Varwere vazhinji vari kumadhipatimendi egastroenterology kana ku endoscopy centers vanokurudzirwa kuti vabviswe mucosal resection ne endoscopic (EMRInoshandiswa kakawanda, asi unoziva here zviratidzo zvayo, zvisingakwanisike, uye matanho ekudzivirira mushure mekuvhiyiwa?
Chinyorwa chino chichakutungamirirai nenzira yakarongwa kuburikidza neruzivo rwakakosha rweEMR kuti chikubatsirei kuita sarudzo ine ruzivo rwakadzama uye ine chivimbo.
Saka, chii chinonzi EMR? Ngatitangei kuidhirowa tione…
❋Nhungamiro dzine simba dzinoti chii nezvezviratidzo zveEMR? Sekureva kweJapan Gastric Cancer Treatment Guidelines, Chinese Expert Consensus, uye European Society of Endoscopy (ESGE), zviratidzo zvinokurudzirwa zveEMR zvinosanganisira zvinotevera:
Ⅰ. Mapolyps asina kunaka kana adenomas
● Maronda ≤ 20 mm ane mipendero yakajeka
● Hapana zviratidzo zviri pachena zvekupindwa kwemudumbu
● Kupararira Kwebundu Pamativi (LST-G)
Ⅱ. Focal high-grade intraepithelial neoplasia (HGIN)
● Yakaganhurirwa nematumbu, hapana maronda
● Maronda madiki kupfuura 10 mm
● Yakasiyana-siyana
Ⅲ. Dysplasia isina kusimba kana maronda asina kunaka ane chirwere chakajeka uye kukura zvishoma nezvishoma
◆ Varwere vanofungidzirwa kuti vakakodzera kubviswa ganda mushure mekuongororwa kwakaitwa
⚠Cherechedza: Kunyangwe nhungamiro dzichiti EMR inogamuchirwa kune kenza dzepakutanga kana chironda chiri chidiki, chisina maronda, uye chakavharirwa mu mucosa, mukurapa chaiko, ESD (endoscopic submucosal dissection) inowanzo shandiswa kuve nechokwadi chekuti kubviswa kwacho kwakakwana, kuchengetedzeka, uye kuongororwa kwakarurama kwezvirwere.
ESD ine zvakawanda zvakanakira zvakakosha:
Kubviswa kwechironda ne bloc kunogoneka
Inobatsira pakuongorora margin, ichideredza njodzi yekudzokazve kwechirwere
Yakakodzera maronda makuru kana akaomarara
Saka, EMR inoshandiswa zvakanyanya mukurapa kwe:
1. Maronda asina kunaka asina njodzi yekenza
2. Mapolyps madiki, anogona kubviswa nyore nyore kana maLST emudumbu
⚠Nzira dzekudzivirira mushure mekuvhiyiwa
1. Kutarisira Kudya: Mumaawa makumi maviri nemana ekutanga mushure mekuvhiyiwa, dzivisa kudya kana kunwa mvura yakachena, wozochinja zvishoma nezvishoma wotanga kudya zvinyoro nyoro. Dzivisa chikafu chine mhiripiri, chinonetsa, uye chinogumbura.
2. Kushandiswa Kwemishonga: Proton pump inhibitors (PPIs) dzinowanzo shandiswa mushure mekuvhiyiwa kwezvironda zvemudumbu kukurudzira kupora kwemaronda uye kudzivirira kubuda ropa.
3. Kutarisa Matambudziko: Chenjerera zviratidzo zvekubuda ropa mushure mekuvhiyiwa, zvakaita se melena, hematemesis, uye kurwadziwa mudumbu. Tsvaga rubatsiro rwechiremba nekukurumidza kana paine chimwe chinhu chisina kunaka chikaitika.
4. Rongai Kuongororwa: Rongai kushanya kwekutevera uye kudzokorora maendoscopy zvichibva pane zvakawanikwa pakuongorora chirwere.
Saka, EMR inzira inokosha pakubvisa maronda emudumbu. Zvisinei, zvakakosha kunzwisisa zviratidzo zvayo nemazvo uye kudzivirira kushandisa zvakanyanya kana kushandisa zvisirizvo. Kune vanachiremba, izvi zvinoda hungwaru nehunyanzvi; kune varwere, zvinoda kuvimba nekunzwisisa.
Ngationei zvatingapa kune EMR.
Heano mashandisirwo edu e endoscopic ane chekuita neEMR anosanganisiraZvidimbu zveHemostatic,Kuvhiyiwa kwePolypectomy Musungo,Tsono yejekiseniuyeMaforceps eBiopsy.
Nguva yekutumira: Gunyana-01-2025