Phakathi kolwazi oludumile mayelana nomdlavuza wesisu wasekuqaleni, kunezinye izinto ezingavamile zolwazi lwezifo ezidinga ukunakwa nokufunda okukhethekile. Elinye lazo umdlavuza wesisu ongenawo i-HP. Umqondo "wama-epithelial tumors angathelelekile" manje usuthandwa kakhulu. Kuzoba nemibono ehlukene ngendaba yegama. Lo mbono wokuqukethwe usekelwe kakhulu kokuqukethwe okuhlobene nomagazini i-"Stomach and Intestine", futhi igama liphinde lisebenzise "umdlavuza wesisu ongenawo i-HP".
Lolu hlobo lwezilonda lunezici zokwanda okuphansi, ubunzima bokuhlonza, ulwazi oluyinkimbinkimbi lwethiyori, futhi inqubo elula ye-MESDA-G ayisebenzi. Ukufunda lolu lwazi kudinga ukubhekana nobunzima.
1. Ulwazi oluyisisekelo ngomdlavuza wesisu ongemuhle we-HP
Umlando
Esikhathini esidlule, kwakukholelwa ukuthi imbangela eyodwa ekuveleni nasekuthuthukisweni komdlavuza wesisu kwakuwukutheleleka kwe-HP, ngakho-ke imodeli yomdlavuza yakudala yi-HP - ukuwohloka - ukuguguleka kwamathumbu - isimila esiphansi - isimila esiphezulu - umdlavuza. Imodeli yakudala ibilokhu iqashelwa kabanzi, yamukelwa futhi ikholweka ngokuqinile. Amathumba akhula ndawonye ngokusekelwe ekuwohlokeni nangaphansi kwesenzo se-HP, ngakho-ke umdlavuza ukhula kakhulu ezindleleni zamathumbu eziwohlokayo kanye ne-mucosa yesisu engeyona evamile.
Kamuva, abanye odokotela bathola ukuthi umdlavuza wesisu ungavela ngisho noma kungekho ukutheleleka kwe-HP. Nakuba izinga lokusabalala kwawo liphansi kakhulu, kungenzeka ngempela. Lolu hlobo lomdlavuza wesisu lubizwa ngokuthi umdlavuza wesisu ongenayo i-HP.
Ngokuqonda kancane kancane lolu hlobo lwesifo, sekuqalile ukubonwa okuhlelekile okujulile kanye nezifinyezo, futhi amagama ashintsha njalo. Kwakukhona isihloko ngo-2012 esibizwa ngokuthi "Umdlavuza Wesisu Ngemva Kokuhlanzwa", isihloko ngo-2014 esibizwa ngokuthi "Umdlavuza Wesisu Ongenawo i-HP", kanye nesihloko ngo-2020 esibizwa ngokuthi "Ama-Epithelial Tumors Angatheleleki nge-Hp". Ukushintsha kwegama kubonisa ukuqonda okujulile nokuphelele.
Izinhlobo Zezindlala Namaphethini Okukhula
Kunezinhlobo ezimbili eziyinhloko zezindlala ze-fundic kanye nezindlala ze-pyloric esiswini:
Izindlala ze-Fundic (izindlala ze-oxyntic) zisakazeka ku-fundus, emzimbeni, emakhoneni, njll. esiswini. Ziyizindlala eziqondile ezine-tubular eyodwa. Zakhiwe ngamaseli e-mucous, amaseli amakhulu, amaseli e-parietal kanye namaseli e-endocrine, ngalinye elenza imisebenzi yalo. Phakathi kwazo, amaseli amakhulu I-PGI kanye ne-MUC6 staining ekhishwe yayinhle, kanti amaseli e-parietal akhipha i-hydrochloric acid kanye ne-intrinsic factor;
Ama-pyloric glands atholakala endaweni yesisu futhi akhiwe ngamaseli e-mucus namaseli e-endocrine. Amaseli e-mucus ane-MUC6 positive, kanti amaseli e-endocrine afaka amaseli e-G, D namaseli e-enterochromaffin. Amaseli e-G akhipha i-gastrin, amaseli e-D akhipha i-somatostatin, namaseli e-enterochromaffin akhipha i-5-HT.
Amaseli ajwayelekile e-mucosal esiswini kanye namaseli esimila akhipha izinhlobo ezahlukene zamaprotheni e-mucus, ahlukaniswe ngamaprotheni e-mucus "esiswini", "amathumbu" kanye "nahlanganisiwe". Ukuvezwa kwe-mucins yesisu kanye neyamathumbu kubizwa ngokuthi i-phenotype hhayi indawo ethile yomzimba wesisu namathumbu.
Kunezinhlobo ezine zamaseli ezimila zesisu: isisu esiphelele, isisu esixubile, isisu esixubile, kanye nesisu esiphelele. Amathumba avela ngokusekelwe ekuguqukeni kwamathumbu ikakhulukazi amathumba axubile. Umdlavuza ohlukanisiwe ubonisa uhlobo lwamathumbu (MUC2+), kanti umdlavuza osabalalayo ubonisa uhlobo lwesisu (MUC5AC+, MUC6+).
Ukunquma ukuthi i-Hp ayilungile kudinga inhlanganisela ethile yezindlela eziningi zokuthola ukuze kutholakale ngokuphelele. Umdlavuza wesisu ongenayo i-HP kanye nomdlavuza wesisu ongemva kokubulala inzalo kuyimibono emibili ehlukene. Ukuze uthole ulwazi mayelana nokubonakaliswa kwe-X-ray komdlavuza wesisu ongenayo i-HP, sicela ubheke ingxenye efanele yomagazini othi "Isisu kanye Nesisu".
2. Ukubonakaliswa kwe-endoscopic komdlavuza wesisu ongemuhle we-HP
Ukuxilongwa kwe-endoscopic yikona okugxilwe kukho umdlavuza wesisu ongemuhle we-HP. Kuhlanganisa kakhulu umdlavuza wesisu wohlobo lwe-fundic gland, umdlavuza wesisu wohlobo lwe-fundic gland mucosal, i-gastric adenoma, i-raspberry foveolar epithelial tumor, i-signet ring cell carcinoma, njll. Lesi sihloko sigxile ekubonakalisweni kwe-endoscopic komdlavuza wesisu ongemuhle we-HP.
1) I-Fundic gland uhlobo lomdlavuza wesisu
-Izilonda ezimhlophe eziphakanyisiwe
uhlobo lomdlavuza we-gastric fundac
◆Icala 1: Izilonda ezimhlophe, eziphakanyisiwe
Incazelo:Ukugoba okukhulu kwe-cardia esiswini, okungu-10 mm, okumhlophe, uhlobo lwe-O-lia (olufana ne-SMT), ngaphandle kokuqina noma ukuguguleka kwamathumbu ngemuva. Imithambo yegazi efana ne-arbor ingabonakala ebusweni (i-NBI kanye nokukhula kancane)
Ukuxilongwa (kuhlanganiswe ne-pathology):U, O-1la, 9mm, fundac gland hlobo lomdlavuza wesisu, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Izilonda ezimhlophe ezisicaba
uhlobo lomdlavuza we-gastric fundac
◆Icala 2: Izilonda ezimhlophe, ezisicaba/ezicindezelekile
Incazelo:Udonga olungaphambili lwe-gastric fundic fornix-cardia greater curvature, 14 mm, mhlophe, uhlobo 0-1lc, olungenayo i-atrophy noma i-intestinal metaplasia ngemuva, imingcele engacacile, kanye nemithambo yegazi ye-dendritic ebonakala ebusweni. (I-NBI kanye ne-amplification efingqiwe)
Ukuxilongwa (kuhlanganiswe ne-pathology):U, 0-Ilc, 14mm, fundac gland hlobo lomdlavuza wesisu, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Izilonda ezibomvu eziphakanyisiwe
uhlobo lomdlavuza we-gastric fundac
◆Icala 3: Izilonda ezibomvu neziphakanyisiwe
Incazelo:Udonga olungaphambili lwe-great curve ye-cardia luyi-12 mm, ngokusobala lubomvu, uhlobo lwe-0-1, alunawo ama-atrophy noma i-intestinal metaplasia ngemuva, imingcele ecacile, kanye nemithambo yegazi ye-dendritic ebusweni (i-NBI kanye nokukhula kancane)
Ukuxilongwa (kuhlanganiswe ne-pathology):U, 0-1, 12mm, fundac gland uhlobo lomdlavuza wesisu, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
-Isilonda esibomvu, esiyisicaba, esicindezelekiles
uhlobo lomdlavuza we-gastric fundac
◆Icala 4: Izilonda ezibomvu, ezisicaba/ezicindezelekile
Incazelo:Udonga lwangemuva lokugoba okukhulu kwengxenye engenhla yomzimba wesisu, 18mm, obomvu okhanyayo, uhlobo lwe-O-1Ic, akukho ukuwohloka noma ukuguguleka kwamathumbu ngemuva, umngcele ongacacile, akukho mithambo yegazi ye-dendritic ebusweni, (i-NBI kanye nokukhulisa kususiwe)
Ukuxilongwa (kuhlanganiswe ne-pathology):U, O-1lc, 19mm, fundac gland hlobo lomdlavuza wesisu, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
xoxa
Abesilisa abanalesi sifo badala kunabesifazane, kanti isilinganiso sobudala siyiminyaka engu-67.7 ubudala. Ngenxa yezici ze-simultaneity kanye ne-heterochrony, iziguli ezitholakale zinomdlavuza wesisu wohlobo lwe-fundic gland kufanele zibuyekezwe kanye ngonyaka. Indawo evame kakhulu yindawo ye-fundic gland engxenyeni ephakathi nengaphezulu yesisu (i-fundus kanye nengxenye ephakathi nengaphezulu yomzimba wesisu). Izilonda ezimhlophe ezifana ne-SMT zivame kakhulu ekukhanyeni okumhlophe. Ukwelashwa okuyinhloko yi-EMR/ESD yokuxilonga.
Akukho ukusabalala kwe-lymphatic noma ukuhlasela kwemithambo yegazi okubonwe kuze kube manje. Ngemva kokwelashwa, kuyadingeka ukunquma ukuthi kufanele kwenziwe yini ukuhlinzwa okwengeziwe futhi kuhlolwe ubudlelwano phakathi kwesimo esibi kanye ne-HP. Akuwona wonke umdlavuza wesisu wohlobo lwe-fundic gland ongenawo i-HP.
1) Umdlavuza wesisu we-Fundic gland mucosal
Umdlavuza wesisu we-Fundic gland mucosal
◆Icala 1
Incazelo:Isilonda siphakanyisiwe kancane, futhi i-RAC non-atrophic gastric mucosa ingabonakala nxazonke. Isakhiwo esincane esishintsha ngokushesha kanye nemithambo emincane ingabonakala engxenyeni ephakanyisiwe ye-ME-NBI, kanye ne-DL ingabonakala.
Ukuxilongwa (kuhlanganiswe ne-pathology):I-Fundic gland mucosal gastric cancer, U zone, 0-1la, 47*32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Umdlavuza wesisu we-Fundic gland mucosal
◆Icala 2
Incazelo: Isilonda esiyisicaba odongeni olungaphambili lwesigobe esincane se-cardia, esinombala oxubile kanye nokubomvu, imithambo yegazi ye-dendritic ingabonakala ebusweni, futhi isilonda siphakanyisiwe kancane.
Ukuxilongwa (kuhlanganiswe ne-pathology): Umdlavuza we-Fundic gland mucosal gastric, 0-lla, pT1a/M, ULO, LyOV0,HM0,VMO
xoxa
Igama elithi "gastric gland mucosal adenocarcinoma" kunzima ukulibiza, futhi izinga lokusabalala kwalo liphansi kakhulu. Kudinga imizamo eyengeziwe ukuze libonwe futhi liqondwe. I-Fundic gland mucosal adenocarcinoma inezici zomdlavuza ophezulu.
Kunezimpawu ezine ezinkulu ze-endoscopy yokukhanya okumhlophe: ① izilonda ezifiphalayo ze-homochromatic; ② i-subepithelial tumor SMT; ③ imithambo yegazi ye-dendritic evulekile; ④ ama-microparticles esifunda. Ukusebenza kwe-ME: I-DL(+)IMVP(+)IMSP(+)MCE yandisa i-IP futhi iyanda. Ngokusebenzisa inqubo enconyiwe ye-MESDA-G, ama-90% omdlavuza wesisu we-mucosal gland ahlangabezana nezindlela zokuxilonga.
3) I-adenoma yesisu (i-adenoma ye-pyloric gland PGA)
i-adenoma yesisu
◆Icala 1
Incazelo:Isilonda esimhlophe esisicaba sabonakala odongeni olungemuva lwe-gastric fornix olunemingcele engacacile. Umbala we-Indigo carmine awubonisanga mingcele ecacile, futhi ukubonakala kwamathumbu amakhulu okufana ne-LST-G kwabonakala (kwakhuliswa kancane).
Ukuxilongwa (kuhlanganiswe ne-pathology):i-carcinoma ye-atypia ephansi, i-O-1la, engu-47*32mm, i-adenocarcinoma yeshubhu ehlukaniswe kahle, i-pT1a/M, i-ULO, i-Ly0, i-VO, i-HMO, i-VMO
i-adenoma yesisu
◆Icala 2
Incazelo: Isilonda esiphakanyisiwe esinamaqhubu odongeni olungaphambili lwengxenye ephakathi yomzimba wesisu. I-gastritis esebenzayo ingabonakala ngemuva. I-Indigo carmine ingabonakala njengomngcele. (I-NBI kanye nokukhulisa kancane)
I-Pathology: Ukuvezwa kwe-MUC5AC kubonwe ku-epithelium engaphezulu, kanti ukuvezwa kwe-MUC6 kubonwe ku-epithelium engaphezulu. Ukuxilongwa kokugcina kwaba yi-PGA.
xoxa
Ama-adenoma esisu empeleni angama-mucinous glands angena ku-stroma futhi ambozwe yi-foveolar epithelium. Ngenxa yokwanda kwama-glandular protrusions, angama-hemispherical noma ama-nodular, ama-gastric adenomas abonakala ngokukhanya okumhlophe kwe-endoscopic wonke angama-nodular futhi aphuma. Kuyadingeka ukunaka izigaba ezine ze-Jiu Ming ngaphansi kokuhlolwa kwe-endoscopic. I-ME-NBI ingabona ukubukeka kwe-papillary/villous kwe-PGA. I-PGA ayinayo i-HP negative futhi ayi-atrophic, futhi inengozi ethile yomdlavuza. Ukuxilongwa kusenesikhathi kanye nokwelashwa kusenesikhathi kuyakhuthazwa, futhi ngemva kokutholwa, kunconywa ukususwa kwe-en bloc okusebenzayo kanye nocwaningo oluningiliziwe olwengeziwe.
4) (njengokungathi yi-raspberry) umdlavuza wesisu we-foveolar epithelial
umdlavuza wesisu we-raspberry foveolar epithelial
◆Icala 2
Incazelo:(kushiywe ngaphandle)
Ukuxilongwa (kuhlanganiswe ne-pathology)umdlavuza wesisu we-foveolar epithelial
umdlavuza wesisu we-raspberry foveolar epithelial
◆Icala 3
Incazelo:(kushiywe ngaphandle)
Ukuxilongwa (kuhlanganiswe ne-pathology):umdlavuza wesisu we-epithelial ye-foveolar
xoxa
I-Raspberry, ebizwa ngokuthi "i-Tuobai'er" edolobheni lakithi, iyisithelo sasendle eceleni komgwaqo ngesikhathi siseyizingane. I-epithelium ye-glandular kanye nama-glandular kuxhunyiwe, kodwa akuzona izinto ezifanayo. Kubalulekile ukuqonda izici zokukhula nokuthuthukiswa kwamaseli e-epithelial. Umdlavuza we-gastric epithelial we-raspberry ufana kakhulu nama-polyps e-gastric futhi ungaphanjaniswa kalula nama-polyps e-gastric. Isici esiphawulekayo se-epithelium ye-foveolar yindlela evelele ye-MUC5AC. Ngakho-ke i-foveolar epithelial carcinoma yigama elijwayelekile lalolu hlobo. Ingaba khona ku-HP negative, positive, noma ngemva kokubulala inzalo. Ukubukeka kwe-Endoscopic: i-bulge ebomvu ekhanyayo efana ne-strawberry, ngokuvamile enemingcele ecacile.
5) I-Signet ring cell carcinoma
I-Signet ring cell carcinoma: ukubukeka kokukhanya okumhlophe
I-Signet ring cell carcinoma: ukubukeka kokukhanya okumhlophe
i-carcinoma yeseli lendandatho yesignesha
◆Icala 1
Incazelo:Isilonda esiyisicaba odongeni olungemuva lwe-vestibule yesisu, esingu-10 mm, sifiphele, uhlobo lwe-O-1Ib, akukho ukuwohloka ngemuva, umngcele obonakalayo ekuqaleni, umngcele ongabonakali lapho kuhlolwa kabusha, i-ME-NBI: ingxenye ephakathi kwe-foveal kuphela eba mhlophe, i-IMVP(-)IMSP (-)
Ukuxilongwa (kuhlanganiswe ne-pathology):Amasampula e-ESD asetshenziselwa ukuxilonga i-signet ring cell carcinoma.
Ukubonakaliswa kwezifo
I-Signet ring cell carcinoma uhlobo olubi kakhulu. Ngokusho kwesigaba sikaLauren, i-gastric signet ring cell carcinoma ihlukaniswa njengohlobo lwe-carcinoma olusabalele futhi uhlobo lwe-carcinoma engahlukanisiwe. Ivame ukwenzeka emzimbeni wesisu, futhi ivame kakhulu ezilondeni ezisicaba nezicwile ezinamabala anombala oshintshile. Izilonda eziphakanyisiwe azivamile futhi zingabonakala nangokuguguleka noma izilonda. Kunzima ukuzithola ngesikhathi sokuhlolwa kwe-endoscopic ezigabeni zokuqala. Ukwelashwa kungaba ukususwa kwezicubu okwelaphekayo njenge-endoscopic ESD, ngokulandelana okuqinile ngemva kokuhlinzwa kanye nokuhlolwa kokuthi ngabe kufanele kwenziwe ukuhlinzwa okwengeziwe. Ukususwa kwezicubu okungamelaphi kumele kudinge ukuhlinzwa okwengeziwe, futhi indlela yokuhlinzwa inqunywa udokotela ohlinzayo.
Ithiyori yombhalo engenhla kanye nezithombe zivela ku-"Isisu Namathumbu"
Ngaphezu kwalokho, kufanele kuqashelwe nomdlavuza we-esophagogastric junction, umdlavuza we-cardia, kanye ne-adenocarcinoma ehlukaniswe kahle etholakala ngemuva kwe-HP-negative.
3. Isifinyezo
Namuhla ngifunde ulwazi olufanele kanye nokubonakaliswa kwe-endoscopic komdlavuza wesisu ongemuhle we-HP. Lokhu kufaka phakathi: umdlavuza wesisu wohlobo lwe-fundic gland, umdlavuza wesisu wohlobo lwe-fundic gland mucosal, i-gastric adenoma, i-foveolar epithelial tumor (efana ne-raspberry) kanye ne-signet ring cell carcinoma.
Izinga lomdlavuza wesisu ongenayo i-HP liphansi, kunzima ukwahlulela, futhi kulula ukuphuthelwa ukuxilongwa. Okunzima nakakhulu ukubonakaliswa kwezifo eziyinkimbinkimbi nezingavamile nge-endoscopic. Kufanele futhi kuqondwe ngombono we-endoscopic, ikakhulukazi ulwazi lwethiyori olungemuva kwawo.
Uma ubheka ama-polyp esiswini, ukuguguleka, kanye nezindawo ezibomvu nezimhlophe, kufanele ucabangele ukuthi kungenzeka ukuthi umdlavuza wesisu one-Hp-negative. Ukwahlulela ukuthi une-HP negative kumele kuhambisane nezindinganiso, futhi kufanele kuqashelwe ama-negative angamanga abangelwa ukuthembela ngokweqile emiphumeleni yokuhlolwa kokuphefumula. Odokotela be-endoscopist abanolwazi bathembela kakhulu emehlweni abo. Njengoba sibhekene nombono oningiliziwe ngemuva komdlavuza wesisu one-HP-negative, kumelwe siqhubeke nokufunda, siqonde futhi sizijwayeze ukuwuqonda.
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 ekhaleni njll.ezisetshenziswa kabanzi ku-I-EMR,I-ESD,I-ERCP.Imikhiqizo 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: Julayi-12-2024