Colon polyps chirwere chakajairika uye chinowanzoitika-chinoitika mugastroenterology. Vanotaura nezve intraluminal protrusions iyo yakakwirira kudarika intestinal mucosa. Kazhinji, colonoscopy ine mwero wekuona weinenge 10% kusvika 15%. Chiyero chechiitiko chinowanzowedzera nezera. simuka. Sezvo inopfuura 90% yecancer colorectal ichikonzerwa nekuchinja kwakashata kwemapolyps, kurapwa kwese kuita endoscopic resection kana ma polyps angoonekwa.
Mucolonoscopy yezuva nezuva, 80% kusvika 90% yepolyps isingasviki 1 cm. Kune adenomatous polyps kana polyps ane kureba ≥ 5 mm (ingava adenomatous kana kwete), elective endoscopic resection inokurudzirwa. Iko mukana wecolon micropolyps (kureba dhayamita ≤5mm) ine bundu zvikamu zvakaderera zvakanyanya (0~0.6%). Nokuti micropolyps ari rectum uye sigmoid colon, kana endoscopist anogona zvakarurama kuona kuti vasiri adenomatous polyps, hapana chikonzero Resection, asi pamusoro pfungwa haawanzoitwa mukiriniki kudzidzira muChina.
Pamusoro pezvo, 5% yepolyps yakati sandara kana kukura nedivi, ine dhayamita inopfuura 2 cm, ine kana isina zvinhu zvinokuvadza. Muchiitiko ichi, mamwe emhando yepamusoro endoscopic polyp ekubvisa maitiro anodiwa, sengeEMRuyeESD. Ngatitarisei matanho akadzama ekubvisa polyp.
Kuvhiya nzira
Murwere akapedza preoperative anesthesia assessment, akaiswa kuruboshwe lateral decubitus position, uye akapiwa intravenous anesthesia ine propofol. Kuwedzerwa kweropa, kurova kwemwoyo, electrocardiogram, uye peripheral blood oxygen saturation zvakaongororwa panguva yekuvhiyiwa.
1 Kutonhora/KupisaBiopsy ForcepsDivision
Inokodzera kubviswa kwemapolyps madiki ≤5mm, asi panogona kunge paine dambudziko rekubviswa kusina kukwana kwemapolyps 4 kusvika 5mm. Pahwaro hwekutonhora biopsy, thermal biopsy inogona kushandisa yakakwira-frequency ikozvino kukonzeresa maronda asara uye kuita hemostasis kurapwa pachironda. Nekudaro, kuchenjerera kunofanirwa kutorwa kudzivirira kukanganisa kune serosa layer yemukati memadziro nekuda kwekuwandisa kwe electrocoagulation.
Panguva yekuvhiyiwa, musoro wepolyp unofanirwa kusungirirwa, kusimudzwa zvakakodzera (kudzivisa kukuvadza mhasuru), uye kuchengetwa pachinhambwe chakakodzera kubva kumadziro emukati. Kana iyo polyp pedicle ikaita chena, mira electrocoagulation uye sunga ronda racho. Zvinofanira kucherechedzwa kuti hazvisi nyore kubvisa yakawandisa polyp, zvikasadaro zvichawedzera nguva yemagetsi uye kuwedzera njodzi yekuzara-ukobvu kukuvara (Mufananidzo 1).
2 Kutonhora/kupisapolypectomy musungokubvisa nzira
Inokodzera maronda akasimudzwa emhando dzakasiyana-siyana I p type, I sp type uye duku (<2cm) I s type (specific classification standards inogona kureva endoscopic yekuona kenza yepakutanga yegomba rekudya. Kune marudzi akawandisa uye ini handizivi kutonga? Ichi chinyorwa Itai kuti zvive pachena) Resection of maronda. Kune diki mhando Ip maronda, musungo resection iri nyore. Misungo inotonhora kana inopisa inogona kushandiswa kugadzirisa. Panguva yekugadziriswa, imwe nguva yakareba ye pedicle inofanira kuchengetwa kana imwe nzvimbo kubva pamadziro emukati paunenge uchiona kubviswa kwakakwana kwechirwere. Mushure mekusimbisa musungo, inofanira kuzununguswa Musungo, cherechedza kana kune yakakomberedza yakajairika intestinal mucosa uye uiise pamwe chete kudzivirira kukanganisa kumadziro emukati.
Mufananidzo 1 Schematic dhayagiramu ye thermal biopsy forceps kubviswa, A isati yabviswa simba, B ronda mushure mekubviswa kweforce. CD: Chengetedzo yekupisabiopsy forcepskubviswa. Kana iyo polyp yakakura kwazvo, inowedzera nguva ye electrocoagulation uye kukonzera transmural kukuvara.
Mufananidzo 2 Schematic dhayagiramu yekupisa kwemusungo resection yediki I sp mhando maronda
3 EMR
■ I p maronda
Kune makuru I p maronda, kunze kwezvidziviriro zviri pamusoro apa, misungo inopisa inofanira kushandiswa pakugadzirisa. Pamberi pekugadzirisa, jekiseni yakakwana ye submucosal inofanira kuitwa pasi pe pedicle (2 kusvika 10 mL ye10,000 units epinephrine + methylene blue + physiological Mushonga we saline unopindwa pasi pemucosa (jekiseni paunenge uchibvisa tsono), kuitira kuti pedicle yakasimudzwa zvakakwana uye iri nyore kubvisa (Mufananidzo 3 wekudzivirira kutarisana nemadziro, panguva yeresesion inofanira kudzivisa kusangana). kugadzira chivharo chakavharwa uye kupisa madziro emukati.
Mufananidzo 3 Schematic diagram yeEMRkurapwa kwe-lp-type maronda
Izvo zvinofanirwa kucherechedzwa kuti kana yakakura mhando I p polyp ine gobvu pedicle, inogona kunge ine hombe vasa vasorum, uye inobuda ropa nyore mushure mekubviswa. Panguva yekuita resection, iyo coagulation-cut-coagulation nzira inogona kushandiswa kuderedza njodzi yekubuda ropa. Mamwe mapolyp akakura anogona kudzokororwa muzvidimbu kuti aderedze kuoma kwekushanda, asi nzira iyi haigone kuongororwa kwepathological.
■ lla-c mhando maronda
Kune maronda emhando yeIla-c uye mamwe maIs maronda ane madhayamita akakura, kureba kwakananga musungo kunogona kukonzera kukanganisa kwakazara. Submucosal jekiseni remvura rinogona kuwedzera kureba kweronda uye kuderedza kuoma kwemusungo uye resection. Pasinei nokuti pane kuputika panguva yekuvhiyiwa ndiyo nheyo inokosha yekuona kana adenoma iine benign kana yakaipa uye kana pane zviratidzo zve endoscopic treatment. Iyi nzira inogona kuwedzera yakakwana resection rate yeadenomas<2cm kureba.
Mufananidzo 4EMRkurapwa kuyerera chati yemhando Il a polyps
4 ESD
Kune adenomas ane dhayamita yakakura kupfuura 2cm inoda kudzokororwa kamwe chete uye chiratidzo chisina kunaka chekusimudza, pamwe nemamwe magomarara ekutanga,EMRzvakasara kana kudzoka zvakare zvakaoma kurapa,ESDkurapwa kunogona kuitwa. Matanho akajairika ndeaya:
1. Mushure mekusvibiswa kwe endoscopic, muganhu wechironda unotsanangurwa zvakajeka uye denderedzwa rinotaridzirwa (chironda hachigoni kuiswa kana muganhu wechironda chiri pachena).
2. Inject submucosally kuita maronda pachena kusimudzwa.
3. Muchidimbu kana circumferentially incise mucosa kuratidza submucosa.
4. Sunungura chidimbu chekubatanidza pamwe chete ne submucosa uye zvishoma nezvishoma bvisa chirwere chinorwara.
5. Nyatsocherechedza chironda chacho uye chengetedza tsinga dzeropa kudzivirira matambudziko.
6. Mushure mekugadzirisa zvienzaniso zvakagadziriswa, zvitumire kune pathological kuongororwa.
Mufananidzo 5ESDkurapwa kwemaronda makuru
Intraoperative precautions
Endoscopic colon polyp resection inoda nzira yakakodzera kuti isarudzwe zvichienderana nemhando yepolyp, nzvimbo, hunyanzvi hwemushandisi, uye midziyo iripo. Panguva imwecheteyo, kubviswa kwepolyp kunoteverawo misimboti yakajairwa, iyo yatinofanira kutevedzera zvakanyanya sezvinobvira kuti tive nechokwadi chekuti nzira yekurapa yakachengeteka uye inoshanda uye varwere vanobatsirwa nayo.
1. Kufanogadzwa kwechirongwa chekurapa ndicho kiyi yekubudirira kupedzwa kwepolyp kurapwa (kunyanya polyps yakakura). Kune yakaoma polyps, zvinodikanwa kusarudza inoenderana resection nzira usati warapwa, kutaurirana nevanamukoti, anesthesiologists uye vamwe vashandi panguva yakakodzera, uye kugadzirira michina yekurapa. Kana mamiriro ezvinhu achibvumira, inogona kupedzwa pasi pekutungamirirwa nachiremba mukuru kudzivirira njodzi dzakasiyana-siyana dzekuvhiya.
2. Kuchengeta yakanaka "dhigirii rerusununguko" pagirazi muviri panguva yekurapa ndicho chinhu chinodiwa kuti uve nechokwadi chekuti chinangwa chekuvhiya chazadziswa. Paunenge uchipinda mugirazi, nyatsotevera "axis kuchengetedza uye kupfupisa nzira" kuchengetedza nzvimbo yekurapa munzvimbo isina loop, iyo inobatsira kurapwa chaiko.
3. Kuona kwakanaka kwekushanda kunoita kuti nzira yekurapa ive nyore uye yakachengeteka. Matumbu emurwere anofanira kunyatsogadzirirwa asati arapwa, nzvimbo yemurwere inofanira kuonekwa isati yavhiyiwa, uye mapolyps anofanira kunyatsoratidzwa negiravhiti. Kazhinji zviri nani kana chironda chiri kune rumwe rutivi rwemvura yakasara mumatumbo emukati.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., inogadzira muChina inyanzvi mune endoscopic consumables, senge.biopsy forceps, hemoclip, polyp musungo, sclerotherapy tsono, pfapfaidza catheter, cytology brushes, guidewire, dombo rekudzosa tswanda, nasal biliary drainage catheteretc. ayo anoshandiswa zvakanyanya muEMR, ESD, ERCP. Zvigadzirwa zvedu ndezveEC Certified, uye zvidyarwa zvedu ISO certified. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East uye chikamu cheAsia, uye zvakanyanya kuwana mutengi wekuzivikanwa nekurumbidzwa!
Nguva yekutumira: Aug-02-2024