Phakathi kolwazi oludumile ngomdlavuza wesisukuqala wesisu, kunezifo ezithile ezingajwayelekile zokufunda ezidinga ukunakwa okukhethekile nokufunda. Enye yazo umdlavuza we-HP-ongemuhle. Umqondo we- "Epinfered Epithelial Tumors" manje uthandwa kakhulu. Kuzoba nemibono ehlukile kwigama legama. Lo mqondo wokuqukethwe usekelwe ikakhulu kokuqukethwe okuhlobene nomagazini "isisu kanye namathumbu", futhi igama liphinde lisebenzise "umdlavuza we-HP-ungelihle".
Lolu hlobo lwezilonda lunezici zezehlakalo eziphansi, ubunzima ekuboneni, ulwazi oluyinkimbinkimbi lwethiyori, futhi inqubo elula ye-MesDA-G ayisebenzi. Funda lolu lwazi ludinga ukubhekana nobunzima.
1. Ulwazi oluyisisekelo lomdlavuza we-HP-ongemuhle
Umlando
Esikhathini esedlule, bekukholelwa ukuthi imbangela eyodwa ekwenzeni kanye nokuthuthuka komdlavuza wesisukutheleleke nge-HP - ngakho-ke imodeli ye-Class Consawransic Imodeli yakudala ibilokhu ibonwa njalo, yamukelwa futhi ikholelwa ngokuqinile. Ama-tumors athuthuka ndawonye ngesisekelo se-atrophy futhi ngaphansi kwesenzo se-HP, ngakho-ke amakhamera akhula kakhulu emaphepheni amathumbu e-atrophic kanye ne-mucosa yesisu esingajwayelekile.
Kamuva, abanye odokotela bathola ukuthi umdlavuza wesisu kungenzeka ngisho nalapho kungekho ukutheleleka nge-HP. Yize izinga lesikhashana liphansi kakhulu, kungenzeka ngempela. Lolu hlobo lomdlavuza wesisulu olubizwa ngokuthi umdlavuza we-HP-ongemuhle.
Ngokuqonda kancane kancane kwalolu hlobo lwesifo, ukujula okuhleliwe kanye nezifingqo sekuqalile, futhi amagama aguquka njalo. Kube khona i-athikili ngonyaka ka-2012 obizwa nge- "Gastric Cancer ngemuva kokubulawana", i-athikili yango-2014 ebizwa ngokuthi "umdlavuza we-HP-Outsult gather", kanye ne-athikili ebizwa ngokuthi "ama-epithelial tumors angatheleleki nge-HP". Igama lishintsha libonisa ukuqonda okujulile nokuphelele.
Izinhlobo Izinhlobo Zobudlova Nezindlela Zokukhula
Kunezinhlobo ezimbili eziphambili zezindlala ze-modusic kanye nezindlala ze-pyloric esiswini:
Izindlala ze-Fundic (ama-oxyntic glands) zisatshalaliswa ku-futus, emzimbeni, emakoneni, njll. Esiswini. Ziyizindlala ezicebile ze-tubular. Bahlanganiswa amaseli ama-mucous, amaseli aphezulu, amaseli e-parietal kanye namaseli e-endocrine, ngalinye lisebenza imisebenzi yalo. Phakathi kwazo, amaseli amakhulu i-PGI efihliwe ye-PGI kanye ne-Muc6 Stain ayenempilo, futhi amangqamuzana e-parietal athembisa i-hydrochloric acid kanye nesici esijwayelekile;
Izindlala ze-pyloric zitholakala endaweni ye-antrum yesisu futhi zakhiwa amaseli we-mucis kanye namaseli e-endocrine. Amaseli we-Mucus anguMuc6 ama-Deal, futhi amaseli e-endocrine afaka ama-G, amaseli e-D namaseli e-Enterochromaffin. Amaseli we-G afiselwa i-gastrin, amaseli e-D afaka iSomatostatin, kanye namaseli e-Enterochromaffin asperete 5-ht.
Normal gastric mucosal cells and tumor cells secrete a variety of different types of mucus proteins, which are divided into "gastric", "intestinal" and "mixed" mucus proteins. Ukubonakaliswa kwesisu kanye namathumbu amathumbu abizwa ngokuthi yi-phenotype hhayi indawo ethile ye-anatomical yesisu namathumbu.
Kune-phenotypes emine yama-tumors esiswini: Isisulu esiphelele, esixubeke kakhulu esigcwele, amathumbu ahlanganisiwe, futhi amathumbu ngokuphelele. Ama-tumors avela ngesisekelo se-metaplasia yamathumbu ikakhulukazi ikakhulukazi ama-tumors we-phenotype. Ama-Conshar ahlukanisiwe ikakhulukazi akhombisa uhlobo lwamathumbu (MUC2 +), kanye nomdlavuza wokusebenzisana ikakhulukazi khombisa uhlobo lwesisu (i-muc5ac +, Muc6 +)).
Ukunquma ukungathandeki kwe-HP kudinga inhlanganisela ethile yezindlela eziningi zokutholwa kokuzimisela okuphelele. Umdlavuza we-HP-Offic Getric kanye nomdlavuza we-post-sterilization gastric imiqondo emibili ehlukene. Ngemininingwane ekubonisweni kwe-X-ray komdlavuza we-HP-Outsing Carncer, sicela ubheke engxenyeni efanele yomagazini "Stomach kanye ne-Amadestine".
2. Ukubonakaliswa kwe-endoscopic komdlavuza we-HP-Outsic Grast
Ukuxilongwa kwe-endoscopic ukugxila komdlavuza we-HP-Outsult Getric. Kufaka ikakhulukazi umdlavuza we-fundic gland, i-fundic gland mucosal umdlavuza wesisu, i-adenoma yesisu, indandatho ye-ring cell carcinoma, njll. Le ndandatho ye-carcinoma, njll. Lo mbhalo ugxile ekubonakalisweni komdlavuza we-endoscopic.
1) Fundic gland uhlobo lomdlavuza wesisu
-Iminye emincane izilonda
Fundic gland uhlobo lomdlavuza wesisu
◆ icala 1: Izilonda ezimhlophe, ezikhulisiwe
Incazelo:I-Gastric Fundic Fornic-Curvature ye-Cardia, 10 mm, imhlophe, uhlobo uhlobo (i-SMT-lia), ngaphandle kwe-atrophy noma i-metaplasia yamathumbu ngemuva. Imithambo yegazi e-arsbor ingabonakala ebusweni (NBI nokwandisa kancane)
Ukuxilongwa (kuhlangene ne-pathology):U, O-1LA, 9mm, i-Fundic Gland hlobo nomdlavuza wesisu, PT1B / SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Witi izilonda ezifuywayo
Fundic gland uhlobo lomdlavuza wesisu
◆ Icala 2: Izilonda ezimhlophe, ezingcolile / ezicindezelekile
Incazelo:Udonga lwangaphandle lwe-Gettric Fundic Fornix-Cardia Greater Curvature, 14 mm, mhlophe, thayipha i-atrophy, ngaphandle kwama-metaplasia noma amathumbu egazi ngemuva, nemithambo yegazi e-dendritic ebonwe ebusweni. (NBI ne-Amplification afushani)
Ukuxilongwa (kuhlangene ne-pathology):U, 0-ilc, 14mm, i-fundic gland hlobo nomdlavuza wesisu, i-PT1B / SM2 (700μm), ULO, LY0, VO, HMO, VMO
-Izilonda ezikhulisiwe
Fundic gland uhlobo lomdlavuza wesisu
◆ icala 3: Izilonda ezibomvu nezikhulisiwe
Incazelo:Udonga lwangaphandle lwe-curvature enkulu ye-cardia yi-12 mm, ngokusobala ibomvu, thayipha i-atrophy noma ama-metaplals amathumbu ngemuva (kanye nemithambo yegazi e-dendritic ebusweni (NBI kanye nokwandisa kancane)
Ukuxilongwa (kuhlangene ne-pathology):U, 0-1, 12mm, i-Fundic gland hlobo nomdlavuza wesisu, i-PT1B / SM1 (200μm), ULO, LU, VO, HMO, VMO
-I-Flat, Flat, Lension Ecindezelekiles
Fundic gland uhlobo lomdlavuza wesisu
◆ Icala 4: Izilonda ezibomvu, ezifuysayo / ezicindezelekile
Incazelo:Udonga lwangemuva lwe-curvature enkulu yengxenye engenhla yomzimba wesisu, i-18mm, i-atrophy ebomvu, i-metaplasia yamathumbu ngemuva, akukho mikhumbi yegazi e-dendritic ebusweni, (NBI nokukhulisa okushiyiwe)
Ukuxilongwa (kuhlangene ne-pathology):U, O-1LC, 19mm, i-Fundic gland hlobo nomdlavuza wesisu, i-PT1B / SM1 (400μm), ULO, VO, VO, HMO, VMO
xoxisana
Abesilisa ngalesi sifo badala kunabesilisa, abaneminyaka emaphakathi beneminyaka engama-67.7 ubudala. Ngenxa yezimpawu ze-simisonety kanye ne-heterochrony, iziguli ezitholakele ngomdlavuza we-fundic gland hlobo kufanele zibuyekezwe kanye ngonyaka. Isayithi elivame kakhulu yindawo ebalulekile ye-gland engxenyeni ephakathi nengenhla yesisu (i-fundus kanye nengxenye ephakathi nendawo yomzimba wesisu). Izilonda ezimhlophe ze-SMT-efana nezingane ezikhulisiwe zivame kakhulu ekukhanyiseni okumhlophe. Ukwelashwa okuyinhloko kutholakala i-EMR / ESD.
Ayikho i-lymphatic metastasis noma ukuhlasela kwe-vascular sekubonakele kuze kube manje. Ngemuva kokwelashwa, kuyadingeka ukuthola ukuthi ngabe wenza yini ukuhlinzwa okwengeziwe futhi uhlole ubudlelwano phakathi kwesimo esibi ne-HP. Akuwona wonke amakhansela we-fundic gland-hlobo hlobo lwe-hp engemihle.
1) I-Fundic Gland Muctric Cancer Gastric
Fundic gland mucosal cancer gastic cancer
◆ icala 1
Incazelo:Isilonda sikhuliswe kancane, futhi i-mucosa yesisu engekho emjahweni ingabonakala kuyo. Ukushintsha ngokushesha ama-miscrumples kanye nama-microvessels angabonakala engxenyeni ephakanyisiwe ye-me-nbi, futhi i-DL iyabonakala.
Ukuxilongwa (kuhlangene ne-pathology):Umdlavuza we-Fundic Gland Mucosal Gastric Gather, Une, 0-1LA, 47 * 32mm, PT1A / SM1 (400μm), ULO, VO, HMO, VMO
Fundic gland mucosal cancer gastic cancer
◆ icala 2
Ukufanisa: Isilonda esisicaba odongeni olungaphandle lwe-curvature emncane ye-cardia, enobomvu okuxubile kanye nobomvu, imithambo yegazi e-dendritic ingabonakala ebusweni, bese kukhuliswa kancane isilonda.
Ukuxilongwa (kuhlangene ne-pathology): Umdlavuza we-Fumic Gland Mucosal Gastric Cancer, 0-LLA, PT1A / M, ULO, LYOV0, HM0, VMO
xoxisana
Igama le- "gastric gland mucosal adenocarcinoma" kunzima kancane ukuyibiza, futhi isilinganiso sezehlakalo siphansi kakhulu. Kudinga imizamo eminingi yokubona nokuyiqonda. I-Fundic Gland Mucosal Adenocarcinoma inezimpawu zokulimala okuphezulu.
Kunezici ezine ezinkulu ze-White Light Endoscopy: ① izilonda ezifiphele zeHomochromatic; ② I-Subetithelial TmobeT SMT; ③ imithambo yegazi ehlisiwe ye-dendritic; ◇ Imicroscrecles yesifunda. Mina Ukusebenza: DL (+) IMVP (+) IMSP (+) MCE AWENESP IP futhi yanda. Usebenzisa inqubo ye-MESDA-G enconyiwe, ama-90% we-Fundic Gland Muctric Conners ahlangabezana nenqubo yokuxilonga.
3) Isisusi se-Adenoma (Pyloric Gland Adenoma PGA)
I-Gastric Adenoma
◆ icala 1
Incazelo:Isilonda esimhlophe esikhulisiwe sabonwa odongeni lwangemva kwesisu se-fornix enemingcele engacacile. I-Indigo Carmine Ebonayo ayikhombisi imingcele ecacile, kanye nokubukeka kwe-LST-G-okufana namathumbu amakhulu kwabonakala (kwandiswa kancane).
Ukuxilongwa (kuhlangene ne-pathology):I-Low Atypia Carcinoma, O-1LA, 47 * 32mm, ehlukaniswe kahle ye-adenocarcinoma, PT1A / M, ULO, LY0, VO, HMO, VMO
I-Gastric Adenoma
◆ icala 2
Ukufanisa: Isilonda esikhulisiwe esinamaqhubu odongeni olungaphandle lwengxenye ephakathi yomzimba wesisu. I-gastritis esebenzayo ingabonakala ngemuva. I-Indigo Carmine ingabonakala njengomngcele. (NBI nokukhulisa kancane)
Isifuba: Inkulumo ye-MUC5AC ibonwe kwi-Epithelium engekho ngokweqile, futhi isisho se-Muc6 sabonwa e-Epithelium engasho lutho. Ukuxilongwa kokugcina kwakungu-PGA.
xoxisana
Ama-adenomas esiswini ama-adenomas empeleni ama-mucinous vends angena emqhudweni futhi embozwe yi-povolar epithelium. Ngenxa yokwanda kwama-proliferions prorrusions, okuyi-hemispherical noma i-nodular adenomas ebonwa ukukhanya okumhlophe kwe-endoscopic konke kuhlangana ne-nodular futhi kuphuma. Kuyadingeka ukunaka ukuhlukaniswa okungu-4 kokuhlolwa kwe-jiu ngaphansi kokuhlolwa kwe-endoscopic. I-Me-NBI ingabheka ukubukeka kwe-papillary / ukubukeka kwe-PAPGA. I-PGA ayiyona neze i-HP i-HP ayilungile futhi ingekho i-atrophic, futhi inengozi ethile yokuphenya. Ukuxilongwa kusenesikhathi kanye nokwelashwa kusenesikhathi kukhuthazwe, nangemva kokutholakele, kunconyelwa ukuthengiswa kabusha kwe-En Bloc futhi kunconywe ocwaningweni olunemininingwane.
4) (oku-raspberry-like) Fodeolar Epithelial Cancer Gastric
I-Raspberry Fodeolar Epithelial Cancer Gastric Cancer
◆ icala 2
Incazelo:(kushiyiwe)
Ukuxilongwa (kuhlangene ne-pathology): Umdlavuza we-epithelial wesisu
I-Raspberry Fodeolar Epithelial Cancer Gastric Cancer
◆ icala 3
Incazelo:(kushiyiwe)
Ukuxilongwa (kuhlangene ne-pathology):Umdlavuza we-Epithelial Epithelial Gactric
xoxisana
Okusajingijolo, okubizwa nge- "Tuobai'er" edolobheni lakithi, kunezithelo zasendle emgaqweni lapho siseyizingane. I-epithelium ye-glandular epithelium ne-gland axhunyiwe, kepha akuzona okuqukethwe okufanayo. Kuyadingeka ukuqonda izici zokukhula nezithuthukiswa zezentuthuko zamaseli e-epithelial. I-Raspberry Epithelial Cancer gastric gacer ifana kakhulu nama-polyps esiswini futhi angaba ngephutha kalula ama-polyps esiswini. Isici esicacile se-Fodeolar Epithelium iyizwi elivelele le-muc5ac. Ngakho-ke i-epithelial epithelial carcinoma iyigama elijwayelekile lalolu hlobo. Kungaba khona ku-HP negative, enhle, noma ngemuva kokunye. Ukubukeka kwe-Endoscopic: Round Bright sitrobheli-njenge-bulge ekhanyayo, ngokuvamile ngemingcele ecacile.
5) I-Signet Ring Cell Carcinoma
I-Signet Ring Cell Carcinoma: Ukubukeka okumhlophe okumhlophe
I-Signet Ring Cell Carcinoma: Ukubukeka okumhlophe okumhlophe
I-Signet Ring Cell Carcinoma
◆ icala 1
Incazelo:Isilonda esisicaba odongeni lwezinto ezingemuva kwe-vestibule yesisu, 10 mm, siphela, thafu, i-o-1 1, akukho mngcele osobala ekuqaleni, i-IMVP (-) I-IMSP (-)
Ukuxilongwa (kuhlangene ne-pathology):Izinhlobo ze-ESD zisetshenziselwa ukuthola i-Signet Ring Cell Carcinoma.
Ukubonakaliswa Kwe-Pathological
I-Signet Ring Cell Carcinoma uhlobo olubi kunazo zonke. Ngokusho kwesigaba se-lauren, i-runtric signess cell carcinoma ihlukaniswe njengohlobo lwe-carcinoma futhi luhlobo lwe-carcinoma engapheli. Kuvame ukwenzeka emzimbeni wesisu, futhi kuvame kakhulu ezilambeni ezifuywayo futhi ezishisiwe ngamathoni ancibilikisiwe. Izilonda eziphakanyisiwe azivamile futhi zingabonakala njengokuguguleka noma izilonda. Kunzima ukuthola ngesikhathi sokuhlolwa kwe-endoscopic ezigabeni zokuqala. Ukwelashwa kungaba sekwelashwa kabusha njenge-Endoscopic ESD, ngokulandela okuqinile kokulandela nokuhlola ukuthi kwenziwe ukuhlinzwa okwengeziwe. Ukuvuselelwa okungelona ekwelapheni kumele kudinga ukuhlinzwa okwengeziwe, futhi indlela yokuhlinzwa inqunywa ngudokotela ohlinzayo.
Umbono wombhalo ongenhla nezithombe zivela "esiswini nasethunzini"
Ngaphezu kwalokho, kufanele futhi kubhekwe ekubhekeni umdlavuza we-esophagogaSTRACTIC, umdlavuza we-cardia, kanye ne-adenocarcinoma ebekelwe kahle etholakala ngemuva kwe-HP-Hight yasemuva.
3. Isifinyezo
Namuhla ngifunde ulwazi olufanele kanye nokubonakaliswa kwe-endoscopic komdlavuza we-HP-Offic Carters. Kubandakanya ikakhulukazi: Umdlavuza we-Fundic Gland, i-Fundic Gland Mucosal Cancer Getric Cancer Getric Cancer, ((okusajingijolo), (okusajingijolo okufana) ne-coveolar epithelial tumovo kanye ne-Internats Ring Carcinoma.
Izehlakalo zemitholampilo ze-HP-Canning Carters ezingezinhle ziphansi, kunzima ukwahlulela, futhi kulula ukukhumbula ukutholakala. Okunzima ngokwengeziwe ukuvezwa kwe-endoscopic kwezifo eziyinkimbinkimbi nezingavamile. Kufanele futhi kuqondwe ngombono we-endoscopic, ikakhulukazi ulwazi lwethiyori ngemuva kwalo.
Uma ubheka ama-polyps esiswini, ukuguguleka, kanye nezindawo ezibomvu nezimhlophe, kufanele ucabangele ukuthi kungenzeka umdlavuza we-HP-ungelihle wesisu. Isahlulelo se-HP Okubi kufanele sihambisane nezindinganiso, futhi ukunakwa kufanele kukhokhwe kubumbano lwamanga olubangelwa ukuthembeka okungaphezulu kwemiphumela yokuhlolwa kokuphefumula. Ama-endoscopist anolwazi athembele ezamehlo abo ngaphezulu. Ukubhekana nombono onemininingwane ngemuva komdlavuza we-HP-Offic Getric, kumele siqhubeke nokufunda, siqonde futhi sikwenzele ukuwazi kahle.
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 BILY CHATHETER njll. asetshenziswa kabanzi kuEMR,ESD,I-ECCP.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: Jul-12-2024