I-Colon polyp yisifo esivamile futhi esivame ukwenzeka ku-gastroenterology. Babhekisela kuma-intraluminal protrusions aphezulu kune-mucosa yamathumbu. Ngokuvamile, i-colonoscopy inezinga lokutholwa okungenani elingu-10% kuya ku-15%. Izinga lezehlakalo livame ukukhuphuka ngokuya ngeminyaka. vuka. Njengoba ngaphezu kuka-90% womdlavuza we-colorectal ubangelwa ukuguqulwa okulimazayo kwama-polyps, ukwelashwa okujwayelekile ukwenza i-endoscopic resection ngokushesha nje lapho ama-polyps ebonakala.
Ku-colonoscopy yansuku zonke, ama-80% kuya ku-90% ama-polyps angaphansi kuka-1 cm. Kuma-polyp adenomatous noma ama-polyp anobude obungu-≥ 5 mm (noma ngabe i-adenomatous noma cha), kunconywa ukukhishwa kwe-endoscopic okukhethiwe. Amathuba okuba nama-micropolyps ekholoni (ubude bobubanzi ≤5mm) aqukethe izingxenye zesimila aphansi kakhulu (0~0.6%). Kuma-micropolyps ku-rectum kanye nekholoni ye-sigmoid, uma i-endoscopist ingakwazi ukunquma ngokunembile ukuthi ayi-polyps engeyona i-adenomatous, asikho isidingo sokukhipha kabusha, kodwa umbono ongenhla awuvamile ukusetshenziswa emisebenzini yomtholampilo e-China.
Ngaphezu kwalokho, ama-polyp angu-5% ayisicaba noma akhula emaceleni, anobubanzi obungaphezu kuka-2 cm, anezingxenye eziyingozi noma ezingenazo. Kulokhu, ezinye izindlela ezithuthukisiwe zokususa i-polyp endoscopic ziyadingeka, njengeI-EMRfuthiESD. Ake sibheke izinyathelo ezinemininingwane zokususwa kwe-polyp.
Inqubo yokuhlinzwa
Isiguli saphothula ukuhlolwa kwe-anesthesia ngaphambi kokuhlinzwa, safakwa endaweni yesokunxele ye-lateral decubitus, futhi sanikezwa i-intravenous anesthesia nge-propofol. Umfutho wegazi, izinga lokushaya kwenhliziyo, i-electrocardiogram, kanye nokugcwala komoya-mpilo egazini kwaqashwa ngesikhathi sokuhlinzwa.
1 Kuyabanda/ KuyashisaI-Biopsy ForcepsUkwehlukana
Ilungele ukususwa kwama-polyps amancane ≤5mm, kodwa kungase kube nenkinga yokukhishwa okungaphelele kwama-polyps 4 kuya ku-5mm. Ngesisekelo se-biopsy ebandayo, i-thermal biopsy ingasebenzisa i-high-frequency current ukuze ibangele izilonda ezisele futhi yenze ukwelashwa kwe-hemostasis esilondeni. Kodwa-ke, kufanele kuqashelwe ukugwema ukulimala kongqimba lwe-serose yodonga lwamathumbu ngenxa ye-electrocoagulation eyeqile.
Ngesikhathi sokuhlinzwa, ingxenye yekhanda le-polyp kufanele iboshwe, iphakanyiswe ngokufanele (ukugwema ukulimaza ungqimba lwemisipha), futhi igcinwe ebangeni elifanele ukusuka odongeni lwamathumbu. Lapho i-polyp pedicle iba mhlophe, yeka i-electrocoagulation futhi ubambe isilonda. Kumele kuqashelwe ukuthi akulula ukususa i-polyp enkulu kakhulu, ngaphandle kwalokho kuzokwandisa isikhathi sokufaka ugesi futhi kwandise ingozi yokulimala okugcwele (Umfanekiso 1).
2 Kuyabanda/kuyashisai-polypectomy snareindlela yokususa
Ifanele izilonda eziphakanyisiwe zosayizi abahlukene I p, uhlobo lwe-sp kanye nohlobo oluncane (<2cm) I s (izindinganiso zokuhlukaniswa eziqondile zingabhekisela ekutholweni kwe-endoscopic yomdlavuza wangaphambi kwesikhathi womzila wokugaya ukudla. Kunezinhlobo eziningi kakhulu futhi angazi ukuthi ngingahlulela kanjani? Lesi sihloko Yenza kucace) Ukukhishwa kabusha kwezilonda. Ngohlobo oluncane lwezilonda ze-Ip, ukususwa kogibe kulula. Izingibe ezibandayo noma ezishisayo zingasetshenziswa ukuze zikhishwe kabusha. Ngesikhathi sokukhishwa, ubude obuthile be-pedicle kufanele bugcinwe noma ibanga elithile ukusuka odongeni lwamathumbu ngenkathi kuqinisekiswa ukususwa okuphelele kwesilonda. Ngemva kokuqinisa ugibe, kufanele inyakaziswe I-Snare, ibheke ukuthi kukhona yini ezungezile i-mucosa yamathumbu evamile futhi ihlanganiswe ndawonye ukuze kuvinjelwe ukulimala odongeni lwamathumbu.
Umfanekiso 1 Umdwebo weSchematic wokususwa kwe-thermal biopsy forceps, A ngaphambi kokususwa kwe-forceps, B isilonda ngemva kokususwa kwe-forceps. I-CD: Izinyathelo zokuqapha ezishisayoi-biopsy forcepsukususwa. Uma i-polyp inkulu kakhulu, izokwandisa isikhathi se-electrocoagulation futhi ibangele ukulimala kwe-transmural.
Umfanekiso 2 Umdwebo ohleliwe wokukhishwa kogibe olushisayo lwezilonda ezincane zohlobo lwe-I sp
3 I-EMR
■ I p izilonda
Ngezilonda ezinkulu ze-I p, ngaphezu kwezinyathelo zokuqapha ezingenhla, izicupho ezishisayo kufanele zisetshenziselwe ukukhishwa kabusha. Ngaphambi kokukhishwa, umjovo okwanele we-submucosal kufanele wenziwe phansi kwe-pedicle (2 kuya ku-10 mL yamayunithi angu-10,000 e-epinephrine + i-methylene blue + physiological Ingxube ye-saline ijojowe ngaphansi kwe-mucosa (jova ngenkathi ihoxisa inaliti), ukuze i-pedicle iphakanyiswe ngokugcwele futhi kulula ukuyisusa (Umfanekiso kufanele ugweme ukuthintana kwe-resestinal, Ngesikhathi sokugwema ukuxhumana kwe-resestinal). ukwakha iluphu evaliwe futhi kushise udonga lwamathumbu.
Umfanekiso 3 Umdwebo wohlelo weI-EMRukwelashwa kwezilonda zohlobo lwe-lp
Kumele kuqashelwe ukuthi uma uhlobo olukhulu lwe-I p polyp lune-pedicle ewugqinsi, lungase lube ne-vasorum enkulu ye-vasorum, futhi luzophuma kalula ngemva kokususwa. Phakathi nenqubo yokukhishwa kabusha, indlela ye-coagulation-cut-coagulation ingasetshenziswa ukunciphisa ingozi yokopha. Amanye ama-polyp amakhulu angaphinde akhishwe abe yizicucu ukuze kuncishiswe ubunzima bokusebenza, kodwa le ndlela ayihambisani nokuhlolwa kwe-pathological.
■ izilonda zohlobo lwe-lla-c
Ngezilonda zohlobo lwe-Ila-c kanye nezinye izilonda ze-Is ezinobubanzi obukhulu, ukukhishwa okuqondile kogibe kungase kubangele ukulimala okugcwele. Umjovo we-submucosal we-liquid ungakhuphula ukuphakama kwesilonda futhi unciphise ubunzima bogibe nokukhishwa kabusha. Ukuthi kukhona i-protrusion ngesikhathi sokuhlinzwa kuyisisekelo esibalulekile sokunquma ukuthi i-adenoma ayilungile noma iyingozi nokuthi zikhona yini izinkomba zokwelashwa kwe-endoscopic. Le ndlela ingakhuphula izinga lokukhishwa okuphelele kwe-adenomas<2cm ububanzi.
Umfanekiso 4I-EMRishadi lokugeleza kokwelashwa lohlobo lwe-Il a polyps
4 ESD
Kuma-adenomas anobubanzi obungaphezu kuka-2cm adinga ukuphinde ahlinzwe kanye kanye nophawu olubi lokuphakamisa, kanye neminye imidlavuza yakuqala,I-EMRizinsalela noma ukuvela okunzima ukukwelapha,ESDukwelashwa kungenziwa. Izinyathelo ezijwayelekile yilezi:
1. Ngemuva kokungcola kwe-endoscopic, umngcele we-lesion uchazwe ngokucacile futhi umjikelezo umakwe (isilonda singase singamakwa uma umngcele wesilonda ucacile).
2. Jova i-submucosally ukuze izilonda zisuswe ngokusobala.
3. Hlanza kancane noma ngokuzungeza umucosa ukuze uveze i-submucosa.
4. Khulula izicubu ezixhumene eduze kwe-submucosa futhi kancane kancane ukhiphe izicubu ezigulayo.
5. Bhekisisa isilonda ngokucophelela futhi welaphe imithambo yegazi ukuze uvimbele izinkinga.
6. Ngemva kokucubungula ama-specimens akhishiwe, zithumele ukuze zihlolwe i-pathological.
Umfanekiso 5ESDukwelashwa kwezilonda ezinkulu
Izinyathelo zokuphepha ze-intraoperative
Ukukhishwa kwe-polyp ye-endoscopic colon kudinga indlela efanelekile ukuze kukhethwe ngokusekelwe ezicini ze-polyp, indawo, izinga lekhono lomsebenzisi, nezinto zokusebenza ezikhona. Ngesikhathi esifanayo, ukususwa kwe-polyp nakho kulandela izimiso ezivamile, okudingeka sizilandele ngangokunokwenzeka ukuze siqinisekise ukuthi inqubo yezokwelapha iphephile futhi iyasebenza futhi iziguli ziyazuza kuyo.
1. Ukumiswa kwangaphambili kohlelo lokwelapha kuyisihluthulelo sokuphothulwa ngempumelelo kokwelashwa kwe-polyp (ikakhulukazi ama-polyps amakhulu). Ukuze uthole ama-polyps ayinkimbinkimbi, kuyadingeka ukukhetha indlela ehambisanayo yokususa ngaphambi kokwelashwa, ukuxhumana nabahlengikazi, odokotela ababulala izinzwa kanye nabanye abasebenzi ngesikhathi esifanele, futhi ulungiselele imishini yokwelapha. Uma izimo zivuma, ingaqedwa ngaphansi kokuqondisa kukadokotela ohlinzayo omdala ukuze kuvinjelwe izingozi ezihlukahlukene zokuhlinzwa.
2. Ukugcina "izinga lenkululeko" elihle emzimbeni wesibuko ngesikhathi sokwelashwa kuyisidingo sokuqinisekisa ukuthi inhloso yokusebenza iyafezeka. Lapho ungena esibukweni, landela ngokuqinile "ukugcinwa kwe-eksisi kanye nendlela yokunciphisa" ukuze ugcine indawo yokwelapha isesimweni esingenayo iluphu, evumela ukwelashwa okunembile.
3. Ukubona okuhle kokusebenza kwenza inqubo yokwelapha ibe lula futhi iphephe. Amathumbu esiguli kufanele alungiselelwe ngokucophelela ngaphambi kokwelashwa, indawo yesiguli kufanele inqunywe ngaphambi kokuhlinzwa, futhi ama-polyp kufanele abonakale ngokugcwele amandla adonsela phansi. Ngokuvamile kuba ngcono uma isilonda sitholakala ngakolunye uhlangothi loketshezi olusele emgodini wamathumbu.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., singumkhiqizi waseChina ogxile ezintweni ezisetshenziswayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, polyp ugibe, inaliti ye-sclerotherapy, fafaza i-catheter, amabhulashi e-cytology, guidewire, ubhasikidi wokubuyisa amatshe, i-catheter ye-nasal biliary drainagenjll ezisetshenziswa kakhulu kuI-EMR, ESD, I-ERCP. Imikhiqizo yethu iqinisekiswe yi-CE, futhi izitshalo zethu ziqinisekiswe yi-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi nasengxenyeni ye-Asia, futhi zithola kabanzi ikhasimende lokuqashelwa nokudumisa!
Isikhathi sokuthumela: Aug-02-2024