Mapolyps emudumbu chirwere chinowanzoitika uye chinowanzoitika mu gastroenterology. Anoreva kubuda kwemukati medumbu kwakanyanya kupfuura mucosa yemudumbu. Kazhinji, colonoscopy ine mwero wekuona weinenge 10% kusvika 15%. Kuwanda kwechirwere ichi kunowanzowedzera nekukura. Sezvo anopfuura 90% ekenza yemudumbu ichikonzerwa nekuchinja kwemapolyps, kurapwa kwakajairika ndekwekubvisa endoscopic resection nekukurumidza kana mapolyps aonekwa.
Mukurapa colonoscopy yezuva nezuva, 80% kusvika 90% yemapolyps ari pasi pe1 cm. Kune adenomatous polyps kana polyps ane urefu hwe ≥ 5 mm (ingave adenomatous kana kwete), kuvhiyiwa kwe endoscopic resection kunokurudzirwa. Mikana ye micropolyps yekoloni (dhayamita yekureba ≤5mm) ine zvikamu zvebundu yakaderera zvikuru (0~0.6%). Kune micropolyps iri mu rectum ne sigmoid colon, kana endoscopist ikakwanisa kuona nemazvo kuti haisi polyps ye adenomatous, hapana chikonzero chekuvhiyiwa, asi maonero ari pamusoro apa haawanzo shandiswa mukurapa muChina.
Pamusoro pezvo, 5% yemapolyps akati sandara kana kuti anokura ari padivi, ane dhayamita inopfuura 2 cm, ane kana asina zvinhu zvinokuvadza. Muchiitiko ichi, mamwe maitiro epamusoro ekubvisa polyp endoscopic anodiwa, akadai seEMRuyeESDNgatitarisei matanho akadzama ekubvisa polyp.
Maitiro ekuvhiya
Murwere akapedza kuongororwa kweanesthesia asati avhiyiwa, akaiswa panzvimbo yekuruboshwe ye decubitus, uye akapihwa anesthesia yemutsinga ine propofol. Kumanikidzwa kweropa, kurova kwemoyo, electrocardiogram, uye oxygen yakawanda yeropa zvakaongororwa panguva yekuvhiyiwa.
1 Kutonhora/KupisaMaforceps eBiopsyChikamu
Yakakodzera kubviswa kwemasero madiki ≤5mm, asi panogona kunge paine dambudziko rekubvisa kwemasero asina kukwana 4 kusvika 5mm. Zvichibva pa biopsy inotonhora, biopsy inodziya inogona kushandisa high-frequency current kuuraya maronda akasara uye kurapa hemostasis paronda. Zvisinei, kungwarira kunofanira kuitwa kudzivirira kukuvara kweserosa layer yemadziro emudumbu nekuda kweelectrocoagulation yakawandisa.
Panguva yekuvhiyiwa, musoro wepolyp unofanira kusungwa, kusimudzwa zvakakodzera (kudzivirira kukuvadza tsandanyama), uye kuchengetwa kure nemadziro emudumbu. Kana pedicle yepolyp yashanduka kuva chena, mira electrocoagulation uye sunga ronda racho. Zvinofanira kucherechedzwa kuti hazvisi nyore kubvisa polyp yakakura zvakanyanya, zvikasadaro zvichawedzera nguva yekuisa magetsi uye kuwedzera njodzi yekukuvadzwa nekukora kwakazara (Mufananidzo 1).
2 Kutonhora/kupisamusungo we polypectomynzira yekubvisa
Yakakodzera maronda akakwidziridzwa ehukuru hwakasiyana hweI p, I sp uye diki (<2cm) I s type (matanho chaiwo ekuisa muzvikamu anogona kureva kuonekwa kwekenza yemudumbu kuburikidza ne endoscopic. Kune mhando dzakawanda uye handizivi kuti ndotonga sei? Chinyorwa chino Zvijekese) Kubviswa kwemaronda. Kune maronda madiki eIp, kubviswa kwemaronda kuri nyore. Maronda anotonhora kana anopisa anogona kushandiswa kubviswa. Panguva yekubvisa, kureba kwepedicle kunofanirwa kuchengetwa kana chinhambwe chakati kubva pamadziro emudumbu uku uchivimbisa kubviswa kwakazara kweronda. Mushure mekusunga musungo, unofanirwa kuzununguswa Musungo, tarisa kana paine mucosa yemudumbu yakapoteredza uye uiise pamwe chete kudzivirira kukuvara kumadziro emudumbu.
Mufananidzo 1. Dhayagiramu yekubvisa forceps mu thermal biopsy, A usati wabvisa forceps, B ronda mushure mekubvisa forceps. CD: Nzira dzekudzivirira pakupisasimba re biopsykubviswa. Kana polyp yakakura zvakanyanya, inowedzera nguva ye electrocoagulation uye inokonzera kukuvara kwe transmural.
Mufananidzo 2. Dhiyagiramu yekuongorora kubviswa kwemusungo wekupisa kwezvironda zvidiki zverudzi rweI sp
3 EMR
■Zvironda zveI p
Kune maronda makuru eIp, pamusoro penzira dzekudzivirira dzataurwa pamusoro apa, misungo yekupisa inofanira kushandiswa pakuvhiya. Usati wavhiya, jekiseni rakakwana resubmucosal rinofanira kuitwa pasi pepedicle (2 kusvika ku10 mL ye10,000 units ye epinephrine + methylene blue + physiological. Musanganiswa wesaline unopinzwa pasi pemucosa (baya jekiseni uchibvisa tsono), kuitira kuti pedicle ikwire zvakakwana uye ive nyore kubvisa (Mufananidzo 3). Munguva yekuvhiya, gomarara rinofanira kudzivirira kusangana nemadziro emudumbu kudzivirira kugadzira denderedzwa rakavharwa uye kupisa madziro emudumbu.
Mufananidzo 3. Dhayagiramu yechirongwa cheEMRkurapwa kwezvironda zvemhando yeLP
Zvinofanira kucherechedzwa kuti kana polyp yakakura yerudzi rweI p ine pedicle yakakora, inogona kunge iine vasa vasorum hombe, uye inobuda ropa zviri nyore mushure mekubviswa. Munguva yekubviswa kwemasero, nzira yekubatanidza ropa nekucheka-kucheka inogona kushandiswa kuderedza njodzi yekubuda ropa. Mamwe mapolyp makuru anogona kubviswa muzvidimbu kuti kuderedze kuoma kwekuvhiyiwa, asi nzira iyi haibatsiri pakuongorora pathological.
■maronda erudzi rwella-c
Kune maronda erudzi rweIla-c uye mamwe maronda eIs ane dhayamita yakakura, kubviswa kwetsvimbo zvakananga kunogona kukonzera kukuvara kwakazara. Kupinza mvura mu submucosal kunogona kuwedzera kureba kweronda uye kuderedza kuoma kwetsvimbo nekubvisa. Kana paine kubuda panguva yekuvhiyiwa hwaro hwakakosha hwekuona kana adenoma isina njodzi kana yakaipa uye kana paine zviratidzo zvekurapa endoscopic. Nzira iyi inogona kuwedzera mwero wekubvisa adenomas zvachose.<2cm mudhayamita.
Mufananidzo 4EMRchati yekuyerera kwekurapa kwerudzi rwe Il a polyps
4 ESD
Kune adenomas dzine dhayamita inodarika 2cm dzinoda kubviswa kamwe chete uye chiratidzo chekusimuka, pamwe nemamwe magomarara ekutanga,EMRzvisaririra kana kudzoka kwezvirwere zvakaoma kurapa,ESDKurapwa kunogona kuitwa. Matanho akajairika ndeaya:
1. Mushure mekucheneswa kwemavara e endoscopic, muganhu wechironda unotsanangurwa zvakajeka uye denderedzwa racho rinonyorwa (chironda chingasanyorwa kana muganhu wechironda wakajeka).
2. Jekiseni pasi peganda kuti maronda acho abude pachena.
3. Kucheka mucosa zvishoma kana kuti zvakatenderedza kuti submucosa ionekwe.
4. Sunungura jira rinobatana riri pedyo ne submucosa wobvisa jira rine chirwere zvishoma nezvishoma.
5. Tarisa ronda nokungwarira uye rapa tsinga dzeropa kudzivirira matambudziko.
6. Mushure mekugadzirisa sampuli dzakabviswa, dzitumirei kuti dziongororwe pathological specimens.
Mufananidzo 5ESDkurapwa kwemaronda makuru
Nzira dzekudzivirira panguva yekuvhiyiwa
Kubviswa kwepolyp muura kunoda nzira yakakodzera kuti isarudze zvichienderana nehunhu hwepolyp, nzvimbo, hunyanzvi hwemushandisi, uye michina iripo. Panguva imwe chete, kubviswa kwepolyp kunoteverawo misimboti yakafanana, yatinofanira kutevedzera zvakanyanya sezvinobvira kuti tive nechokwadi chekuti nzira yekurapa yakachengeteka uye inoshanda uye varwere vanobatsirwa nayo.
1. Kugadzirira chirongwa chekurapa ndicho chinhu chikuru chinoita kuti kurapwa kwepolyp kubudirire (kunyanya polyps hombe). Kune polyps dzakaoma, zvakakosha kusarudza nzira inoenderana yekuvhiya usati warapwa, kutaurirana nevanamukoti, vanachiremba veanesthesia nevamwe vashandi nenguva, uye kugadzirira michina yekurapa. Kana mamiriro ezvinhu achibvumira, inogona kupedzwa pasi pekutungamirirwa kwachiremba mukuru wezvekurapa kudzivirira tsaona dzakasiyana-siyana dzekuvhiya.
2. Kuchengetedza "rusununguko" rwakanaka pamuviri wegirazi panguva yekurapwa ndicho chinhu chinodiwa kuti uve nechokwadi chekuti chinangwa chekuvhiya chazadzikiswa. Paunopinda mugirazi, tevera "nzira yekuchengetedza nekupfupisa axis" kuti uchengetedze nzvimbo yekurapa isina denderedzwa, izvo zvinobatsira kurapwa kwakanyatsojeka.
3. Kuona zvakanaka mashandiro kunoita kuti kurapwa kuve nyore uye kwakachengeteka. Matumbu emurwere anofanira kugadzirirwa nokungwarira asati arapwa, nzvimbo yemurwere inofanira kucherechedzwa asati avhiyiwa, uye mapolyps anofanira kuratidzwa zvizere negiravhiti. Kazhinji zviri nani kana gomarara riri kune rimwe divi remvura yasara mudumbu.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., tinogadzira zvinhu muChina zvine chekuita ne endoscopic consumables, zvakaita sesimba re biopsy, hemoclip, musungo wepolyp, tsono yekurapa sclerotherapy, katheta yekupfapfaidza, mabhurashi e cytology, waya yekufambisa, tswanda yekutorwa kwematombo, katheta yekubuditsa mvura yemumhinonezvimwewo zvinoshandiswa zvakanyanya muEMR, ESD, ERCPZvigadzirwa zvedu zvakanyoreswa neCE, uye mafekitori edu akanyoreswa neISO. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East nedzimwe nzvimbo dzeAsia, uye zviri kuita kuti mutengi azivikanwe uye arumbidzwe zvikuru!
Nguva yekutumira: Nyamavhuvhu-02-2024