Ama-polyp ekholoni ayisifo esivamile futhi esivame ukwenzeka ku-gastroenterology. Abhekisela ekuveleni kwangaphakathi kwe-luminal okuphakeme kune-mucosa yamathumbu. Ngokuvamile, i-colonoscopy inezinga lokutholakala okungenani elingu-10% kuya ku-15%. Izinga lokusabalala livame ukwanda ngokukhula. Njengoba umdlavuza we-colon ongaphezu kuka-90% ubangelwa ukuguqulwa kwama-polyp okunonya, ukwelashwa okuvamile ukwenza ukususwa kwe-endoscopic ngokushesha nje lapho ama-polyp ebonakala.
Ku-colonoscopy yansuku zonke, ama-polyp angu-80% kuya ku-90% angaphansi kuka-1 cm. Kuma-polyp noma ama-polyp ane-adenomatous ubude obungu-≥ 5 mm (kungakhathaliseki ukuthi ane-adenomatous noma cha), kunconywa ukususwa kwe-endoscopic okukhethwayo. Amathuba ama-micropolyp ekholoni (ubude obungu-≤5mm) aqukethe izingxenye zesimila aphansi kakhulu (0~0.6%). Kuma-micropolyp ekholoni ye-rectum kanye ne-sigmoid, uma i-endoscopist inganquma ngokunembile ukuthi ayi-polyp engeyona i-adenomatous, asikho isidingo sokususwa, kodwa umbono ongenhla awuvamile ukusetshenziswa emitholampilo eShayina.
Ngaphezu kwalokho, ama-5% ama-polyp ayisicaba noma akhula eceleni, anobubanzi obungaphezu kwama-2 cm, anezingxenye ezinobungozi noma ezingenazo. Kulesi simo, kudingeka amanye amasu okususa ama-polyp endoscopic athuthukile, njengeI-EMRfuthiI-ESDAke sibheke izinyathelo eziningiliziwe zokususa ama-polyp.
Inqubo yokuhlinzwa
Isiguli siqede ukuhlolwa kokuhlinzwa ngaphambi kokuhlinzwa, sabekwa endaweni yesobunxele ye-decubitus, futhi sanikezwa i-inhalation nge-propofol. Umfutho wegazi, izinga lokushaya kwenhliziyo, i-electrocardiogram, kanye nokugcwala komoya-mpilo egazini kwaqashwa ngesikhathi sokuhlinzwa.
1 Okubandayo/OkushisayoAma-Forceps e-BiopsyIsigaba
Ifanele ukususwa kwama-polyp amancane ≤5mm, kodwa kungase kube nenkinga yokususwa okungaphelele kwama-polyp angu-4 kuya ku-5mm. Ngokusekelwe ku-biopsy ebandayo, i-thermal biopsy ingasebenzisa i-high-frequency current ukuze ibulale izilonda ezisele futhi yenze ukwelashwa kwe-hemostasis enxebeni. Kodwa-ke, kufanele kuqashelwe ukugwema ukulimala kwengqimba ye-serosa yodonga lwamathumbu ngenxa yokusetshenziswa kwe-electrocoagulation ngokweqile.
Ngesikhathi sokuhlinzwa, ingxenye eyinhloko ye-polyp kufanele iboshwe, iphakanyiswe ngendlela efanele (ukugwema ukulimaza ungqimba lwemisipha), futhi igcinwe ibanga elifanele ukusuka odongeni lwamathumbu. Uma i-pedicle ye-polyp iba mhlophe, yeka ukugaya igazi ngogesi bese ubamba isilonda. Kufanele kuqashelwe ukuthi akulula ukususa i-polyp enkulu kakhulu, ngaphandle kwalokho kuzokwandisa isikhathi sokufaka ugesi futhi kwandise ingozi yokulimala kobukhulu obugcwele (Isithombe 1).
2 Kubanda/kushisaugibe lokususwa kwe-polypectomyindlela yokususa
Ifanele izilonda eziphakanyisiwe zobukhulu obuhlukene uhlobo lwe-p, uhlobo lwe-sp kanye noluncane (<2cm) uhlobo lwe-I (izindinganiso ezithile zokuhlukaniswa zingabhekisela ekutholakaleni kwe-endoscopic komdlavuza wokuqala womgudu wokugaya ukudla. Kunezinhlobo eziningi kakhulu futhi angazi ukuthi ngingahlulela kanjani? Lesi sihloko senza kucace) Ukususwa kwezilonda. Kwezilonda ezincane zohlobo lwe-Ip, ukususwa kwe-snare kulula kakhulu. Izithiyo ezibandayo noma ezishisayo zingasetshenziswa ukususwa. Ngesikhathi sokususwa, ubude obuthile be-pedicle kufanele bugcinwe noma ibanga elithile odongeni lwamathumbu ngenkathi kuqinisekiswa ukususwa okuphelele kwesilonda. Ngemva kokuqinisa i-snare, kufanele inyakaziswe i-Snare, bheka ukuthi kukhona yini i-mucosa yamathumbu evamile ezungezile bese uyihlanganisa ndawonye ukuvimbela umonakalo odongeni lwamathumbu.
Umfanekiso 1 Umdwebo weskimu wokususwa kwe-forceps ye-biopsy yokushisa, A ngaphambi kokususwa kwe-forceps, B inxeba ngemva kokususwa kwe-forceps. I-CD: Izinyathelo zokuphepha ngokushisai-biopsy forcepsukususwa. Uma i-polyp inkulu kakhulu, izokwandisa isikhathi sokujiya kwe-electrocoagulation futhi ibangele umonakalo we-transmural.
Umfanekiso 2 Umdwebo weskimu wokususwa kwe-thermal snare kwezilonda ezincane zohlobo lwe-I sp
3 I-EMR
■Izilonda ze-I p
Ngezilonda ezinkulu ze-Ip, ngaphezu kwezinyathelo zokuqapha ezingenhla, kufanele kusetshenziswe izithiyo zokushisa ukuze kunqunywe kabusha. Ngaphambi kokususwa kabusha, kufanele kwenziwe umjovo owanele we-submucosal phansi kwe-pedicle (2 kuya ku-10 mL wamayunithi ayi-10,000 e-epinephrine + i-methylene blue + physiological. Ingxube ye-saline ifakwa ngaphansi kwe-mucosa (ijove ngenkathi ikhipha inaliti), ukuze i-pedicle iphakame ngokugcwele futhi kube lula ukuyisusa (Isithombe 3). Ngesikhathi senqubo yokususwa kabusha, isilonda kufanele sigweme ukuthintana nodonga lwamathumbu ukuze kugwenywe ukwakha iluphu evaliwe nokushisa udonga lwamathumbu.
Umfanekiso 3 Umdwebo we-schematic weI-EMRukwelashwa kwezilonda zohlobo lwe-LP
Kufanele kuqashelwe ukuthi uma uhlobo olukhulu lwe-polyp I-p lune-pedicle ejiyile, lungase luqukathe i-vasa vasorum enkulu, futhi luzophuma igazi kalula ngemva kokususwa. Ngesikhathi senqubo yokususwa, indlela yokuhlanganisa ama-coagulation-cut-coagulation ingasetshenziswa ukunciphisa ingozi yokopha. Amanye ama-polyp amakhulu angasuswa abe yizicucu ukuze kuncishiswe ubunzima bokuhlinzwa, kodwa le ndlela ayivumeli ukuhlolwa kwe-pathological.
■izilonda zohlobo lwe-lla-c
Ngezilonda zohlobo lwe-Ila-c kanye nezinye izilonda ze-Is ezinobubanzi obukhulu, ukususwa kwe-strabe ngqo kungabangela umonakalo wokujiya okugcwele. Ukujova uketshezi olungaphansi kwe-mucosal kungandisa ukuphakama kwe-lesion futhi kunciphise ubunzima be-snare kanye ne-resection. Ukuthi kukhona yini ukuphuma ngesikhathi sokuhlinzwa kuyisisekelo esibalulekile sokunquma ukuthi i-adenoma ayinabungozi noma iyingozi nokuthi ngabe kunezinkomba zokwelapha nge-endoscopic. Le ndlela ingandisa izinga lokususwa okuphelele kwe-adenomas<2cm ububanzi.
Umfanekiso 4I-EMRishadi lokugeleza kokwelashwa kwama-polyps ohlobo lwe-Il
4 I-ESD
Kuma-adenoma anobubanzi obukhulu kuno-2cm adinga ukususwa kanye kanye kanye nesibonakaliso sokuphakanyiswa okungalungile, kanye neminye imidlavuza yokuqala,I-EMRizinsalela noma ukuphinda kwesifo okunzima ukukwelapha,I-ESDukwelashwa kungenziwa. Izinyathelo ezijwayelekile yilezi:
1. Ngemva kokufaka imibala e-endoscopic, umngcele wesilonda uchazwa ngokucacile futhi umjikelezo uyaphawulwa (isilonda kungenzeka singaphawulwa uma umngcele wesilonda ucacile).
2. Jova nge-submucosa ukuze izilonda ziphakame ngokusobala.
3. Ukuhlikihla i-mucosa ngokwengxenye noma ngokuzungezile ukuze kuvezwe i-submucosa.
4. Khulula izicubu ezixhumene eduze kwe-submucosa bese ususa kancane kancane izicubu ezigulayo.
5. Qapha inxeba ngokucophelela bese welapha imithambo yegazi ukuze uvimbele izinkinga.
6. Ngemva kokucubungula amasampula asusiwe, wathumele ukuze ayohlolwa ngezifo.
Umfanekiso 5I-ESDukwelashwa kwezilonda ezinkulu
Izinyathelo zokuphepha ngesikhathi sokuhlinzwa
Ukususwa kwe-polyp yamathumbu amakhulu nge-endoscopic kudinga indlela efanele yokukhetha ngokusekelwe ezicini ze-polyp, indawo, izinga lekhono lomqhubi, kanye nemishini ekhona. Ngesikhathi esifanayo, ukususwa kwe-polyp kulandela nezimiso ezivamile, okudingeka sizilandele ngangokunokwenzeka ukuqinisekisa ukuthi inqubo yezokwelapha iphephile futhi isebenza kahle nokuthi iziguli ziyazuza kuyo.
1. Ukuhlelwa kwangaphambili kohlelo lokwelashwa kuyisihluthulelo sokuqedwa ngempumelelo kokwelashwa kwe-polyp (ikakhulukazi ama-polyp amakhulu). Kuma-polyp ayinkimbinkimbi, kuyadingeka ukukhetha indlela yokususa ehambisanayo ngaphambi kokwelashwa, ukuxhumana nabahlengikazi, odokotela be-anesthesiologists kanye nabanye abasebenzi ngesikhathi esifanele, nokulungisa imishini yokwelapha. Uma izimo zivuma, kungaqedwa ngaphansi kwesiqondiso sikadokotela ohlinzayo omkhulu ukuvimbela izingozi ezahlukene zokuhlinzwa.
2. Ukugcina "izinga lenkululeko" elihle emzimbeni wesibuko ngesikhathi sokwelashwa kuyimfuneko yokuqinisekisa ukuthi inhloso yokuhlinzwa iyafezeka. Uma ungena esibukweni, landela ngokuqinile "indlela yokulungisa nokunciphisa i-axis" ukuze ugcine indawo yokwelashwa isesimweni esingenaluphu, esivumela ukwelashwa okunembile.
3. Umbono omuhle wokusebenza wenza inqubo yokwelapha ibe lula futhi iphephile. Amathumbu esiguli kufanele alungiswe ngokucophelela ngaphambi kokwelashwa, indawo yesiguli kufanele inqunywe ngaphambi kokuhlinzwa, futhi ama-polyp kufanele avele ngokuphelele ngamandla adonsela phansi. Ngokuvamile kungcono uma isilonda sitholakala ohlangothini oluphambene noketshezi olusele emgodini wamathumbu.
Thina, iJiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumkhiqizi eShayina ogxile ezintweni ezisetshenziswayo ze-endoscopic, njengei-biopsy forceps, i-hemoclip, ugibe lwe-polyp, inaliti ye-sclerotherapy, i-catheter yokufafaza, amabhulashi e-cytology, ucingo lokuqondisa, ubhasikidi wokuthola amatshe, i-catheter yokukhipha amanzi ekhaleninjll. ezisetshenziswa kabanzi ku-I-EMR, I-ESD, I-ERCPImikhiqizo yethu inesitifiketi se-CE, kanti izitshalo zethu zinesitifiketi se-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi kanye nengxenye ye-Asia, futhi zithola ukuqashelwa nokunconywa kakhulu ngamakhasimende!
Isikhathi sokuthunyelwe: Agasti-02-2024