Endoscopic kurapwa kwetsitsi submucosal yeiyo yekugaya turakiti: 3 mapoinzi makuru akapfupikiswa mune imwe nyaya

Submucosal tumors (smt) yegastrointestinal turakiti rakakwiridzirwa Nekuvandudzwa kwehunyanzvi hwekurapa, sarudzo dzechinyakare dzekuvhiya dzekuvhiya dzakapinda zvishoma nezvishoma nguva yekubatwa zvishoma kurapwa, senge lAPOSCOPIC Kuvhiya uye Dobotic Kuvhiya. Nekudaro, mumakiriniki maitiro, zvinogona kuwanikwa kuti "kuvhiya" hakuna kukodzera kune vese varwere. Mumakore achangopfuura, kukosha kweEndoscopic kurapwa kwakatambira zvishoma nezvishoma. Iyo yazvino vhezheni yeiyo Chinese nyanzvi kubvumirana pane endoscopic kuongororwa uye kurapwa kweSMT kwasunungurwa. Ichi chinyorwa chichafunda muchidimbu ruzivo rwakakodzera.

1.smt epidemic characteristics

(1) zviitiko zve smT haina kufanana munzvimbo dzakasiyana siyana dzeTurakiti rekugaya, uye dumbu ndiro nzvimbo yakajairika yeSMT.

Chiitiko cheVariouZvikamu zvezvikamu zvekugaya turakiti hazvina kufanana, neiyo yekugaya yekugaya turakiti raizivikanwa. Pane izvi, 2/3 inoitika mudumbu, ichiteverwa neiyo esophagus, duodenum, uye koloni.

(2) iyo hertopathological Mhando dzeSMT dzakaoma, asi vazhinji SMT ibhenji dzakakosha, uye vashoma chete ndivo vanokuvadza.

A.SMT inosanganisira kweteN-neoplastic Lesions yakadai seEctopic pancreatic tishu uye neoplastic lesions.

B.among the neoplastic lesions, gastrointestinal Leiomyga, Lipomas, Brucelsa Cell Tumors, Schanulosa Cell, uye tumors Glomus

C.Gastrointestinal Stromal tumors (gist) uye neurodengacrine tumors (net) mu smt itsvenji nedzimwe inokuvadza kugona, asi izvi zvinoenderana nehukuru hwayo, nzvimbo uye mhando.

D.Nzvimbo yenzvimbo yeSMT ine hukamakuKugadziriswa kwePatOlogical: a. Liomyomas ivhuva patyhological rudzi rwe smt muEsophagus, accounting for 60% kusvika ku80% yeEsophageal smts, uye inowanzoitika zvikamu zvepakati uye zvakadzika zvikwangwani zveSesophagus; B.The marudzi ezasi eGastric smt ana yakaoma kunzwisisa, ine gist, liolomyoma nectopic pancreas kuve kwakanyanya. Pakati peGastric Smt, gist inowanzo kuwanikwa mu fundus uye muviri wedumbu, Liomyoma inowanzo kuwanikwa muMutengo uye chikamu chepamusoro chemuviri, uye Ectop Pancreas neEctop pancreas zvakanyanya. Lipomas akajairika mune gastric antrum; c. Lipomas nemakwenzi akajairika mukuburuka uye zvikamu zvidimbu zve duodenum; d. Mu smt yeiyo yakadzika gastrointestina turakiti, Lipomas inowanzoitika mukoloni, nepo mambure ari predominant mune rectum.

(3) Shandisa CT uye MRI kune giredhi, kubata, uye kuongorora tumors. Zvekuputa izvo zvinofungidzirwa kuti kuve nekukuvadza kana kuve nemapundu makuru (akarebaDIAMETER> 2 CM), CT uye MRI zvinokurudzirwa.

Dzimwe nzira dzekufungidzira, kusanganisira CT uye MRI, ndezve kukosha kukuru kwekuongororwa kweSMT. Vanogona kuratidza zvakananga nzvimbo yejira kuitika, kukura kwehunyanzvi, kukura kwerima, chimiro kana kusavapo kwekuwedzera, kusimba kwehukama, etc., uye inogona kuwana kana iyo degree yehurefuening of the gastrointestinal Wall Wall. Ndidzo nzira huru yemakiriniki grining grading, kurapwa uye prognosis ongororo yematumwa.

(4) tishu sampling haina kutoraInodzorwa kuti isatendekesa smts inogona kuongororwa neyekupedzisira endoscopy yakasanganiswa naEus, senge lipomas, makosi, uye ectspic pancreas.

Zvekurima lentions dzinofungidzirwa kuti kana paine kuwanda kweChechiEedle Aspiration / Biopsy, EUS-FNA / FNB), Mucosal Incision Biopsy (Mucosalincision - Mibsalincisiony, Miab), etc. Ita kuti Biopsy Sampling yekuongorora preopotera Tichifunga nezvezvisingakwanisi zveEUS-FNA uye iyo inotevera kukanganisa kweEndoscopic

Chero nzira yekuwana pathologic line asati avhiya uye ichakuvadza Mucosa kana kukonzeresa kuoma kwekuvhiya uye pamwe nekuwedzera njodzi dzekubuda ropa, Perforation, uye bundu kuperevedza. Naizvozvo, preaperative biopsy hazvidikanwe. Zvinodiwa, kunyanya kune smts izvo zvinogona kuongororwa neChigaro Centerscopy zvakasanganiswa neEUS, senge lipomas, cystoc pancreas, hapana tishu sampling inodiwa.

2.SMT endoscopic chiberekont

(1) nheyo dzekurapwa

Lesions isina Lymph node metastasis kana yakaderera njodzi yeLymph node yeMetastasis, uye uve nenjodzi yekugara uye kudzokorora kwakakodzera kuti iite kuti ibate basa rekupedzisira kana kurapwa kuri madikanwa. Kubviswa kwakazara kwejora kunoderedza bundu rakasara uye njodzi yekudzokorora. The theNheyo yebundo-remahara kurapwa rinofanira kuteverwa panguva yekuzvarwa kweEndoscopic, uye kutendeka kwebundu capsule kunofanirwa kuvezwa panguva yekubikwa.

(2) zviratidzo

i.tumors neakashata kugona kufungidzirwa nekuongororwa kwekunyepedzera kana kusimbiswa ne biipsy pathology, kunyanya avo vanofungidzirwa kuti GiSt nekuongororwa kwekunyepedzera kweiyo bundu renyama ye č2cm uye njodzi yakaderera yekudzokorora uye metastasis, uye pamwe nekureba kwakakwana, kunogona kuve kwakawedzera kuganhurirwa; Kune tumors ine refu diameter yekufungidzira yakaderera-njodzi gist> kutongwa.

Ii. Chiratidzo (semuenzaniso, kubuda ropa, chipinganidzo) smt.

III.Vatoresi vane tumors vanofungidzirwa kuti vakanyengedzwa nekuongororwa kana kusimbiswa neParthology, asi vasingakwanisi kuteverwa nguva nenguva kana vatove vane nguva pfupi yenguva panguva yekutevera uye vane dhiziri rakasimbae e e endoscopic kurapwa.

(3) kukanganisa

Ini. Ziva maronda aneniinoraswa kune lymph node kana nzvimbo dziri kure.

Ii. Kune vamwe smt ine yakajeka lymphnodekana kure kure metastasis, bulk biopsy inodikanwa kuti uwane zvidzidzo, izvo zvinogona kutariswa sekudyidzana kwehama.

III. Mushure mekutsanangurwa kwakadzamaKuongorora, kwakatemwa kuti mamiriro emafuro ane urombo uye anovhiya zvekuvhiya hazvigoneke.

Benjies Lesions seLipoma neEctopic pancreas kazhinji haikonzeri zviratidzo zvakadai sekurwadziwa, kubuda ropa, uye kuvhiringidzika. Kana sMT anoratidza kugumisa, ulcer, kana nekukurumidza kuwedzera munguva pfupi, mukana wazvo uri maronda akaipa anowedzera.

(4) Sarudzo yeTection Nzirad

Endoscopic snare tsika: NekutiSMT izvo zvakaringana, proturu muzvikamu zvakatsanangurwa neyekutsiva neEUS uye CT bvunzo, uye zvinogona kuve zvakazara pane imwe nguva uine musungo, endoscopic snire basa rinogona kushandiswa.

Zvidzidzo zvoga uye zvidzidzo zvekunze zvakasimbisa kuti zvakachengeteka uye zvinoshanda mune yepamusoro smt <2CM, ine njodzi yekubuda ropa ye4% kusvika 13% uye kufungidziranjodzi ye2% kusvika 70%.

Endoscopic submucosal kuchera, eese: ye smts nehurefu hwakaenzanaPamhepo protrudes mu cavity, eese inoenderana neye endoscopic sleeve basa rekutsoropodza smts.

Atse anotevera tsika dzehunyanzvi hweEndecopic Submucosal Disced , Kuti uwane chinangwa chekuchengetedza kutendeka kwebunako, kuvandudza runyararo rwekuvhiya, uye kuderedza zvinetso zvinopesana. Kune tumors ≤1.5 cm, chiyero chakazara chezana zana muzana chinogona kuwanikwa.

Submucosal tunneling endoscopic fundoIon, ster: for smt inotangira kubva kuMuscularis propria muEsophagus, Hilum Curtum uye rectric yeTunnels, uye iyo Crameter's Dighm, Ster Cm, ster inogona kuve nzira yakati wandei yekurapa.

STER ICHI CHINANGWA CHINANGWA CHEMA RINOGONESWA ZVINOGONESWA PAMUSORO PENYAYA YEMAHARA ESOPOGEL SPHINCTERTETETETETETETE (nhetembo) uye ndeyekuwedzera kwesd technology. Iyo en bloc tsika yekugadzirisa ye sper ye smt yekurapa inosvika 84.9% kusvika 97.59%.

Endoscopic yakazara-gobvu lecknessctIon, EFTR: Inogona kushandiswa yeSMT uko kwakaoma kutanga mugero kana apo iyo yakakwira transverse diamita ndeye ≥3.5 cm uye haina kukodzera ster. Kana iyo tumor ichitungidza pasi pepepuru membrane kana kuti inokura kunze kwechikamu checavity, uye bundu rikawanikwa rakanyatsoenderana neSerosa layer panguva yekuvhiya uye haigone kuparadzaniswa, inogona kushandiswa. EFTR inoita inoita seyoscopic kurapwa.

Kubvumidzwa kwakakodzera kweiyo ferforationSaiti mushure mekunge Eftr ndiyo kiyi yekubudirira kweEFTR. Kuti uongorore chaizvo njodzi yekudzokorora bundu uye kuderedza njodzi yekupindirana, haina kukurudzirwa kucheka uye kubvisa iyo yakagadzirirwa tumor fungidziro panguva yeEFTR. Kana zvichidikanwa kubvisa bundu kuita zvidimbu, kufungisisa kunoda kugadziriswa kutanga kuderedza njodzi yebundu nekupararira. Dzimwe nzira dzekutengesa dzinosanganisira: Simbi Clip Suture, kurongedza clip Suture Turnnique, Otsc

(5) Zvinotarisirwa zvakatarisana

Intraoperative kubuda ropa
Kuti udzivise kubhuroka kukuru kwemukati.Yakakwana submucosal jekiseni inofanirwa kuitwa panguva yekushanda kufumura mibairo yakakura yeropa uye inofambisa magetsi emagetsi kuti arege kubuda ropa. Bhuroka rinopinda ropa rinogona kurapwa nemapanga akasiyana-siyana kana masimba masimbi, uye kudzivirira maHastasis yemidziyo yeropa inowanikwa panguva yekupararira.

Postopengerative kubuda ropa Mune zviitiko zvikuru, hemorrhagic kuvhunduka kunogona kuitika. Izvo zvinonyanya kuitika mukati mevhiki 1 mushure mekuvhiyiwa, asi zvinogonawo kuitika 2 kusvika mana vhiki mushure mekuvhiyiwa.

Postoperative kubuda ropa kunowanzoenderana neZvinhu zvakadai sebarire reropa rekumanikidza kudzora kudzora uye kuparadzira kwemidziyo yeropa yakasara ne gastric acid. Mukuwedzera, kubuda ropa kwepamutemo kunoenderana nenzvimbo yechirwere, uye kwakajairika mune gastric antrum uye yakaderera rectum.

Kunonoka kufungidzirwa: Kazhinji kuratidzira kushomeka kwemudumbu, sekuwedzera kushungurudzika kwemidziyo, zviratidzo zvepfuma, uye kufungidzira kuongorora kwegasi kuunganidzwa kana kuwedzerwa gasi kuunganidzwa kwakaenzaniswa.

Izvo zvinonyanya kurondedzera nezvinhu zvakadai sekutengesa zvisina kunaka kwemaronda, zvakanyanyisa magetsi, zvichimhanya zvakanyanya kuti ufambe, kudya kweruzhinji kweruzhinji, uye kugura maronda ne gastric acid. a. Kana ronda racho rakakura kana rakadzika kana ronda rine fisChokwadi-sekuchinja, nguva yekuzorora nguva uye nguva yekutsanya inofanira kunge yakaenzana uye gastrointestinal decompres inofanira kuitwa mushure mekuvhiyiwa (varwere vakadzika egastrointestinal yekuvhiya kunofanirwa kuve neAnal Canage); b. Varwere vane chirwere cheshuga vanofanirwa kudzora zvishoma ropa ravo reropa; Avo vane zvidiki zvidiki uye zvine hutachiona hwepedyo uye mudumbu zvine hutachiona vanofanira kupihwa kurapwa kwakadai sekutsanya, hutachiona hwehutachiona, uye kusarudzika acid; c. Kune avo vane fungidziro, yakavharwa chipfuva chechipfuva uye mudumbu matumbu anogona kuitwa machubhu anofanira kuiswa kuti arambe akaomarara; d. Kana hutachiona husingakwanisi kurapwa mushure mekurapa kwekuchengetedza kana kusanganiswa neyakaomeswa thoracoabina hutachiona, kuvhiya laparoscopy kunofanirwa kuitwa nekukurumidza, uye kugadziriswa kwesimba uye kudhirowa mudumbu zvinofanirwa kuitwa.

Zvinyorwa zvegesi zvine chekuita negesi: kusanganisira subcutaNeous emphysema, pneum oumastinum, pneumothorax uye pneumoperitoneum.

Intraoperative subcutaneous emphysema (inoratidzwa se emphysema pachiso, mutsipa, chest wall, uye scrotum) uye yemutungamiriri pneumophysema (sWelling of epiglottis inogona kuwanikwa panguva yeGastroscopy) kazhinji haidi kurapwa kwakakosha, uye emphysema ichatsunga pachayo.

Severe pneumothorax inoitika DKuvhiringidza Kuvhiya [Kurudziro ye Airway inodarika 20 mmhg panguva yekuvhiya

.inage.

Kune varwere vaine pachena pneumoperitoneum panguva yekushanda, shandisa pneumoperitoneum sindano yekuisa iyo McFarland PointMumadhadha akadzika akadzika kuti asvibise mhepo, uye siya sindano ye puncle munzvimbo kusvika kumagumo ekuvhiya, obva abvisa mushure mekusimbisa kuti hapana gasi riri pachena rinodzingwa.

Gastrointestinal Fistula: Digestive Fluid inokonzerwa nekuvhiya kwekupedzisira kunoyerera muchipfuva kana mudumbu mudumbu kuburikidza nekukwira.
Esophagel Medristinal Fistulas uye Esophagothoracic Fistulas yakajairika. Kamwe chete fistula ikaitika, ita yakavharwa chipfuva kudhirowa kune maintaMudururu rakatsetseka uye upe rutsigiro rwakakwana rwehutano hwekutsigira. Kana zvichidikanwa, zvesimbi masendimita uye zvishandiso zvakasiyana-siyana zvekuvhara zvinogona kushandiswa, kana chifukidzo chizere chinogona kudzoreredzwa. Stents uye dzimwe nzira dzinoshandiswa kuvhara iyofistula. Zviitiko zvakakura zvinoda kukurumidza kupindira.

3.Postoperative Management (Follow-up)

(1) Benign Lesions:Pathology SZvidzamasi izvo zvinorema maronda senge lipoma uye leiomyoma hazvidi zvekumanikidza nguva dzose.

(2) smt pasina malignAns Ant:Semuenzaniso, masertal net 2cm, uye yepakati- uye yakakwirira-njodzi gisting inofanira kuitwa uye nekuwedzera kurapwa (kuvhiya, chemoradyrapy. kurapa). Kuumbwa kwehurongwa kunofanirwa kuve kwakavakirwa pakubata multidisciprary uye pane imwe chete.

(3) akaderera anokuvadza anogona kunge ari SMT:Semuenzaniso, yakaderera-njodzi gist inoda kuongororwa naEus kana kufungidzira wega wega mwedzi kusvika gumi nemaviri mushure mekurapwa, uye wobva wabatwa maererano nemirairo yekiriniki.

(4) Smt neyevhi uye yakakwirira inokuvadza inogona:Kana postoperative pathology inosimbisa Type 3 Gastric Net, Colorel net nehurefu> 2CM kurapa). Kuumbwa kwehurongwa kunofanirwa kuve kwakavakirwa pane[About US 011.Docx] Multidisciplinary Kukurukurirana uye pane imwe chete.