Pakati peruzivo rwakakurumbira nezvegomarara rekutanga remudumbu, pane zvimwe zvinhu zvisingawanzoitiki zveruzivo rwezvirwere zvinoda kutarisirwa zvakanyanya uye kudzidza. Chimwe chazvo igomarara remudumbu risina HP. Pfungwa ye "matumbu emudumbu asina utachiona" yava kufarirwa zvakanyanya. Pachava nemafungiro akasiyana panyaya yezita. Dzidziso iyi yezviri mukati inonyanya kubva pane zviri mukati zvine chekuita nemagazini inonzi "Stomach and Intestine", uye zita racho rinoshandisawo "gomarara remudumbu risina HP".
Rudzi urwu rwemaronda rune hunhu hwekuti haruwanzoitiki, kuoma kuziva, ruzivo rwakaoma rwedzidziso, uye maitiro akareruka eMESDA-G haashande. Kudzidza ruzivo urwu kunoda kutarisana nematambudziko.
1. Ruzivo rwekutanga nezvegomarara remudumbu risingashande zvakanaka (HP-negative cancer)
Nhoroondo
Kare, zvaitendwa kuti chinhu chimwe chete chinokonzera kenza yemudumbu kwaiva hutachiona hweHP, saka modhi yekare yekenza ndeye HP - atrophy - intestinal metaplasia - bundu diki - bundu rakawanda - kenza. Modhi yekare yagara ichizivikanwa, ichigamuchirwa uye ichitendwa zvakasimba. Mabundu anokura pamwe chete zvichibva paatrophy uye pasi pesimba reHP, saka kenza inowanzokura mumatumbu emudumbu asina kusimba uye mudumbu remudumbu risina kusimba.
Gare gare, vamwe vanachiremba vakaona kuti kenza yemudumbu inogona kuitika kunyangwe pasina hutachiona hweHP. Kunyangwe huwandu hwevanhu vanobatwa nechirwere ichi huri pasi, zvinokwanisika. Rudzi urwu rwekenza yemudumbu runonzi HP-negative gastric cancer.
Nekunzwisisa zvishoma nezvishoma rudzi urwu rwechirwere, ongororo dzakadzama dzakarongwa uye pfupiso dzakatanga, uye mazita ari kuchinja nguva dzose. Paiva nenyaya muna 2012 yainzi "Gastric Cancer after Sterilization", nyaya muna 2014 yainzi "HP-negative Gastric Cancer", uye nyaya muna 2020 yainzi "Epithelial Tumors Not Infected with Hp". Kuchinja kwezita kunoratidza kunzwisisa kwakadzama uye kwakakwana.
Mhando dzeGland uye Maitiro Ekukura
Kune mhando mbiri huru dzema "fundic glands" ne "pyloric glands" mudumbu:
Matumbu eFundic (oxyntic glands) anopararira mufundus, muviri, makona, nezvimwewo zvemudumbu. Idzi inhengo dzine tubular imwe chete. Dzinoumbwa nemasero emucous, masero makuru, masero eparietal uye masero eendocrine, rimwe nerimwe rinoita mabasa aro. Pakati pawo, masero makuru. Mavara ePGI neMUC6 akabudiswa aive akanaka, uye masero eparietal akaburitsa hydrochloric acid uye intrinsic factor;
Ma "pyloric glands" ari munzvimbo yedumbu uye anoumbwa nemasero e "mucus" nemasero e "endocrine". Masero e "mucus" ane MUC6 positive, uye masero e "endocrine" anosanganisira masero eG, D nemasero e "enterochromaffin". Masero eG anoburitsa gastrin, masero eD anoburitsa somatostatin, uye masero e "enterochromaffin" anoburitsa 5-HT.
Masero emudumbu nemasero egomarara anowanzoburitsa mapuroteni akasiyana-siyana emudumbu, ayo akakamurwa kuita mapuroteni emudumbu "emudumbu", "emudumbu" uye "akasanganiswa". Kuonekwa kwemudumbu nemukati medumbu kunonzi phenotype kwete nzvimbo chaiyo yemuviri wedumbu nemukati.
Kune mhando ina dzemasero emabundu emudumbu: akazara mudumbu, akazara mudumbu, akazara mudumbu, uye akazara mudumbu. Mabundu anoitika zvichibva pakupararira kwemudumbu kazhinji ndiwo mabundu emudumbu. Magomarara akasiyana anonyanya kuratidza rudzi rwemudumbu (MUC2+), uye magomarara anopararira anonyanya kuratidza rudzi rwemudumbu (MUC5AC+, MUC6+).
Kuziva Hp negative kunoda musanganiswa chaiwo wenzira dzakawanda dzekuongorora kuti uwane ruzivo rwakakwana. Kenza yemudumbu isina HP uye kenza yemudumbu mushure mekuvhiyiwa hutachiona pfungwa mbiri dzakasiyana. Kuti uwane rumwe ruzivo nezve X-ray zviratidzo zvekenza yemudumbu isina HP, ndapota tarisa chikamu chakakodzera chemagazini inonzi "Stomach and Intestine".
2. Zviratidzo zve endoscopic zvegomarara remudumbu reHP-negative
Kuongororwa kwe endoscopic ndiko kunonyanya kutaurwa nezvekenza yemudumbu isina HP. Inonyanya kusanganisira kenza yemudumbu yerudzi rwe fundic gland, kenza yemudumbu yerudzi rwe fundic gland, gastric adenoma, raspberry foveolar epithelial bundu, signet ring cell carcinoma, nezvimwewo. Chinyorwa chino chinotarisa kuratidzwa kwe endoscopic kwekenza yemudumbu isina HP.
1) Fundic gland type gastric cancer
-Maronda machena akakwidziridzwa
fundic gland type gastric cancer
◆Nyaya 1: Maronda machena, akakwidziridzwa
Tsananguro:Kukombama kwemoyo mudumbu, 10 mm, chena, rudzi rweO-lia (rwakafanana neSMT), pasina atrophy kana metaplasia yemudumbu kumashure. Mitsipa yeropa yakaita searbor inogona kuonekwa pamusoro (NBI uye kukura zvishoma)
Kuongororwa (kunosanganiswa nechirwere):U, O-1la, 9mm, fundic gland type gastric cancer, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Maronda machena akatetepa
fundic gland type gastric cancer
◆Nyaya yechipiri: Maronda machena, akati sandara/asina kusimba
Tsananguro:Rusvingo rwepamberi rwe gastric fundic fornix-cardia rwakakombama zvikuru, 14 mm, ruchena, rudzi rwe 0-1lc, rusina atrophy kana intestinal metaplasia kumashure, miganhu isina kujeka, uye dendritic blood vessels dzinoonekwa pamusoro. (NBI ne amplification zvakapfupikiswa)
Kuongororwa (kunosanganiswa nechirwere):U, 0-Ilc, 14mm, fundic gland type gastric cancer, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Maronda matsvuku akakwidziridzwa
fundic gland type gastric cancer
◆Nyaya 3: Maronda matsvuku uye akakwidziridzwa
Tsananguro:Rusvingo rwepamberi rwe great curvature ye cardia rwakareba 12 mm, zviri pachena kuti rutsvuku, rudzi rwe 0-1, rusina atrophy kana intestinal metaplasia kumashure, miganhu yakajeka, uye dendritic blood vessels pamusoro (NBI uye kukura zvishoma)
Kuongororwa (kunosanganiswa nechirwere):U, 0-1, 12mm, fundic gland type gastric cancer, pT1b/SM1 (200μm), ULO, LYO, VO, HMO, VMO
-Chironda chitsvuku, chakati sandara, chakaora mwoyos
fundic gland type gastric cancer
◆Nyaya 4: Maronda matsvuku, akati sandara/asina kusimba
Tsananguro:Rusvingo rwekumashure rwekukombama kukuru kwechikamu chepamusoro chedumbu, 18mm, rutsvuku rwakachenuruka, rudzi rweO-1Ic, hapana atrophy kana metaplasia yemudumbu kumashure, muganhu usina kujeka, hapana dendritic blood vessels pamusoro, (NBI nekukura zvabviswa)
Kuongororwa (kunosanganiswa nechirwere):U, O-1lc, 19mm, fundic gland type gastric cancer, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
kurukura
Varume vane chirwere ichi vakwegura kupfuura vakadzi, uye avhareji yezera ravo iri makore 67.7 ekuberekwa. Nekuda kwehunhu hwenguva imwe chete uye heterochrony, varwere vanoonekwa vaine kenza yemudumbu yerudzi rwefundic gland vanofanirwa kuongororwa kamwe chete pagore. Nzvimbo inonyanya kuwanikwa inzvimbo yefundic gland iri pakati nepamusoro pedumbu (fundus nepakati nepamusoro pemuviri wedumbu). Maronda machena akafanana neSMT anowanzoonekwa muchiedza chichena. Kurapa kukuru ndeyekuongorora EMR/ESD.
Hapana lymphatic metastasis kana kupinda kweropa mutsinga kwakaonekwa kusvika pari zvino. Mushure mekurapwa, zvakakosha kuona kana kuvhiyiwa kwekuwedzera uye kuongorora hukama huripo pakati pechirwere chekenza neHP. Haasi ese magomarara emudumbu erudzi rwefundic gland asina HP.
1) Kenza yemudumbu yeFundic gland
Kenza yemudumbu yeFundic gland
◆Nyaya 1
Tsananguro:Chironda chacho chakakwira zvishoma, uye RAC non-atrophic gastric mucosa inogona kuonekwa yakaipoteredza. Kuchinja nekukurumidza kwechimiro che microstructure ne microvessels zvinogona kuonekwa muchikamu chakasimudzwa cheME-NBI, uye DL inogona kuonekwa.
Kuongororwa (kunosanganiswa nechirwere):Fundic gland mucosal gastric cancer, U zone, 0-1la, 47 * 32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Kenza yemudumbu yeFundic gland
◆Nyaya yechipiri
Tsananguro: Chironda chakati sandara pamadziro epamberi ecardia isina kukombama, ine ruvara rwakasiyana-siyana uye kutsvuka, mitsipa yeropa ine dendritic inogona kuonekwa pamusoro, uye chironda chacho chinosimudzwa zvishoma.
Kuongororwa (kunosanganiswa nechirwere): Fundic gland mucosal gastric cancer, 0-lla, pT1a/M, ULO, LyOV0,HM0,VMO
kurukura
Zita rekuti "gastric gland mucosal adenocarcinoma" rakaoma kutaura, uye huwandu hwevanhu vanobatwa nechirwere ichi hwakaderera zvikuru. Zvinoda kushanda nesimba kuti uzive uye unzwisise chirwere ichi. Fundic gland mucosal adenocarcinoma ine hunhu hwekenza yakanyanya.
Pane zvinhu zvina zvikuru zvinoitwa ne endoscopy yechiedza chichena: ① maronda anodzima mumuviri; ② subepithelial bundu SMT; ③ tsinga dzeropa dzakakura dze dendritic; ④ regional microparticles. ME performance: DL(+)IMVP(+)IMSP(+)MCE inowedzera IP uye inowedzera. Uchishandisa nzira inokurudzirwa neMESDA-G, 90% yekenza yemucosal mucosal gastric cancers inosangana nezvinodiwa zvekuongorora.
3) Dumbu remudumbu (adenoma yepyloric gland PGA)
gastric adenoma
◆Nyaya 1
Tsananguro:Chironda chichena chakati sandara chakaonekwa pamadziro ekumashure egastric fornix nemiganhu isina kujeka. Mavara eIndigo carmine haana kuratidza miganhu yakajeka, uye chitarisiko chakafanana neLST-G cheura hukuru chakaonekwa (chakakura zvishoma).
Kuongororwa (kunosanganiswa nechirwere):kansa ye atypia yakaderera, O-1la, 47*32mm, tubular adenocarcinoma yakanyatsosiyana, pT1a/M, ULO, Ly0, VO, HMO, VMO
gastric adenoma
◆Nyaya yechipiri
Tsananguro: Gomarara rakakwira rine mapundu pamadziro epamberi echikamu chepakati chemuviri wemudumbu. Gastritis inoshanda inogona kuonekwa kumashure. Indigo carmine inogona kuonekwa semuganhu. (NBI uye kukura zvishoma)
Zvokurwara: Kuonekwa kweMUC5AC kwakaonekwa mu superficial epithelium, uye kuonekwa kweMUC6 kwakaonekwa mu superficial epithelium. Kuongororwa kwekupedzisira kwaive PGA.
kurukura
Matumbu emudumbu ndiwo maburi emucinous anopinda mustroma uye akafukidzwa nefoveolar epithelium. Nekuda kwekuwanda kwemaburi emudumbu, ayo ari hemispherical kana nodular, maburi emudumbu anoonekwa ne endoscopic white light ese ane maburi uye anobuda. Zvakakosha kutarisisa maclassification mana eJiu Ming pasi pekuongororwa kwe endoscopic. ME-NBI inogona kuona chitarisiko chePGA chepapillary/villous. PGA haina HP negative zvachose uye haina atrophic, uye ine njodzi yekenza. Kuongororwa nekukurumidza uye kurapwa kwekutanga kunokurudzirwa, uye mushure mekuwanikwa, active en bloc resection uye kumwe kudzidza kwakadzama kunokurudzirwa.
4) (senge raspberry) foveolar epithelial gastric cancer
kenza yemudumbu yeraspberry foveolar epithelial
◆Nyaya yechipiri
Tsananguro:(yasiyiwa)
Kuongororwa (kunosanganiswa nechirwere): kenza yemudumbu ye foveolar epithelial
kenza yemudumbu yeraspberry foveolar epithelial
◆Nyaya 3
Tsananguro:(yasiyiwa)
Kuongororwa (kunosanganiswa nechirwere):kenza yemudumbu ye foveolar epithelial
kurukura
Raspberry, inonzi "Tuobai'er" muguta redu, muchero wemusango uri padivi pemugwagwa pataiva vana. Glandular epithelium nemagland zvakabatana, asi hazvina kufanana. Zvakakosha kunzwisisa kukura uye kukura kwemasero eepithelial. Kenza yemudumbu yeRaspberry epithelial yakafanana zvikuru nemapolyps emudumbu uye inogona kukanganiswa nyore nyore nemapolyps emudumbu. Chinhu chikuru che foveolar epithelium ndicho chiratidzo chikuru cheMUC5AC. Saka foveolar epithelial carcinoma izwi rerudzi urwu. Rinogona kuvapo muHP negative, positive, kana mushure mekuvhiyiwa. Kuonekwa kweEndoscopic: bulge yakatenderera yakaita sestrawberry, kazhinji ine miganhu yakajeka.
5) Kansa yemusero wesignet ring cell
Kansa yemusero weSignet ring: chitarisiko chechiedza chichena
Kansa yemusero weSignet ring: chitarisiko chechiedza chichena
kansa yemusero wesignet ring cell
◆Nyaya 1
Tsananguro:Chironda chakati sandara pamadziro ekumashure kwegumbo remudumbu, 10 mm, chakadzima, rudzi rweO-1Ib, hapana kupera simba kumashure, muganhu unoonekwa pakutanga, muganhu usingaonekwe pakuongororwazve, ME-NBI: chikamu chepakati pegumbo chete chinova chena, IMVP(-)IMSP (-)
Kuongororwa (kunosanganiswa nechirwere):Zviyero zveESD zvinoshandiswa kuongorora kenza yemudumbu inonzi signet ring cell carcinoma.
Zviratidzo zvezvirwere
Kansa yeSignet ring cell ndiyo inonyanya kuipa. Zvichienderana neLauren classification, gastric signet ring cell carcinoma inoonekwa semhando yekansa inopararira uye imhando yekansa isingasiyaniswi. Inowanzoitika mumuviri wemudumbu, uye inonyanya kuonekwa mumaronda akati sandara uye akanyura ane mavara akachinja ruvara. Maronda akakwidziridzwa haawanzoonekwi uye anogonawo kuoneka sekukura kana maronda. Zvakaoma kuona panguva yekuongororwa kwe endoscopic mumatanho ekutanga. Kurapa kunogona kuitwa nekubvisa masero akadai se endoscopic ESD, nekutevera kwakasimba mushure mekuvhiyiwa uye kuongororwa kana kuvhiyiwa kwekuwedzera. Kubvisa masero kusingarapike kunofanira kuda kuvhiyiwa kwekuwedzera, uye nzira yekuvhiya inosarudzwa nachiremba wekuvhiya.
Dzidziso yechinyorwa nemifananidzo zviri pamusoro apa zvinobva ku "Dumbu neMatumbu"
Pamusoro pezvo, kutarisirwa kunofanirawo kupihwa kune kenza yemudumbu, kenza yemwoyo, uye adenocarcinoma yakawanikwa zvakanaka inowanikwa mu HP-negative background.
3. Pfupiso
Nhasi ndadzidza ruzivo rwakakodzera uye zviratidzo zvegomarara remudumbu reHP-negative. Rinonyanya kusanganisira: gomarara remudumbu remhando yefundic gland, gomarara remudumbu remhando yefundic gland, gomarara remudumbu remhando yefundic gland, gomarara remudumbu, gomarara refoveolar epithelial bundu (raspberry-like) uye gomarara resignet ring cell carcinoma.
Kuwanda kwekenza yemudumbu isina HP kwakaderera, zvakaoma kutonga, uye zviri nyore kupotsa kuongororwa. Chinonyanya kuoma kuratidzwa kwezvirwere zvakaoma uye zvisingawanzoitiki mu endoscopic. Inofanirawo kunzwisiswa kubva pamaonero e endoscopic, kunyanya ruzivo rwedzidziso rwuripo.
Kana ukatarisa ma polyps emudumbu, kuchekwa kwemvura, uye nzvimbo dzvuku nechena, unofanira kufunga nezve mukana wekuti une kenza yemudumbu isina Hp. Kuongororwa kwe HP isina kufanira kunoenderana nezvinodiwa, uye kutariswa kwenhema dzisina kusimba dzinokonzerwa nekuvimba zvakanyanya nemhedzisiro yekuyedzwa kwekufema. Vanachiremba vane ruzivo rwe endoscopist vanovimba nemaziso avo zvakanyanya. Tichitarisana nedzidziso yakadzama iri shure kwekenza yemudumbu isina HP, tinofanira kuramba tichidzidza, tichinzwisisa uye tichidzidzira kuti tiigone.
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 yemhino nezvimwewo. anoshandiswa zvakanyanya muEMR,ESD,ERCP.Zvigadzirwa 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: Chikunguru-12-2024