IColon PolyPS yisifo esivamile futhi esivame ukwenzeka kaningi ku-gastroenterology. Babhekisela kuma-protor aphakathi nendawo aphakeme kune-mucosa yamathumbu. Ngokuvamile, i-colonoscopy inesilinganiso sokutholwa okungenani kwe-10% kuya ku-15%. Izinga lezehlakalo livame ukukhuphuka ngeminyaka. vuka. Kusukela ngaphezulu kwama-90% omdlavuza wemibala kubangelwa ukuguqulwa okulimazayo kwama-polyps, ukwelashwa okujwayelekile ukwenza kabusha kabusha kwe-endoscopic ngokushesha nje lapho kubonakala khona ama-polyps.
EColonoscopy yansuku zonke, ama-80% kuya kwayi-90% ama-polyps angaphansi kwe-1 cm. Kuma-polyps noma ama-polyps anobude obude ≥ 5 mm (noma ngabe ancono noma cha), ukusetha kabusha kwe-endoscopic e-endoscopic. Amathuba ama-micropolyps (ubude obude ≤5mm) aqukethe ama-tumor complen aphansi kakhulu (0 ~ 0.6%). Okwe-micropolyps ku-rectum kanye ne-sigmoid colon, uma i-endoscopist inganquma ngokunembile ukuthi ama-polyps angewona ama-adenomatos, asikho isidingo sokuma kabusha, kepha iphuzu elingenhla alivamile ukuthi lisetshenziswe emtholampilo eChina.
Ngaphezu kwalokho, ama-5% ama-polyps ayizicaba noma akhula eceleni kwemigwaqo, enobubanzi obungaphezu kwama-2 cm, ngezakhi ezibucayi noma ngaphandle kwezakhi ezibuhlungu. Kulokhu, amasu wokususa ama-polyp athuthukisiwe athuthukile adingekayo, anjengeEMRna-Ivi. Ake sibheke izinyathelo ezinemininingwane yokususwa kwe-polyp.
Inqubo yokuhlinzwa
Isiguli siphothule ukuhlolwa kwe-anesthesia ePelasteritative, sabekwa endaweni yangakwesobunxele isikhundla se-lateral decalubike, futhi sanikezwa i-anesthesia ye-intrevenous nge-propofol. Umfutho wegazi, izinga lenhliziyo, electrocardiogram, kanye ne-peripheral moya oklygen sahlulelwa ngesikhathi sokusebenza.
1 kubanda / kuyashisaI-Biopsy ForcepsIsabelo
Ilungele ukususwa kwama-polyps amancane ≤5mm, kepha kungahle kube nenkinga yokususwa okungaphelele kwama-polyps 4 kuya ku-5mm. Ngokwesisekelo sokubanda kwe-biopsy, i-biopsy eshisayo ingasebenzisa imvamisa ephezulu yamanje ukuze isebenze izilonda ezisele futhi isebenzise ukwelashwa kwe-hemostasis esilondeni. Kodwa-ke, ukunakekelwa kufanele kuthathwe ukugwema ukulimala kwesendlalelo se-serosa sodonga lwamathumbu ngenxa ye-electrocaitional ngokweqile.
Ngesikhathi sokusebenza, ukuphela kwekhanda le-polyp kufanele kuvalwe, kuphakanyiswe ngendlela efanele (ukugwema ukulimaza ungqimba lwemisipha), futhi kugcinwe ibanga elifanele kusuka odongeni lwamathumbu. Lapho i-pedicle ye-polyp iphenduka yaba mhlophe, yeka ama-electrocaagulation futhi uvimbele i-lesion. Kumele kwaziwe ukuthi akulula ukususa kakhulu i-polyk, uma kungenjalo kuzokwelula isikhathi sokufakelwa kukagesi futhi kwandise ubungozi bokulimala okugcwele (Umdwebo 1).
2 kubanda / kuyashisaugibe lwe-polypectomyindlela yokususa
Ilungele izilonda eziphakanyisiwe zesayizi ehlukene ngohlobo, ngithayipha futhi nginohlobo oluncane (<2cm) (amazinga athile wokuhlukaniswa angabhekisa ekutholweni kwe-endoscopic komdlavuza wokugaya ukudla. Okwezinhlobo ezincane ze-IP LESISOL, ukusetha okulula kulula. Izingibe ezibandayo noma ezishisayo zingasetshenziselwa ukusetha kabusha. Ngesikhathi sokuvuselelwa, ubude obuthile be-pedicle kufanele bugcinwe noma ibanga elithile kusuka odongeni lwamathumbu ngenkathi uqinisekisa ukususwa okuphelele kwesilonda. Ngemuva kokuqinisa ugibe, kufanele kunyakaziswe ugibe, kubonakale ukuthi ngabe kukhona i-mucosa evamile yamathumbu bese uyifaka ndawonye ukuvikela ukulimala odongeni lwamathumbu.
Umdwebo ongu-1 we-Schematic umdwebo wokususwa kwe-Thermal Biopsy Forceps, ngaphambi kokukhishwa kwe-Forceps, b inxeba ngemuva kokususwa kwebutho. I-CD: Izindlela zokuqapha ze-ThermalI-Biopsy Forcepsukususwa. Uma i-polyp inkulu kakhulu, izokhulisa isikhathi se-elekthroliction futhi ibangele ukulimala okuthe xaxa.
Umdwebo 2 Umdwebo we-Schematic we-Thermal Snare Revection of incane I SP LESSIONS
3 EMR
■ I P LESONS
Okwezinhlangothi ezinkulu ze-I P, ngaphezu kwezinyathelo zokuphepha ezingenhla, izicupho ezishisayo kufanele zisetshenziselwe ukusetha kabusha. Before resection, sufficient submucosal injection should be made at the base of the pedicle (2 to 10 mL of 10,000 units of epinephrine + methylene blue + physiological The saline mixture is injected under the mucosa (inject while withdrawing the needle), so that the pedicle is fully raised and easy to remove (Figure 3). During the resection process, the lesion should avoid contact with the intestinal wall to avoid forming a closed loop futhi uvutha udonga lwamathumbu.
Umdwebo 3 umdwebo weEMRUkwelashwa kwezilonda zohlobo lwe-LP
Kumele kwaziwe ukuthi uma uhlobo olukhulu lwe-P polyp lune-pedicle enkulu, ingaqukatha i-vasa vasorum enkulu, futhi izopha amanzi ngemuva kokukhishwa. Ngesikhathi senqubo yokuhlela kabusha, indlela yokugoqa-ukusikwa ingasetshenziswa ukunciphisa ingozi yokopha. Amanye ama-polyps amakhulu angavulelwa kabusha ukuze anciphise ubunzima bokusebenza, kepha le ndlela ayilungele ukuhlolwa kwe-pathological.
■ lla-c izinhlobo zohlobo
Okwezilonda zohlobo lwe-ILA-C kanti ezinye ziyizilonda ezinamadayimane amakhulu, ukulungiswa kwesigaxa esiqondile kungadala ukulimala okugcwele. Ukujova kwe-subbeCosal uketshezi kungakhuphula ukuphakama kwesilonda futhi kunciphise ubunzima besigaxa kanye nokuvuselelwa kabusha. Noma ngabe kukhona ukuphefumula ngesikhathi sokuhlinzwa kuyisisekelo esibalulekile sokunquma ukuthi i-adenoma iyabonakala noma i-malignant nokuthi ngabe kukhona izinkomba zokwelashwa kwe-endoscopic. Le ndlela ingakhuphula izinga lokuhlaziya eliphelele lama-adenomas<2cm ububanzi.
Umdwebo 4EMRIshadi lokugeleza lokwelashwa lohlobo il ama-polyps
4 Ivi
Okwama-adenomas ane-mainget enkulu kune-2cm edinga ukusetha kabusha kwesikhathi esisodwa kanye nesibonakaliso esingesihle sokuphakamisa, kanye nomdlavuza wokuqala,EMRizinsalela noma ukuphindaphinda okunzima ukwelapha,IviUkwelashwa kungenziwa. Izinyathelo ezijwayelekile yilezi:
1. Ngemuva kokubala ama-endoscopic, umngcele wesilonda uchazwa ngokucacile futhi ukujikeleza kumakwe (lesi siwona kungenzeka singaphawulwa uma umngcele wesilonda ucacile).
2. Ijoke ngokungazenzisi ukwenza izilonda ngokusobala ziphakame.
3. Ingxenye noma incike noma incike kakhulu i-mucosa ukudalula i-submucosa.
4. Khulula izicubu ezithintekayo eduze kwe-submucosa futhi kancane kancane ukhokha izicubu ezigulayo.
5. Bheka inxeba ngokucophelela futhi uphathe imithambo yegazi ukuvikela izinkinga.
I-6. Ngemuva kokucubungula izinhlobo ezikhohlisayo, zibathumele ekuhlolweni kwe-pathological.
Umdwebo 5IviUkwelashwa kwezilonda ezinkulu
Ukuqapha kwe-Intraperaterative
I-Endoscopic colon polyp resection idinga indlela efanelekile yokukhethwa ngokuya ngezimpawu ze-polyp, indawo, izinga lekhono le-opharetha, nemishini ekhona. Ngasikhathi sinye, ukususwa kwama-polyp kubuye kulandela imigomo ejwayelekile, okudingeka siyilandele ngangokunokwenzeka ukuze siqinisekise ukuthi inqubo yezokwelapha iphephile futhi iyasebenza futhi iziguli ziyazuza kukho.
1. Ukusetha kwangaphambili kohlelo lokwelashwa kuyisihluthulelo sokuqedwa ngempumelelo kokwelashwa kwe-polyp (ikakhulukazi ama-polyps amakhulu). Kuma-polyps ayinkimbinkimbi, kuyadingeka ukuthi ukhethe indlela ehambisanayo yesetha kabusha ngaphambi kokwelashwa, ukuxhumana nabahlengikazi, ama-anesthesiologists nabanye abasebenzi ngesikhathi esifanele, bese ulungiselela imishini yokwelashwa. Uma izimo zivuma, zingaphothulwa ngaphansi kokuholwa ngudokotela ohlinzayo ophezulu ukuvikela izingozi ezahlukahlukene zokuhlinza.
2 Lapho ungena esibukweni, landela ngokuqinile "ukulungiswa kwe-axis kanye nendlela yokunciphisa" ukuze ugcine isikhundla sokwelashwa esimweni se-loop-free, esilungele ukwelashwa okuqondile.
3. Umbono omuhle wokusebenza wenza inqubo yokwelashwa ibe lula futhi iphephe. Amathumbu wesiguli kufanele alungiswe ngokucophelela ngaphambi kokwelashwa, isikhundla sesiguli kufanele sinqunywe ngaphambi kokuhlinzwa, futhi ama-polyps kufanele avezwe ngokuphelele ngamandla adonsela phansi. Ngokuvamile kungcono uma i-lesion itholakala ngaphesheya koketshezi olusele egumbini lamathumbu.
We, Jiangxi Zhuoruihui Medical Incument Co, Ltd, umenzi waseChina ochwepheshe kokudla kwe-endoscopic, njengeI-Biopsy Forceps, hemoclip, I-PolyP Snare, inaliti ye-sclerotherapy, fafaza i-catheter, ama-cytolology amabhulashi, Umhlahlandlela, I-Stone Retrieval Basket, I-Catheter ye-Nasal Buily Catheternjll. Kusetshenziswe kabanziEMR, Ivi, I-ERCPP. Imikhiqizo yethu iqinisekisiwe, futhi izitshalo zethu ziqinisekisiwe ze-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi nendawo nengxenye ye-Asia, futhi zithola amakhasimende wokuqashelwa nokudumisa!
Isikhathi sePosi: Aug-02-2024