Phakathi kolwazi oludumileyo malunga nomhlaza wesisu sokuqala, kukho amanqaku olwazi lwesifo esinqabileyo afuna ingqalelo ekhethekileyo kunye nokufunda.Enye yazo ngumhlaza wesisu se-HP-negative.Ingcamango "ye-epithelial tumors" engabonakaliyo ngoku ithandwa kakhulu.Kuya kubakho iimbono ezahlukeneyo malunga nomba wamagama.Le ithiyori yomxholo isekelwe ikakhulu kumxholo onxulumene nephephancwadi elithi "Isisu kunye neThumbu", kwaye igama likwasebenzisa "umhlaza wesisu se-HP-negative".
Olu hlobo lwezilonda luneempawu zeziganeko eziphantsi, ubunzima bokuchongwa, ulwazi oluyinkimbinkimbi lwethiyori, kunye nenkqubo ye-MESDA-G elula ayisebenzi.Ukufunda olu lwazi kufuna ukujongana nobunzima.
1. Ulwazi olusisiseko lwe-HP-negative umhlaza wesisu
Imbali
Ngaphambili, kwakukholelwa ukuba unobangela omnye ukwenzeka kunye nophuhliso umhlaza esiswini kwaba usulelo HP, ngoko imodeli yomhlaza zakudala HP - atrophy - metaplasia emathunjini - ithumba eliphantsi - ithumba eliphezulu - umhlaza.Imodeli yeklasikhi isoloko isaziwa ngokubanzi, yamkelwe kwaye ikholelwa ngokuqinileyo.Amathumba aphuhla kunye ngesiseko se-atrophy kunye naphantsi kwesenzo se-HP, ngoko ke imihlaza ikhula kakhulu kwiiphecana ze-atrophic intestinal kunye ne-non-atrophic gastric mucosa.
Kamva, abanye oogqirha bafumanisa ukuba umhlaza wesisu unokwenzeka naxa kungekho usulelo lwe-HP.Nangona izinga lezehlo lisezantsi kakhulu, liyenzeka ngenene.Olu hlobo lomhlaza wesisu lubizwa ngokuba yi-HP-negative gastric cancer.
Ngokuqondwa ngokuthe ngcembe kolu hlobo lwesifo, ukuqwalaselwa okunzulu okucwangcisiweyo kunye nezishwankathelo ziqalile, kwaye amagama ahlala etshintsha.Kwakukho inqaku ngo-2012 elibizwa ngokuba yi "Gastric Cancer after Sterilization", inqaku ngo-2014 elibizwa ngokuba "yi-HP-negative Gastric Cancer", kunye nenqaku ngo-2020 elibizwa ngokuba "I-Epithelial Tumors Not Infected with Hp".Ukutshintshwa kwegama kubonisa ukuqonda okunzulu kunye nokubanzi.
Iintlobo zeGland kunye neePatheni zokuKhula
Kukho iintlobo ezimbini eziphambili ze-fundic glands kunye ne-pyloric glands esiswini:
Amadlala e-Fundic (i-oxyntic glands) asasazwa kwi-fundus, umzimba, iikona, njl.Zingamadlala etyhubhu angqamene.Ziqulunqwe ngamaseli e-mucous, iiseli eziphambili, iiseli ze-parietal kunye neeseli ze-endocrine, nganye eyenza imisebenzi yayo.Phakathi kwazo, iiseli eziphambili I-PGI efihliweyo kunye ne-MUC6 yokungcolisa yayilungile, kwaye iiseli ze-parietal zifihla i-hydrochloric acid kunye ne-intrinsic factor;
Iingqungquthela ze-pyloric zifumaneka kwindawo ye-antrum yesisu kwaye zenziwe ngeeseli ze-mucus kunye neeseli ze-endocrine.Iiseli ze-mucus zi-MUC6 ezilungileyo, kwaye iiseli ze-endocrine ziquka iiseli ze-G, D kunye neeseli ze-enterochromaffin.Iiseli ze-G zikhupha i-gastrin, iiseli ze-D zikhupha i-somatostatin, kunye neeseli ze-enterochromaffin zikhupha i-5-HT.
Iiseli ze-gastric mucosal eziqhelekileyo kunye neeseli ze-tumor zikhupha iintlobo ezahlukeneyo zeeprotheni ze-mucus, ezihlulwe zibe "zesisu", "amathumbu" kunye "ne-mixed" ye-mucus proteins.Ukubonakaliswa kwe-gastric and intestinal mucins kuthiwa yi-phenotype kwaye kungekhona indawo ethile ye-anatomical yesisu kunye namathumbu.
Kukho i-phenotypes ye-cell ye-gastric tumors: i-gastric ngokupheleleyo, i-gastric-dominant exutywe, i-intestinal-dominant exutywe, kunye namathumbu ngokupheleleyo.Amathumba avela kwisiseko se-metaplasia yamathumbu ubukhulu becala ngamathumba e-phenotype axutywe ngamathumbu.Umhlaza ohlukeneyo ubonisa ubukhulu becala uhlobo lwamathumbu (MUC2 +), kwaye umhlaza osasazekileyo ubonisa uhlobo lwesisu (MUC5AC +, MUC6 +).
Ukumisela i-Hp engalunganga kufuna indibaniselwano ethile yeendlela ezininzi zokubona ukuzimisela okubanzi.Umhlaza wesisu we-HP-negative kunye nomhlaza wesisu wasemva kokuvalwa inzala ziikhonsepthi ezimbini ezahlukeneyo.Ngolwazi malunga nokubonakaliswa kwe-X-reyi ye-HP-negative gastric cancer, nceda ubhekisele kwicandelo elifanelekileyo lephephancwadi elithi "Isisu kunye neThumbu".
2. Ukubonakaliswa kwe-Endoscopic ye-HP-negative gastric cancer
Ukuxilongwa kwe-Endoscopic kugxilwe kumhlaza wesisu se-HP-negative.Ikakhulu ibandakanya idlala lohlobo lomhlaza wesisu, idlala lengqula lomhlaza womhlaza wesisu, i-gastric adenoma, ithumba le-raspberry foveolar epithelial, i-signet ring cell carcinoma, njl.
1) I-Fundic gland uhlobo lomhlaza wesisu
-Izilonda eziphakanyisiweyo ezimhlophe
uhlobo lwedlala lomhlaza wesisu
◆Ityala loku-1: Izilonda ezimhlophe, eziphakanyisiweyo
Inkcazo:I-gastric fundic fornix-i-curvature enkulu ye-cardia, i-10 mm, emhlophe, uhlobo lwe-O-lia (i-SMT-like), ngaphandle kwe-atrophy okanye i-intestinal metaplasia ngasemva.Imithambo yegazi efana ne-Arbor inokubonwa kumphezulu (i-NBI kunye nokwandisa kancinci)
Ukuxilongwa (kudityaniswa ne-pathology):U, O-1la, 9mm, fundic gland uhlobo lomhlaza wesisu, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Izilonda ezimhlophe ezimcaba
uhlobo lwedlala lomhlaza wesisu
◆Ityala lesi-2: Izilonda ezimhlophe, ezisicaba/ ezidakumbileyo
Inkcazo:Udonga lwangaphambili lwe-gastric fundic fornix-cardia i-curvature enkulu, i-14 mm, emhlophe, uhlobo lwe-0-1lc, olungenayo i-atrophy okanye i-intestinal metaplasia ngasemva, imida engacacanga, kunye nemithambo yegazi ye-dendritic ebonwa phezulu.(i-NBI kunye nolwandiso olufinyeziweyo)
Ukuxilongwa (kudityaniswa ne-pathology):U, 0-Ilc, 14mm, fundic gland uhlobo lomhlaza wesisu, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Izilonda eziphakanyisiweyo ezibomvu
uhlobo lwedlala lomhlaza wesisu
◆Ityala lesi-3: Izilonda ezibomvu neziphakanyisiweyo
Inkcazo:Udonga lwangaphambili lwe-curvature enkulu ye-cardia yi-12 mm, ngokucacileyo ebomvu, uhlobo lwe-0-1, olungenayo i-atrophy okanye i-metaplasia yamathumbu ngasemva, imida ecacileyo, kunye nemithambo yegazi ye-dendritic phezu komhlaba (NBI kunye nokwandisa kancane)
Ukuxilongwa (kudityaniswa ne-pathology):U, 0-1, 12mm, fundic gland uhlobo lomhlaza wesisu, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
-Ibomvu, i-flat, isilonda esidangeles
uhlobo lwedlala lomhlaza wesisu
◆Ityala lesi-4: Izilonda ezibomvu, ezisicaba/ ezidakumbileyo
Inkcazo:Udonga olungasemva lwe-curvature enkulu yendawo ephezulu yomzimba wesisu, i-18mm, ibomvu ebomvu, uhlobo lwe-O-1Ic, akukho atrophy okanye i-metaplasia yamathumbu ngasemva, umda ongacacanga, akukho mithambo yegazi ye-dendritic phezu komhlaba, (i-NBI kunye nokwandiswa kushiywe )
Ukuxilongwa (kudityaniswa ne-pathology):U, O-1lc, 19mm, fundic gland uhlobo lomhlaza wesisu, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
xoxa
Amadoda anesi sifo badala kunamabhinqa, ngokomndilili weminyaka engama-67.7 ubudala.Ngenxa yeempawu zexesha elifanayo kunye ne-heterochrony, izigulane ezifunyanwe ukuba zinesifo somhlaza wesisu se-fundic gland kufuneka zihlaziywe kanye ngonyaka.Eyona ndawo ixhaphakileyo yindawo ye-fundic gland kumbindi nangaphezulu kwesisu (i-fundus kunye nombindi kunye nenxalenye ephezulu yomzimba wesisu).Izilonda eziphakamileyo ezifana ne-SMT ezimhlophe zixhaphake kakhulu ekukhanyeni okumhlophe.Unyango oluphambili luxilongo lwe-EMR/ESD.
Akukho metastasis ye-lymphatic okanye ukuhlasela kwemithambo kuye kwabonwa ukuza kuthi ga ngoku.Emva kokonyango, kuyimfuneko ukugqiba ukuba ngaba ukwenza utyando olongezelelweyo kunye nokuvavanya ubudlelwane phakathi kwesimo esibi kunye ne-HP.Ayizizo zonke iintlobo zomhlaza zesisu ze-fundac ezine-HP negative.
1) Umhlaza wesisu se-Fudic gland mucosal gastric
Umhlaza wesisu seFundic mucosal gastric
◆Ityala loku-1
Inkcazo:Isilonda siphakanyiswe kancinci, kwaye i-RAC engeyiyo i-atrophic gastric mucosa inokubonwa ngeenxa zonke kuyo.Ukutshintsha ngokukhawuleza i-microstructure kunye ne-microvessels kunokubonwa kwindawo ephakanyisiweyo ye-ME-NBI, kwaye i-DL inokubonwa.
Ukuxilongwa (kudityaniswa ne-pathology):Fundic gland mucosal umhlaza wesisu, U zone, 0-1la, 47 * 32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Umhlaza wesisu seFundic mucosal gastric
◆Ityala lesi-2
Inkcazo: Isilonda esisicaba kudonga lwangaphambili lwe-curvature encinci ye-cardia, kunye ne-discoloration edibeneyo kunye nobomvu, imithwalo yegazi ye-dendritic ingabonwa phezu komhlaba, kwaye i-lesion iphakanyiswe kancane.
Ukuxilongwa (kudityaniswe 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 lezehlo liphantsi kakhulu.Kufuna imigudu engakumbi yokuyiqonda nokuyiqonda.I-Fundic gland mucosal adenocarcinoma ineempawu zobubi obuphezulu.
Kukho iimpawu ezine eziphambili ze-endoscopy yokukhanya okumhlophe: ① izilonda ze-homochromatic-eziphelayo;② subepithelial tumor SMT;③ imithambo yegazi yedendritic;④ amasuntswana engingqi.Ukusebenza kwe-ME: DL(+)IMVP(+)IMSP(+)MCE yandisa i-IP kwaye yanda.Ukusebenzisa inkqubo ecetyiswayo ye-MESDA-G, i-90% ye-fundic gland mucosal gastric cancers ihlangabezana neendlela zokuxilonga.
3) I-gastric adenoma (pyloric gland adenoma PGA)
i-adenoma yesisu
◆Ityala loku-1
Inkcazo:Isilonda esimhlophe esiphakamileyo esiphakamileyo sabonwa kwindonga yangasemva ye-fornix yesisu kunye nemida engacacanga.I-Indigo carmine staining ayibonakali imida ecacileyo, kwaye ukubonakala kwe-LST-G-efana ne-intestine enkulu kubonakala (kwandiswa kancane).
Ukuxilongwa (kudityaniswa ne-pathology):i-atypia carcinoma ephantsi, i-O-1la, i-47 * 32mm, i-adenocarcinoma ye-tubula eyahlukileyo, i-pT1a / M, i-ULO, i-Ly0, i-VO, i-HMO, i-VMO
i-adenoma yesisu
◆Ityala lesi-2
Inkcazo: Isilonda esiphakanyisiweyo esinamaqhuqhuva kudonga lwangaphambili lwenxalenye ephakathi yomzimba wesisu.I-gastritis esebenzayo ingabonwa ngasemva.I-Indigo carmine inokubonwa njengomda.(NBI kunye nokwandiswa kancinci)
I-Pathology: Ukubonakaliswa kwe-MUC5AC kubonwe kwi-epithelium ephezulu, kwaye i-MUC6 ibonakaliso yabonwa kwi-epithelium ephezulu.Ukuxilongwa kokugqibela kwaba yiPGA.
xoxa
I-gastric adenomas ngokuyimfuneko ngamadlala ane-mucinous angena kwi-stroma kwaye agqunywe yi-foveolar epithelium.Ngenxa yokwanda kwe-glaular protrusions, ene-hemispherical okanye i-nodular, i-adenomas ye-gastric ebonwa ngokukhanya okumhlophe kwe-endoscopic zonke ziyi-nodular kwaye ziphuma.Kuyimfuneko ukunikela ingqalelo kwii-4 zokuhlelwa kweJiu Ming phantsi koviwo lwe-endoscopic.I-ME-NBI inokuqwalasela uphawu lwe-papillary/inkangeleko embi ye-PGA.I-PGA ayikho ngokupheleleyo i-HP engalunganga kunye ne-non-atrophic, kwaye inomngcipheko othile womhlaza.Ukuxilongwa kwangethuba kunye nonyango lwakwangoko luyakhuthazwa, kwaye emva kokufunyanwa, i-en bloc resection esebenzayo kunye nophononongo olubanzi luyacetyiswa.
4) (i-raspberry-like) i-foveolar epithelial umhlaza wesisu
iraspberry foveolar epithelial umhlaza wesisu
◆Ityala lesi-2
Inkcazo:(ishiyiwe)
Ukuxilongwa (kudityaniswe ne-pathology): umhlaza wesisu se-foveolar epithelial
iraspberry foveolar epithelial umhlaza wesisu
◆Ityala lesi-3
Inkcazo:(ishiyiwe)
Ukuxilongwa (kudityaniswa ne-pathology):foveolar epithelial umhlaza wesisu
xoxa
I-Raspberry, ebizwa ngokuba yi "Tuobai'er" kwidolophu yethu, sisiqhamo sasendle ecaleni kwendlela xa sasingabantwana.I-epithelium ye-glandular kunye neengqungquthela zixhunyiwe, kodwa azikho umxholo ofanayo.Kuyimfuneko ukuqonda ukukhula kunye neempawu zophuhliso lweeseli ze-epithelial.Umhlaza we-Raspberry epithelial gastric ufana kakhulu neepolyps zesisu kwaye unokuphazanywa ngokulula neepolyps zesisu.Uphawu oluphawulekayo lwe-foveolar epithelium luphawu olubalaseleyo lwe-MUC5AC.Ke ifoveolar epithelial carcinoma ligama eliqhelekileyo kolu hlobo.Inokubakho kwi-HP engalunganga, ilungile, okanye emva kokuvalwa inzala.Ukubonakala kwe-Endoscopic: ingqukuva ebomvu ebomvu ye-strawberry, ngokubanzi kunye nemida ecacileyo.
5) Isayini yentsimbi ye-cell carcinoma
Umsayino weringi yeseli carcinoma: imbonakalo yokukhanya okumhlophe
Umsayino weringi yeseli carcinoma: imbonakalo yokukhanya okumhlophe
ikhonkco ring cell carcinoma
◆Ityala loku-1
Inkcazo:I-Flat lesion kudonga olungasemva lwe-vestibule ye-gastric, i-10 mm, i-faded, uhlobo lwe-O-1Ib, akukho atrophy ngasemva, umda obonakalayo ekuqaleni, umda ongabonakaliyo ekuhloliseni kwakhona, i-ME-NBI: kuphela inxalenye ye-interfoveal iba mhlophe, i-IMVP (-)IMSP (-)
Ukuxilongwa (kudityaniswa ne-pathology):Imizekelo ye-ESD isetyenziselwa ukuxilonga i-signet ring cell carcinoma.
Ukubonakaliswa kwePathological
I-signet ring cell carcinoma lolona hlobo luyingozi.Ngokohlelo lwe-Lauren, i-gastric signet ring cell carcinoma ihlelwa njenge-diffuse type ye-carcinoma kwaye luhlobo lwe-carcinoma engahlukanga.Iqhele ukwenzeka kumzimba wesisu, kwaye ixhaphake kakhulu kwizilonda ezisicaba nezitshoneyo ezineethowuni eziguqulwe umbala.Izilonda eziphakanyisiweyo zinqabile kwaye zinokubonakala njengokhukuliseko okanye izilonda.Kunzima ukufumanisa ngexesha lokuhlolwa kwe-endoscopic kumanqanaba okuqala.Unyango lunokuba yi-resection yonyango efana ne-ESD ye-endoscopic, kunye nokulandelela okungqongqo emva kokuhlinzwa kunye novavanyo lokuba kwenziwe utyando olongezelelweyo.Utyando olunganyangekiyo kufuneka lufune utyando olongezelelweyo, kwaye indlela yotyando igqitywe ngugqirha wotyando.
Ithiyori yokubhaliweyo engentla kunye nemifanekiso ivela kwi "Isisu kunye neThumbu"
Ukongeza, ingqwalasela kufuneka ihlawulwe kwakhona kumhlaza we-esophagogastric junction, umhlaza we-cardia, kunye ne-adenocarcinoma eyahluke ngokupheleleyo efumaneka kwimvelaphi ye-HP-negative.
3. Isishwankathelo
Namhlanje ndifunde ulwazi olufanelekileyo kunye nokubonakaliswa kwe-endoscopic ye-HP-negative gastric cancer.Ikakhulu ibandakanya: uhlobo lwedlala lomhlaza wesisu, uhlobo lomhlaza wesisu se-fundic gland mucosal, i-gastric adenoma, (i-raspberry-like) ithumba le-foveolar epithelial kunye ne-signet ring cell carcinoma.
Izehlo zekliniki zomhlaza wesisu we-HP-negative ziphantsi, kunzima ukukugweba, kwaye kulula ukuphosakela ukuxilongwa.Yintoni enzima ngakumbi ukubonakaliswa kwe-endoscopic yezifo ezinzima kunye nezinqabileyo.Kufuneka kwakhona iqondwe kumbono we-endoscopic, ngakumbi ulwazi lwethiyori emva kwayo.
Ukuba ujonga i-polyps yesisu, ukhukuliseko, kunye neendawo ezibomvu nezimhlophe, kufuneka ucinge ukuba kunokwenzeka umhlaza wesisu se-Hp-negative.Isigwebo se-HP esingalunganga kufuneka sihambelane nemigangatho, kwaye ingqalelo kufuneka ihlawulwe kwizinto ezingalunganga ezibangelwa ukuthembela kakhulu kwiziphumo zovavanyo lokuphefumula.Ii-endoscopists ezinamava zithembela ngakumbi amehlo azo.Ukujongana nethiyori eneenkcukacha emva kwe-HP-negative gastric cancer, kufuneka siqhubeke nokufunda, ukuqonda kunye nokuziqhelanisa ukuze siphumelele.
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Ixesha lokuposa: Jul-12-2024