo ezine zeeseli zeethumba zesisu: ezixutywe ngokupheleleyo esiswini, ezixutywe ngokupheleleyo esiswini, ezixutywe ngokupheleleyo emathunjini, kunye nezixutywe ngokupheleleyo emathunjini. Iithumba ezenzeka ngokusekelwe kwi-metaplasia yamathumbu ikakhulu ziithumba ezixutywe esiswini. Iintlobo ezahlukeneyo zomhlaza zibonisa uhlobo lwamathumbu (MUC2+), kwaye iintlobo ezahlukeneyo zomhlaza zibonisa uhlobo lwesisu (MUC5AC+, MUC6+).
Ukufumanisa ukuba i-Hp negative kufuna indibaniselwano ethile yeendlela ezininzi zokufumanisa ukuze kufunyanwe ngokupheleleyo. Umhlaza wesisu ongeyo-HP kunye nomhlaza wesisu emva kokubulala iintsholongwane ziingcamango ezimbini ezahlukeneyo. Ukuze ufumane ulwazi malunga nokubonakaliswa kwe-X-ray komhlaza wesisu ongeyo-HP, nceda ujonge icandelo elifanelekileyo lemagazini ethi "Isisu namathumbu".
2. Iimpawu ze-endoscopic zomhlaza wesisu ongenamandla kwi-HP
Ukuxilongwa kwe-endoscopic yeyona nto iphambili kumhlaza wesisu ongengowe-HP. Ngokuyintloko kubandakanya umhlaza wesisu wohlobo lwe-fundic gland, umhlaza wesisu wohlobo lwe-fundic gland mucosal, i-gastric adenoma, i-raspberry foveolar epithelial tumor, i-signet ring cell carcinoma, njl. Eli nqaku ligxile kwiimpawu ze-endoscopic zomhlaza wesisu ongengowe-HP.
1) I-Fundic gland uhlobo lomhlaza wesisu
-Izilonda ezimhlophe eziphakanyisiweyo
uhlobo lwedlala lomhlaza wesisu
◆Imeko 1: Izilonda ezimhlophe neziphakanyisiweyo
Inkcazo:I-gastric fundic fornix-greater curvature ye-cardia, eyi-10 mm, emhlophe, uhlobo lwe-O-lia (olufana ne-SMT), ngaphandle kokuqina okanye i-intestinal metaplasia ngasemva. Imithambo yegazi efana ne-arbor inokubonwa kumphezulu (i-NBI kunye nokukhula kancinci)
Uxilongo (oludityaniswe ne-pathology):U, O-1la, 9mm, fundic gland uhlobo lomhlaza wesisu, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Izilonda ezimhlophe ezisicaba
uhlobo lwedlala lomhlaza wesisu
◆Ityala lesi-2: Izilonda ezimhlophe, ezithe tyaba/ezixinezelekileyo
Inkcazo:Udonga olungaphambili lwe-gastric fundic fornix-cardia lugobile kakhulu, luyi-14 mm, lumhlophe, luyi-0-1lc, aluna-atrophy okanye i-intestinal metaplasia ngasemva, imida engacacanga, kunye nemithambo yegazi ye-dendritic ebonakala kumphezulu. (I-NBI kunye ne-amplification zifinyeziwe)
Uxilongo (oludityaniswe ne-pathology):U, 0-Ilc, 14mm, fundic gland uhlobo lomhlaza wesisu, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Izilonda ezibomvu eziphakanyisiweyo
uhlobo lwedlala lomhlaza wesisu
◆Ityala lesi-3: Izilonda ezibomvu neziphakanyisiweyo
Inkcazo:Udonga olungaphambili lwe-great curvature ye-cardia yi-12 mm, ngokucacileyo ibomvu, uhlobo lwe-0-1, aluna-atrophy okanye i-intestinal metaplasia ngasemva, imida ecacileyo, kunye nemithambo yegazi ye-dendritic kumphezulu (i-NBI kunye nokukhula kancinci)
Uxilongo (oludityaniswe ne-pathology):U, 0-1, 12mm, fundic gland uhlobo lomhlaza wesisu, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
-Isilonda esibomvu, esithe tyaba, esixineneyos
uhlobo lwedlala lomhlaza wesisu
◆Ityala lesi-4: Izilonda ezibomvu, ezithe tyaba/ezixinezelekileyo
Inkcazo:Udonga olungasemva lwesiphako esikhulu senxalenye ephezulu yomzimba wesisu, 18mm, bomvu obukhanyayo, uhlobo lwe-O-1Ic, akukho kubola okanye ukubola kwamathumbu ngasemva, umda ongacacanga, akukho mithambo yegazi ye-dendritic kumphezulu, (i-NBI kunye nokukhulisa kususiwe)
Uxilongo (oludityaniswe ne-pathology):U, O-1lc, 19mm, fundic gland uhlobo lomhlaza wesisu, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
xoxa
Amadoda anesi sifo madala kunamabhinqa, kwaye ubudala obuqhelekileyo buyiminyaka engama-67.7 ubudala. Ngenxa yeempawu ze-simultaneity kunye ne-heterochrony, izigulane ezifunyaniswe zinomhlaza wesisu wohlobo lwe-fundic gland kufuneka zihlolwe kanye ngonyaka. Indawo eqhelekileyo yindawo ye-fundic gland embindini nakwinxalenye ephezulu yesisu (i-fundus kunye nenxalenye ephakathi nephezulu yomzimba wesisu). Izilonda ezimhlophe ezifana ne-SMT zixhaphake kakhulu ekukhanyeni okumhlophe. Unyango oluphambili yi-diagnostic EMR/ESD.
Akukho metastasis ye-lymphatic okanye ukuhlasela kwemithambo yegazi okubonweyo ukuza kuthi ga ngoku. Emva konyango, kuyimfuneko ukumisela ukuba kwenziwe utyando olongezelelweyo na kwaye kuhlolwe ulwalamano phakathi kwesimo esibi kunye ne-HP. Ayizizo zonke iintlobo zomhlaza wesisu zohlobo lwe-fundic gland ezingenayo i-HP.
1) Umhlaza wesisu we-Fundic gland mucosal
Umhlaza wesisu we-Fundic gland mucosal
◆Ityala 1
Inkcazo:Isilonda siphakanyisiwe kancinci, kwaye i-RAC non-atrophic gastric mucosa inokubonwa ngeenxa zonke. Ukutshintsha ngokukhawuleza kwesakhiwo se-microstructure kunye ne-microvessels kunokubonwa kwinxalenye ephakamileyo ye-ME-NBI, kwaye i-DL inokubonwa.
Uxilongo (oludityaniswe ne-pathology):Fundic gland mucosal umhlaza wesisu, U zone, 0-1la, 47 * 32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Umhlaza wesisu we-Fundic gland mucosal
◆Ityala lesi-2
Inkcazo: Isilonda esithe tyaba eludongeni olungaphambili lwesigoso esincinci se-cardia, esinombala oxubeneyo kunye nokubomvu, imithambo yegazi ye-dendritic inokubonwa kumphezulu, kwaye isilonda siphakanyisiwe kancinci.
Uxilongo (ludityaniswe ne-pathology): Umhlaza wesisu seFundic gland mucosal gastric, 0-lla, pT1a/M, ULO, LyOV0,HM0,VMO
xoxa
Igama elithi "gastric gland mucosal adenocarcinoma" kunzima ukulibiza, kwaye izinga lokusasazeka kwalo liphantsi kakhulu. Kufuna imizamo engakumbi ukuze liqondwe kwaye liqondwe. I-Fundic gland mucosal adenocarcinoma ineempawu zomhlaza ophezulu.
Kukho iimpawu ezine eziphambili ze-white light endoscopy: ① izilonda ezifayo ze-homochromatic; ② i-subepithelial tumor SMT; ③ imithambo yegazi ye-dendritic evulekileyo; ④ ii-microparticles zengingqi. Ukusebenza kwe-ME: I-DL(+)IMVP(+)IMSP(+)MCE yandisa i-IP kwaye iyanda. Ukusebenzisa inkqubo ecetyiswayo yi-MESDA-G, i-90% yomhlaza wesisu we-mucosal gland mucosal ihlangabezana neemfuno zokuxilonga.
3) I-adenoma yesisu (i-adenoma ye-pyloric gland PGA)
i-adenoma yesisu
◆Ityala 1
Inkcazo:Kubonwe isilonda esimhlophe esithe tyaba eludongeni olungasemva lwe-gastric fornix esinemida engacacanga. Idayi ye-Indigo carmine ayizange ibonise mida icacileyo, kwaye kwabonakala imbonakalo efana ne-LST-G yamathumbu amakhulu (ekhuliswe kancinci).
Uxilongo (oludityaniswe ne-pathology):i-carcinoma ye-atypia ephantsi, i-O-1la, i-47*32mm, i-adenocarcinoma yetyhubhu eyahlukileyo kakuhle, i-pT1a/M, i-ULO, i-Ly0, i-VO, i-HMO, i-VMO
i-adenoma yesisu
◆Ityala lesi-2
Inkcazo: Isilonda esiphakanyisiweyo esinamaqhuqhuva eludongeni olungaphambili lwenxalenye ephakathi yomzimba wesisu. I-gastritis esebenzayo inokubonwa ngasemva. I-Indigo carmine inokubonwa njengomda. (I-NBI kunye nokukhulisa kancinci)
I-Pathology: Ukubonakaliswa kwe-MUC5AC kubonwe kwi-epithelium engaphezulu, kwaye ukubonakaliswa kwe-MUC6 kubonwe kwi-epithelium engaphezulu. Ukuxilongwa kokugqibela yayiyi-PGA.
xoxa
Ii-adenoma zesisu ngokuyintloko zii-mucinous glands ezingena kwi-stroma kwaye zigqunywe yi-foveolar epithelium. Ngenxa yokwanda kwee-glandular protrusions, ezikwi-hemispherical okanye kwi-nodular, ii-gastric adenomas ezibonwa ngokukhanya okumhlophe kwe-endoscopic zonke zi-nodular kwaye ziphuma. Kubalulekile ukuqaphela iindidi ezine zeJiu Ming phantsi kovavanyo lwe-endoscopic. I-ME-NBI inokubona ukubonakala kwe-PGA kwe-papillary/villous. I-PGA ayisiyongxaki ye-HP kwaye ayisiyongxaki, kwaye inomngcipheko othile womhlaza. Ukuxilongwa kwangoko kunye nonyango kwangoko kuyakhuthazwa, kwaye emva kokufunyanwa, ukususwa kwe-en bloc esebenzayo kunye nophando oluthe kratya luyacetyiswa.
4) (njengeraspberry) umhlaza wesisu we-foveolar epithelial
umhlaza wesisu we-raspberry foveolar epithelial
◆Ityala lesi-2
Inkcazo:(ayifakwanga)
Uxilongo (ludityaniswe ne-pathology)umhlaza wesisu we-epithelial ye-foveolar
umhlaza wesisu we-raspberry foveolar epithelial
◆Ityala lesi-3
Inkcazo:(ayifakwanga)
Uxilongo (oludityaniswe ne-pathology):umhlaza wesisu we-epithelial ye-foveolar
xoxa
I-Raspberry, ebizwa ngokuba yi-"Tuobai'er" kwidolophu yethu, sisiqhamo sasendle ecaleni kwendlela xa sasisengabantwana. I-epithelium ye-glandular kunye ne-glands zidibene, kodwa azifani. Kubalulekile ukuqonda iimpawu zokukhula nophuhliso lweeseli ze-epithelial. Umhlaza wesisu we-raspberry epithelial ufana kakhulu ne-gastric polyps kwaye unokuphambukiswa ngokulula njenge-gastric polyps. Uphawu oluphambili lwe-foveolar epithelium yindlela ebalaseleyo ye-MUC5AC. Ngoko ke i-foveolar epithelial carcinoma ligama eliqhelekileyo lolu hlobo. Inokubakho kwi-HP negative, positive, okanye emva kokubulala iintsholongwane. Inkangeleko ye-Endoscopic: i-bulge ebomvu eqaqambileyo efana ne-strawberry, ngokubanzi inemida ecacileyo.
5) I-Signet ring cell carcinoma
I-Signet ring cell carcinoma: ukubonakala kokukhanya okumhlophe
I-Signet ring cell carcinoma: ukubonakala kokukhanya okumhlophe
i-carcinoma yeseli yendandatho yesiginesha
◆Ityala 1
Inkcazo:Isilonda esithe tyaba eludongeni olungasemva lwevestibule yesisu, i-10 mm, ifiphele, uhlobo lwe-O-1Ib, akukho kubola ngasemva, umda obonakalayo ekuqaleni, umda ongabonakaliyo xa uhlolwa kwakhona, i-ME-NBI: kuphela inxalenye ephakathi kwe-foveal eba mhlophe, i-IMVP(-)IMSP (-)
Uxilongo (oludityaniswe ne-pathology):Iisampuli ze-ESD zisetyenziselwa ukuxilonga i-signet ring cell carcinoma.
Iimpawu zezifo
I-Signet ring cell carcinoma lolona hlobo lunobungozi. Ngokwendlela uLauren ahlela ngayo, i-gastric signet ring cell carcinoma ihlelwa njengohlobo lwe-carcinoma olusasazekayo kwaye luhlobo lwe-carcinoma engahlukaniyo. Ihlala isenzeka emzimbeni wesisu, kwaye ixhaphake kakhulu kwizilonda ezithe tyaba nezitshonileyo ezinemibala eguqukayo. Izilonda eziphakanyisiweyo aziqhelekanga kwaye zinokubonakala njengokukhukuliseka okanye izilonda. Kunzima ukuzibona ngexesha lovavanyo lwe-endoscopic kumanqanaba okuqala. Unyango lunokuba kukususwa kwezicubu okunyangayo njenge-endoscopic ESD, kunye nokulandelelana okungqongqo emva kotyando kunye novavanyo lokuba kwenziwe na utyando olongezelelweyo. Ukususwa kwezicubu okunganyangekiyo kufuneka kufune utyando olongezelelweyo, kwaye indlela yotyando igqitywa ngugqirha otyandayo.
Le ngcamango kunye nemifanekiso engentla ivela kwi "Isisu namathumbu"
Ukongeza, kufuneka kuqwalaselwe nomhlaza we-esophagogastric junction, umhlaza we-cardia, kunye ne-adenocarcinoma eyahlukileyo efumaneka kwimvelaphi ye-HP-negative.
3. Isishwankathelo
Namhlanje ndifunde ulwazi olufanelekileyo kunye neempawu ze-endoscopic zomhlaza wesisu ongengowe-HP. Oku kuquka ikakhulu: umhlaza wesisu wohlobo lwe-fundic gland, umhlaza wesisu wohlobo lwe-fundic gland, i-gastric adenoma, i-foveolar epithelial tumor (efana ne-raspberry) kunye ne-signet ring cell carcinoma.
Ukwanda komhlaza wesisu ongenayo i-HP kuphantsi, kunzima ukuwugweba, kwaye kulula ukuwuphoswa ngugqirha. Okunzima nangakumbi kukubonakaliswa kwezifo ezintsonkothileyo nezingaqhelekanga kwi-endoscopic. Kufuneka kuqondwe ngokwembono ye-endoscopic, ingakumbi ulwazi olusekelwe kuyo.
Ukuba ujonga ii-polyps zesisu, ukukhuhlana, kunye neendawo ezibomvu nezimhlophe, kufuneka uqwalasele ukuba kunokwenzeka ukuba umhlaza wesisu one-Hp-negative. Ukugweba i-HP negative kufuneka kuhambelane nemigangatho, kwaye kufuneka kunikwe ingqalelo kwii-negative ezingezizo ezibangelwa kukuxhomekeka kakhulu kwiziphumo zovavanyo lokuphefumla. Iingcali ze-endoscopist ezinamava zithembela ngakumbi emehlweni azo. Sijongene nethiyori eneenkcukacha ezingasemva komhlaza wesisu one-HP-negative, kufuneka siqhubeke nokufunda, siqonde kwaye siziqhelise ukuwuqonda.
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 empumlweni njl.njl.ezisetyenziswa kakhulu kwiI-EMR,I-ESD,I-ERCP.Iimveliso zethu ziqinisekisiwe yi-CE, kwaye izityalo zethu ziqinisekisiwe yi-ISO. Iimpahla zethu zithunyelwe eYurophu, eMntla Melika, eMbindi Mpuma nakwinxalenye ye-Asia, kwaye zifumana umthengi udumo nodumo!
Ixesha lokuthumela: Julayi-12-2024