Pakati peruzivo rwakakurumbira nezvegomarara rekutanga remudumbu, pane zvimwe zvisingawanzo ruzivo nezvechirwere zvinoda kutariswa zvakanyanya uye kudzidza.Imwe yacho ndeye HP-negative gastric cancer.Pfungwa ye "uninfected epithelial tumors" ikozvino yakakurumbira.Pachave nemafungiro akasiyana panyaya yezita.Iyi dzidziso yemukati inonyanya kubva pane izvo zvine chekuita nemagazini "Mudumbu uye Ura", uye zita rinoshandisawo "HP-negative gastric cancer".
Rudzi urwu rwemaronda rune hunhu hwekuderera kwechiitiko, kuomerwa mukuzivikanwa, yakaoma dzidziso ruzivo, uye nyore MESDA-G maitiro haashande.Kudzidza ruzivo urwu kunoda kutarisana nematambudziko.
1. Ruzivo rwekutanga rweHP-negative gastric cancer
Nhoroondo
Kare, zvaidavirwa kuti chete muitiro muchiitiko uye kukura gastric kenza aiva HP utachiona, saka yekare kenza muenzaniso HP - atrophy - intestinal metaplasia - yakaderera bundu - yakakwirira bundu - kenza.Iyo yemhando yepamusoro yagara ichizivikanwa zvakanyanya, yakagamuchirwa uye yakatendwa zvakasimba.Mabundu anokura pamwe chete pahwaro hweatrophy uye pasi pechiito cheHP, saka kenza dzinokura zvakanyanya mumaturakiti emudumbu uye isingawanzo atrophic gastric mucosa.
Gare gare, vamwe vanachiremba vakawana kuti gomarara remudumbu rinogona kuitika kunyangwe pasina hutachiona hweHP.Kunyangwe mwero wezviitiko wakaderera zvakanyanya, zvinogoneka.Mhando yegomarara remudumbu iri inodaidzwa kuti HP-negative gastric cancer.
Nekunzwisisa zvishoma nezvishoma rudzi urwu rwechirwere, zvakadzika zvakarongwa zvakarongwa uye zvipfupiso zvakatanga, uye mazita anoramba achichinja.Paive nechinyorwa muna 2012 chinonzi "Gastric Cancer after Sterilization", chinyorwa muna 2014 chinonzi "HP-negative Gastric Cancer", uye chinyorwa muna 2020 chinonzi "Epithelial Tumors Not Infected with Hp".Kushandurwa kwezita kunoratidza kudzika uye kunzwisisa kwakadzama.
Mhando dzeGland uye Kukura Kwemaitiro
Kune mhando mbiri huru dzefundoc glands uye pyloric glands mudumbu:
Fundic glands (oxyntic glands) inogoverwa mu fundus, muviri, makona, nezvimwewo zvemudumbu.Iwo ane mitsetse imwe tubular glands.Izvo zvinoumbwa nemasero emucous, masero makuru, parietal masero uye endocrine masero, rimwe nerimwe rinoita mabasa avo.Pakati pavo, masero makuru The PGI yakavanzwa uye MUC6 staining yakanga yakanaka, uye masero eparietal akavhara hydrochloric acid uye intrinsic factor;
Iyo pyloric glands iri munzvimbo yegastric antrum uye inoumbwa nemasero emucus uye endocrine masero.Mucus masero ari MUC6 akanaka, uye endocrine masero anosanganisira G, D masero uye enterochromaffin masero.G masero anobudisa gastrin, D masero anobudisa somatostatin, uye masero e enterochromaffin anobudisa 5-HT.
Normal gastric mucosal masero uye bundu masero secrete zvakasiyana-siyana zvakasiyana-siyana mapuroteni mucus, iyo yakakamurwa kuva "gastric", "intestinal" uye "akavhenganiswa" mucus mapuroteni.Kutaura kwegastric uye intestinal mucins kunonzi phenotype uye kwete chaiyo anatomical nzvimbo yemudumbu nematumbu.
Kune mana masero phenotypes egastric tumors: zvachose gastric, gastric-inotonga yakasanganiswa, intestinal-inotonga yakasanganiswa, uye intestinal zvachose.Mapundu anoitika pahwaro hwemataplasia emudumbu anowanzova emudumbu musanganiswa phenotype mapundu.Magomarara akasiyana anonyanya kuratidza rudzi rwemudumbu (MUC2+), uye gomarara rinopararira rinonyanya kuratidza rudzi rwegastric (MUC5AC+, MUC6+).
Kuona Hp isina kunaka kunoda kusanganisa kwakawanda kwenzira dzekuona dzakawanda dzekutsunga kwakazara.HP-negative gastric cancer uye post-sterilization gastric cancer pfungwa mbiri dzakasiyana.Kuti uwane ruzivo nezve X-ray kuratidzwa kweHP-negative gastric cancer, ndapota tarisa kune chikamu chakakodzera chemagazini "Mudumbu uye Ura".
2. Endoscopic zviratidzo zveHP-negative gastric cancer
Endoscopic kuongororwa ndiyo inotarisa yeHP-negative gastric cancer.Inonyanya kusanganisira fundic gland mhando gastric cancer, fundic gland mucosal type gastric cancer, gastric adenoma, raspberry foveolar epithelial bundu, sigineti ring cell carcinoma, etc. Ichi chinyorwa chinotarisa endoscopic kuratidzwa kweHP-negative gastric cancer.
1) Fundic gland type gastric cancer
-White yakasimudza maronda
fundic gland type gastric cancer
◆Nyaya 1: Maronda machena, akasimudzwa
Tsanangudzo:Gastric fundic fornix-yakakura curvature ye cardia, 10 mm, chena, O-lia mhando (SMT-yakafanana), isina atrophy kana intestinal metaplasia kumashure.Arbor-semitsipa yeropa inogona kuonekwa pamusoro (NBI uye kuwedzera zvishoma)
Kuongororwa (kusanganisira pathology):U, O-1la, 9mm, fundic gland type gastric cancer, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-White flat maronda
fundic gland type gastric cancer
◆ Nyaya 2: Maronda machena, akadzikama / akaora mwoyo
Tsanangudzo:The anterior wall of the gastric fundic fornix-cardia yakakura curvature, 14 mm, white, type 0-1lc, isina atrophy kana intestinal metaplasia kumashure, miganhu isina kujeka, uye dendritic tsinga dzeropa dzinoonekwa pamusoro.(NBI uye amplification yakapfupikiswa)
Kuongororwa (kusanganisira pathology):U, 0-Ilc, 14mm, fundic gland type gastric cancer, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Red yakasimudza maronda
fundic gland type gastric cancer
◆ Nyaya 3: Zvitsvuku uye zvakasimudza maronda
Tsanangudzo:The anterior wall of the great curvature of the cardia is 12 mm, zviri pachena red, type 0-1, isina atrophy kana intestinal metaplasia kumashure, miganhu yakajeka, uye dendritic tsinga dzeropa pamusoro (NBI uye kuwedzera zvishoma)
Kuongororwa (kusanganisira pathology):U, 0-1, 12mm, fundic gland type gastric cancer, pT1b/SM1 (200μm), ULO, LYO, VO, HMO, VMO
-Red, flat, kuora mwoyo rondas
fundic gland type gastric cancer
◆ Nyaya 4: Zvitsvuku, flat / kuora mwoyo maronda
Tsanangudzo:Posterior rusvingo rwepamusoro curvature chikamu chepamusoro chegastric body, 18mm, chiedza chitsvuku, O-1Ic rudzi, hapana atrophy kana intestinal metaplasia kumashure, muganhu usina kujeka, hapana dendritic midziyo yeropa pamusoro, (NBI uye kuwedzera kwakasiiwa. )
Kuongororwa (kusanganisira pathology):U, O-1lc, 19mm, fundic gland type gastric cancer, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
kurukura
Vanhurume vane chirwere ichi vakura kudarika vanhukadzi, neavhareji yezera iri makore 67.7.Nekuda kwehunhu hwekusangana uye heterochrony, varwere vanoonekwa vaine fundic gland rudzi rwegomarara remudumbu vanofanirwa kuongororwa kamwe pagore.Nzvimbo inonyanyozivikanwa ndiyo fundic gland nzvimbo iri pakati nepamusoro pedumbu (fundus nepakati nepamusoro pedumbu redumbu).White SMT-yakafanana yakasimudzwa maronda anowanzoitika muchiedza chichena.Mushonga mukuru ndeye diagnostic EMR/ESD.
Hapana lymphatic metastasis kana vascular invasion yakaonekwa kusvika zvino.Mushure mekurapa, zvinodikanwa kuona kana kuita kuvhiyiwa kwakawedzerwa uye kuongorora hukama huripo pakati pehuipi uye HP.Haasi ese fundic gland-type gastric cancers ari HP negative.
1) Fundic gland mucosal gastric cancer
Fundic gland mucosal gastric cancer
◆Nyaya 1
Tsanangudzo:Chironda chinosimudzwa zvishoma, uye RAC isiri-atrophic gastric mucosa inogona kuonekwa yakaipoteredza.Kukurumidza kuchinja microstructure uye microvessels inogona kuonekwa mune yakasimudzwa chikamu che ME-NBI, uye DL inogona kuonekwa.
Kuongororwa (kusanganisira pathology):Fundic gland mucosal gastric cancer, U zone, 0-1la, 47 * 32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Fundic gland mucosal gastric cancer
◆Nyaya yechipiri
Tsanangudzo: Chironda chakatsetseka pamadziro anterior echidzitiro chechidiki checardia, ine yakasanganiswa discoloration uye yakatsvuka, dendritic mitsipa yeropa inogona kuonekwa pamusoro, uye chironda chinosimudzwa zvishoma.
Kuongororwa (kusanganiswa ne pathology): Fundic gland mucosal gastric cancer, 0-lla, pT1a/M, ULO, LyOV0,HM0,VMO
kurukura
Zita rekuti "gastric gland mucosal adenocarcinoma" rakati kuoma kutaura, uye chiyero chechiitiko chakaderera kwazvo.Zvinoda nhamburiko dzakawanda kuti uzvizive uye uzvinzwisise.Fundic gland mucosal adenocarcinoma ine hunhu hwehutsinye hwepamusoro.
Pane maitiro mana makuru e endoscopy mwenje chena: ① homochromatic-inopera maronda;② subepithelial bundu SMT;③ dilated dendritic tsinga dzeropa;④ redunhu microparticles.ME kuita: DL(+)IMVP(+)IMSP(+)MCE inowedzera IP uye inowedzera.Uchishandisa chirongwa cheMESDA-G chinokurudzirwa, 90% ye fundic gland mucosal gastric cancers inosangana nemaitiro ekuongorora.
3) Gastric adenoma (pyloric gland adenoma PGA)
gastric adenoma
◆Nyaya 1
Tsanangudzo:Chironda chichena chakasimudzwa chakaonekwa pamadziro emashure egastric fornix ane miganhu isina kujeka.Indigo carmine staining yakaratidza pasina miganhu yakajeka, uye LST-G-yakafanana nechitarisiko chemukati mukuru yakaonekwa (yakawedzera zvishoma).
Kuongororwa (kusanganisira pathology):low atypia carcinoma, O-1la, 47*32mm, yakanyatsosiyana tubular adenocarcinoma, pT1a/M, ULO, Ly0, VO, HMO, VMO
gastric adenoma
◆Nyaya yechipiri
Tsanangudzo: Chironda chakasimudzwa chine machundu pamadziro epamberi pechikamu chepakati chedumbu redumbu.Active gastritis inogona kuonekwa kumashure.Indigo carmine inogona kuonekwa semuganhu.(NBI uye kukura zvishoma)
Pathology: MUC5AC kutaura kwakaonekwa mu epithelium yepamusoro, uye MUC6 kutaura kwakaonekwa mu epithelium yepamusoro.Kuongororwa kwekupedzisira kwaiva PGA.
kurukura
Gastric adenomas akanyanya mucinous glands anopinda mukati me stroma uye akafukidzwa nefoveolar epithelium.Nekuda kwekuwanda kweglandular protrusions, ayo ari hemispherical kana nodular, gastric adenomas inoonekwa ne endoscopic white light yese ine nodular uye yakabudikira.Izvo zvinodiwa kuti utarise kune 4 classifications yeJiu Ming pasi pe endoscopic bvunzo.ME-NBI inogona kuona hunhu hwepapillary/huipi kutaridzika kwePGA.PGA haisi zvachose HP isina kunaka uye isiri-atrophic, uye ine imwe njodzi yegomarara.Kuongororwa kwekutanga uye kurapwa kwekutanga kunotsigirwa, uye mushure mekuwanikwa, kushingaira en bloc resection uye kumwe kuongorora kwakadzama kunokurudzirwa.
4) (raspberry-like) foveolar epithelial gastric cancer
raspberry foveolar epithelial gastric cancer
◆Nyaya yechipiri
Tsanangudzo:(yasiiwa)
Kuongororwa (kusanganiswa ne pathology): foveolar epithelial gastric cancer
raspberry foveolar epithelial gastric cancer
◆Nyaya 3
Tsanangudzo:(yasiiwa)
Kuongororwa (kusanganisira pathology):foveolar epithelial gastric cancer
kurukura
Raspberry, inonzi "Tuobai'er" mudhorobha redu, muchero wemusango padivi penzira patakanga tiri vana.Glandular epithelium uye glands zvakabatanidzwa, asi hazvisi zvakafanana zvemukati.Izvo zvinodiwa kuti unzwisise kukura uye kukura maitiro eepithelial masero.Raspberry epithelial gastric cancer yakafanana chaizvo negastric polyps uye inogona kukanganisa zviri nyore negastric polyps.Chiratidzo chefoveolar epithelium ndiyo inonyanya kutaura yeMUC5AC.Saka foveolar epithelial carcinoma ndiro izwi guru rerudzi urwu.Inogona kuvepo muHP isina kunaka, yakanaka, kana mushure mekuita sterilization.Endoscopic chitarisiko: denderedzwa dzvuku strawberry-senge bulge, kazhinji ine miganhu yakajeka.
5) Signet ring cell carcinoma
Signet ring cell carcinoma: chena chiedza chitarisiko
Signet ring cell carcinoma: chena chiedza chitarisiko
chidhindo ring cell carcinoma
◆Nyaya 1
Tsanangudzo:Flat lesion pamadziro emashure egastric vestibule, 10 mm, yakapera, mhando O-1Ib, hapana atrophy kumashure, inooneka muganhu pakutanga, kwete pachena muganhu pakuongororazve, ME-NBI: chete chikamu chemukati chinova chichena, IMVP (-)IMSP (-)
Kuongororwa (kusanganisira pathology):ESD mienzaniso inoshandiswa kuongorora signet ring cell carcinoma.
Pathological kuratidzwa
Signet ring cell carcinoma ndiyo yakaipisisa mhando.Zvinoenderana neiyo Lauren classification, gastric sigineti ring cell carcinoma inoiswa serudzi rwakapararira rwecarcinoma uye imhando yeusingaverengeki carcinoma.Inowanzoitika mumuviri wemudumbu, uye inowanzoitika mumaronda akadzikama uye akanyura ane toni dzisina ruvara.Maronda akasimudzwa haawanzo kuwanda uye anogonawo kuratidza sekukurwa kana maronda.Zvakaoma kuona panguva yekuongorora endoscopic mumatanho ekutanga.Kurapa kunogona kuve kurapa kwekurapa senge endoscopic ESD, nekunyatsotevera mushure mekuvhiyiwa uye kuongororwa kwekuita kumwe kuvhiya.Non-currative resection inoda kuvhiyiwa kwakawedzerwa, uye nzira yekuvhiya inosarudzwa nachiremba anovhiya.
Iwo mameseji epamusoro dzidziso uye mapikicha anobva ku "Mudumbu uye Ura"
Pamusoro pezvo, kutarisisa kunofanirwawo kubhadharwa kune esophagogastric junction cancer, cancer cardia, uye yakanyatso mutsauko adenocarcinoma inowanikwa muHP-negative kumashure.
3. Pfupiso
Nhasi ndadzidza ruzivo rwakakodzera uye endoscopic kuratidzwa kweHP-negative gastric cancer.Zvinonyanya kusanganisira: fundic gland mhando gastric cancer, fundic gland mucosal type gastric cancer, gastric adenoma, (raspberry-like) foveolar epithelial tumor uye sigineti ring cell carcinoma.
Kuitika kwekiriniki kweHP-negative gastric cancer yakaderera, zvakaoma kutonga, uye zviri nyore kupotsa kuongororwa.Chinonyanya kuoma ndeye endoscopic kuratidzwa kwezvirwere zvakaoma uye zvisingawanzo.Inofanirawo kunzwisiswa kubva kune endoscopic maonero, kunyanya ruzivo rwezvinyorwa shure kwayo.
Kana iwe ukatarisa gastric polyps, erosions, uye tsvuku uye chena nzvimbo, iwe unofanirwa kufunga nezve mukana weHp-negative gastric cancer.Kutongwa kweHP negative kunofanirwa kuenderana nezviyero, uye kutarisisa kunofanirwa kubhadharwa kune zvisirizvo zvenhema zvinokonzerwa nekunyanya kuvimba nemhedzisiro yekufema.Vane ruzivo endoscopists vanovimba nemeso avo zvakanyanya.Kutarisana nedzidziso yakadzama kuseri kweHP-negative gastric cancer, isu tinofanirwa kuenderera mberi nekudzidza, kunzwisisa uye kudzidzira kuigona.
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 catheter nezvimwewo.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: Jul-12-2024