Phakathi kolwazi oludumile mayelana nomdlavuza wesisu wakuqala, kunamaphuzu olwazi lwezifo ezingandile adinga ukunakwa okukhethekile nokufunda. Omunye wabo umdlavuza wesisu we-HP-negative. Umqondo othi "izicubu ze-epithelial ezingatheleleki" manje usuthandwa kakhulu. Kuzoba nemibono eyahlukene mayelana nodaba lwegama. Lo mbono wokuqukethwe usekelwe ikakhulukazi kokuqukethwe okuhlobene nomagazini othi "Isisu Namathumbu", futhi igama lisebenzisa "umdlavuza wesisu we-HP-negative".
Lolu hlobo lwezilonda lunezici zezehlakalo eziphansi, ubunzima bokuhlonza, ulwazi oluyinkimbinkimbi lwethiyori, futhi inqubo elula ye-MESDA-G ayisebenzi. Ukufunda lolu lwazi kudinga ukubhekana nobunzima.
1. Ulwazi oluyisisekelo ngomdlavuza wesisu we-HP-negative
Umlando
Esikhathini esidlule, kwakunenkolelo yokuthi onecala elilodwa ekuveleni nasekuthuthukisweni komdlavuza wesisu kwaba ukutheleleka kwe-HP, ngakho-ke imodeli yomdlavuza yakudala i-HP - atrophy - metaplasia yamathumbu - isimila esiphansi - isimila esiphezulu - umdlavuza. Imodeli yakudala ibilokhu iqashelwa kabanzi, yamukelwa futhi ikholelwa ngokuqinile. Amathumba akhula ndawonye ngesisekelo se-atrophy nangaphansi kwesenzo se-HP, ngakho-ke umdlavuza ukhula kakhulu emapheshaneni e-atrophic amathumbu kanye ne-non-atrophic gastric mucosa engajwayelekile.
Kamuva, abanye odokotela bathola ukuthi umdlavuza wesisu ungenzeka noma kungekho ukutheleleka nge-HP. Nakuba izinga lezehlakalo liphansi kakhulu, kungenzeka ngempela. Lolu hlobo lomdlavuza wesisu lubizwa nge-HP-negative gastric cancer.
Ngokuqondwa kancane kancane kwalolu hlobo lwesifo, ukubhekwa okujulile okuhlelekile nezifinyezo sekuqalile, futhi amagama ashintsha njalo. Kube nendatshana ngo-2012 ebizwa ngokuthi "Gastric Cancer after Sterilization", indatshana ngo-2014 ebizwa ngokuthi "HP-negative Gastric Cancer", kanye nendatshana ngo-2020 ebizwa ngokuthi "Epithelial Tumors Not Infected with Hp". Ukuguqulwa kwegama kubonisa ukuqonda okujulile nokuphelele.
Izinhlobo zezindlala kanye namaphethini okukhula
Kunezinhlobo ezimbili eziyinhloko zezindlala ze-fundac nezindlala ze-pyloric esiswini:
Izindlala ze-Fundic (izindlala ze-oxyntic) zisakazwa ku-fundus, umzimba, emakhoneni, njll. Ziyizindlala ze-tubular eziqondile. Akhiwa amangqamuzana amafinyila, amaseli ayinhloko, amangqamuzana e-parietal namaseli e-endocrine, ngalinye lenza imisebenzi yalo. Phakathi kwazo, amangqamuzana ayinhloko I-PGI eyimfihlo kanye ne-MUC6 staining yayinhle, futhi amangqamuzana e-parietal afihla i-hydrochloric acid kanye ne-intrinsic factor;
Izindlala ze-pyloric zitholakala endaweni ye-gastric antrum futhi zakhiwe amangqamuzana e-mucus namaseli e-endocrine. Amaseli amafinyila ane-MUC6 positive, kanti amaseli e-endocrine ahlanganisa amaseli e-G, D namaseli e-enterochromaffin. Amaseli e-G akhiqiza i-gastrin, amaseli e-D akhiqiza i-somatostatin, futhi amaseli e-enterochromaffin akhiqiza i-5-HT.
Amaseli ajwayelekile we-gastric mucosal namaseli wesimila akhiqiza izinhlobo ezahlukene zamaphrotheni amafinyila, ahlukaniswa abe "isisu", "amathumbu" kanye "nama-mixed" amaphrotheni amafinyila. Ukubonakaliswa kwe-gastric mucins namathumbu kubizwa ngokuthi i-phenotype hhayi indawo ethile ye-anatomical yesisu namathumbu.
Kunama-cell phenotypes ama-gastric tumors: i-gastric ngokuphelele, i-gastric-dominant exutshwe, ingxube yamathumbu-ebusayo, kanye namathumbu aphelele. Izimila ezenzeka ngesisekelo se-metaplasia yamathumbu ngokuvamile ziyizimila ze-phenotype ezixubile zamathumbu. Imidlavuza ehlukene ikhombisa ikakhulukazi uhlobo lwamathumbu (MUC2+), futhi imidlavuza esabalele kakhulu ikhombisa uhlobo lwesisu (MUC5AC+, MUC6+).
Ukunquma ukuthi i-Hp inegethivu kudinga inhlanganisela ethile yezindlela zokuthola eziningi ukuze uthole ukuzimisela okuphelele. Umdlavuza wesisu we-HP-negative kanye nomdlavuza wesisu wangemuva kokuvalwa inzalo imiqondo emibili ehlukene. Ukuze uthole ulwazi mayelana nokubonakaliswa kwe-X-ray komdlavuza wesisu we-HP-negative, sicela ubheke isigaba esifanele sephephabhuku elithi "Isisu Namathumbu".
2. Ukubonakaliswa kwe-Endoscopic yomdlavuza wesisu we-HP-negative
Ukuxilongwa kwe-Endoscopic kugxile kumdlavuza wesisu we-HP-negative. Ikakhulukazi ihlanganisa i-fundic indlala uhlobo umdlavuza wesisu, fundic indlala mucosal uhlobo umdlavuza wesisu, adenoma esiswini, okusajingijolo foveolar epithelial isimila, signet ring cell carcinoma, njll Lesi sihloko sigxile ukubonakaliswa endoscopic of HP-negative umdlavuza wesisu.
1) I-Fundic gland uhlobo lomdlavuza wesisu
- Izilonda ezimhlophe eziphakanyisiwe
uhlobo lomdlavuza we-gastric fundac
◆Icala 1: Izilonda ezimhlophe, eziphakanyisiwe
Incazelo:I-Gastric fundic fornix-ijika elikhudlwana le-cardia, 10 mm, elimhlophe, uhlobo lwe-O-lia (okufana ne-SMT), ngaphandle kwe-atrophy noma i-metaplasia yamathumbu ngemuva. Imithambo yegazi efana ne-Arbor ingabonakala phezulu (i-NBI futhi ikhulise kancane)
Ukuxilongwa (kuhlanganiswe ne-pathology):U, O-1la, 9mm, fundac gland hlobo lomdlavuza wesisu, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
- Izilonda ezimhlophe eziyisicaba
uhlobo lomdlavuza we-gastric fundac
◆Icala 2: Izilonda ezimhlophe, eziyisicaba/ezicindezelekile
Incazelo:Udonga lwangaphambili lwe-gastric fundic fornix-cardia i-curvature enkulu, 14 mm, emhlophe, uhlobo lwe-0-1lc, olungenayo i-atrophy noma i-metaplasia yamathumbu ngemuva, imingcele engacacile, kanye nemithambo yegazi ye-dendritic ebonwa phezulu. (I-NBI kanye nokukhulisa kufinyeziwe)
Ukuxilongwa (kuhlanganiswe ne-pathology):U, 0-Ilc, 14mm, fundac gland hlobo lomdlavuza wesisu, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Izilonda eziphakanyisiwe ezibomvu
uhlobo lomdlavuza we-gastric fundac
◆Icala lesi-3: Izilonda ezibomvu neziphakanyisiwe
Incazelo:Udonga lwangaphambili lwe-curvature enkulu ye-cardia luyi-12 mm, ngokusobala lubomvu, uhlobo lwe-0-1, olungenayo i-atrophy noma i-metaplasia yamathumbu ngemuva, imingcele ecacile, kanye nemithambo yegazi ye-dendritic ebusweni (i-NBI nokukhulisa 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, esidangeles
uhlobo lomdlavuza we-gastric fundac
◆Icala lesi-4: Izilonda ezibomvu, eziyisicaba/ ezicindezelekile
Incazelo:Udonga lwangemuva lokugoba okukhulu kwengxenye engaphezulu yomzimba wesisu, i-18mm, ebomvu ngokukhanyayo, uhlobo lwe-O-1Ic, alukho i-atrophy noma i-metaplasia yamathumbu ngemuva, umngcele ongacacile, akukho mithambo yegazi ye-dendritic ngaphezulu, (i-NBI 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 ngokwesilinganiso iminyaka yobudala ineminyaka engama-67.7. Ngenxa yezici zesikhathi esisodwa kanye ne-heterochrony, iziguli ezitholwe zinomdlavuza wohlobo lwe-fundac gland kufanele zibuyekezwe kanye ngonyaka. Indawo evame kakhulu indawo yendlala ye-fundac ephakathi nendawo engenhla yesisu (i-fundus nengxenye ephakathi nendawo engenhla yomzimba wesisu). Izilonda eziphakeme ezifana ne-SMT ezimhlophe zivame kakhulu ekukhanyeni okumhlophe. Ukwelashwa okuyinhloko ukuxilonga i-EMR/ESD.
Akukho metastasis ye-lymphatic noma ukuhlasela kwemithambo okuye kwabonwa kuze kube manje. Ngemuva kokwelashwa, kuyadingeka ukunquma ukuthi kwenziwa yini ukuhlinzwa okwengeziwe futhi kuhlolwe ubudlelwano phakathi kwesimo esiyingozi kanye ne-HP. Akuwona wonke umdlavuza wesisu wohlobo lwe-fundac gland one-HP negative.
1) Umdlavuza we-Fundic gland mucosal gastric
Umdlavuza we-Fundic gland mucosal gastric
◆Icala 1
Incazelo:Isilonda siphakanyiswe kancane, futhi i-RAC non-atrophic gastric mucosa ingabonwa nxazonke. Ukushintsha ngokushesha i-microstructure kanye nama-microvessels kungabonakala engxenyeni ephakanyisiwe ye-ME-NBI, futhi i-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 we-Fundic gland mucosal gastric
◆Icala 2
Incazelo: Isilonda esiyisicaba odongeni lwangaphambili lwe-curvature encane ye-cardia, ngokushintshashintsha kombala nokubomvu, imithambo yegazi ye-dendritic ingabonakala phezulu, futhi isilonda siphakanyiswa 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" linzima ukulibiza, futhi izinga lesigameko liphansi kakhulu. Kudinga imizamo eyengeziwe ukuze uyibone futhi uyiqonde. I-Fundic gland mucosal adenocarcinoma inezici ze-malignancy ephezulu.
Kunezici ezine ezinkulu ze-endoscopy yokukhanya okumhlophe: ① izilonda ezi-homochromatic-fiding; ② isimila subpithelial SMT; ③ imithambo yegazi ye-dendritic enwetshiwe; ④ ama-microparticles esifunda. Ukusebenza kwe-ME: DL(+)IMVP(+)IMSP(+)MCE inweba i-IP futhi inyuke. Ngokusebenzisa inqubo enconyiwe ye-MESDA-G, ama-90% omdlavuza we-fundac gland mucosal gastric ahlangabezana nenqubo yokuxilonga.
3) I-gastric adenoma (pyloric gland adenoma PGA)
i-adenoma yesisu
◆Icala 1
Incazelo:Isilonda esimhlophe esiyisicaba esiphakanyisiwe sibonakale odongeni olungemuva lwe-gastric fornix enemingcele engacacile. I-Indigo carmine staining ayizange ibonise imingcele ecacile, futhi ukubonakala okufana ne-LST-G kwamathumbu amakhulu kubonakala (kukhuliswe kancane).
Ukuxilongwa (kuhlanganiswe ne-pathology):i-atypia carcinoma ephansi, i-O-1la, 47*32mm, i-adenocarcinoma ye-tubula ehluke kahle, i-pT1a/M, ULO, Ly0, VO, HMO, VMO
i-adenoma yesisu
◆Icala 2
Incazelo: Isilonda esiphakanyisiwe esinamaqhuqhuva odongeni lwangaphambili lwengxenye emaphakathi yomzimba wesisu. I-gastritis esebenzayo ingabonakala ngemuva. I-Indigo carmine ingabonwa njengomngcele. (I-NBI nokukhulisa kancane)
I-Pathology: Isisho se-MUC5AC sibonwe ku-epithelium engaphezulu, futhi isisho se-MUC6 sibonwe ku-epithelium engaphezulu. Ukuxilongwa kokugcina kwakuyi-PGA.
xoxa
I-Gastric adenomas empeleni yizindlala ezinama-mucinous ezingena ku-stroma futhi zimbozwe yi-foveolar epithelium. Ngenxa yokwanda kwezindlala zezindlala, eziyi-hemispherical noma ama-nodular, i-gastric adenomas ebonwa ngokukhanya okumhlophe kwe-endoscopic wonke ama-nodular futhi aphumela ngaphandle. Kuyadingeka ukunaka izigaba ezi-4 zeJiu Ming ngaphansi kokuhlolwa kwe-endoscopic. I-ME-NBI ingabona isici se-papillary/i-vilous ukubukeka kwe-PGA. I-PGA akuyona ngokuphelele i-HP negative futhi ayinayo i-atrophic, futhi inengozi ethile yokuba nomdlavuza. Ukuxilongwa kusenesikhathi kanye nokwelashwa kusenesikhathi kuyakhuthazwa, futhi ngemva kokutholakala, kunconywa ukukhishwa okusebenzayo kwe-en bloc kanye nocwaningo olunemininingwane eyengeziwe.
4) (okusajingijolo) umdlavuza wesisu we-foveolar epithelial
umdlavuza we-raspberry foveolar epithelial gastric
◆Icala 2
Incazelo:(yeqiwe)
Ukuxilongwa (kuhlanganiswe ne-pathology): i-foveolar epithelial gastric cancer
umdlavuza we-raspberry foveolar epithelial gastric
◆Icala 3
Incazelo:(yeqiwe)
Ukuxilongwa (kuhlanganiswe ne-pathology):umdlavuza we-foveolar epithelial gastric
xoxa
I-raspberry, ebizwa ngokuthi "i-Tuobai'er" edolobheni lakithi, isithelo sasendle eceleni komgwaqo ngesikhathi siseyizingane. I-epithelium ye-glandular kanye nezindlala zixhunyiwe, kodwa azikho okuqukethwe okufanayo. Kuyadingeka ukuqonda izici zokukhula nokuthuthukiswa kwamaseli e-epithelial. Umdlavuza we-Raspberry epithelial gastric ufana kakhulu nama-polyps esiswini futhi ungenziwa iphutha kalula nama-polyps esiswini. Isici esiphawulekayo se-foveolar epithelium ukubonakaliswa okuvelele kwe-MUC5AC. Ngakho-ke i-foveolar epithelial carcinoma yigama elivamile lalolu hlobo. Ingaba khona ku-HP negative, positive, noma ngemva kokuvalwa inzalo. Ukubukeka kwe-Endoscopic: iqhubu eliyindilinga elibomvu elibomvu njenge-strawberry, ngokuvamile elinemingcele ecacile.
5) I-Siginet ring cell carcinoma
I-signet ring cell carcinoma: ukubukeka kokukhanya okumhlophe
I-signet ring cell carcinoma: ukubukeka kokukhanya okumhlophe
i-ring ring cell carcinoma
◆Icala 1
Incazelo:I-flat lesion odongeni olungemuva lwe-vestibule yesisu, i-10 mm, iphelile, uhlobo lwe-O-1Ib, ayikho i-atrophy ngemuva, umngcele obonakalayo ekuqaleni, umngcele ongekho ocacile wokuhlolwa kabusha, i-ME-NBI: ingxenye ye-interfoveal kuphela iba mhlophe, i-IMVP (-)IMSP (-)
Ukuxilongwa (kuhlanganiswe ne-pathology):Izibonelo ze-ESD zisetshenziselwa ukuxilonga i-signet ring cell carcinoma.
Izimpawu ze-Pathological
I-signet ring cell carcinoma iwuhlobo oluyingozi kakhulu. Ngokwesigaba sikaLauren, i-gastric signet ring cell carcinoma ihlukaniswa njengohlobo olusabalele lwe-carcinoma futhi iwuhlobo lwe-carcinoma engahlukanisiwe. Ivamise ukuvela emzimbeni wesisu, futhi ivame kakhulu ezilonda eziyisicaba nezishonelwe ezinamathoni ashintshe umbala. Izilonda ezikhuphukile azivamile futhi zingabonakala njengokuguguleka noma izilonda. Kunzima ukubona ngesikhathi sokuhlolwa kwe-endoscopic ezigabeni zokuqala. Ukwelashwa kungaba ukuhlinza okwelaphayo okufana ne-endoscopic ESD, ngokulandelelwa okuqinile kwangemva kokuhlinzwa kanye nokuhlolwa kokuthi kwenziwe ukuhlinzwa okwengeziwe. Ukuhlinza okungalapheki kufanele kudinga ukuhlinzwa okwengeziwe, futhi indlela yokuhlinza inqunywa udokotela ohlinzayo.
Ithiyori yombhalo engenhla nezithombe zivela "Esiswini Namathumbu"
Ngaphezu kwalokho, kufanele futhi kuqashelwe umdlavuza we-esophagogastric junction, umdlavuza we-cardia, kanye ne-adenocarcinoma ehluke kahle etholakala kusizinda se-HP-negative.
3. Isifinyezo
Namuhla ngifunde ulwazi olufanele kanye nokubonakaliswa kwe-endoscopic yomdlavuza wesisu we-HP-negative. Ngokuyinhloko ihlanganisa: uhlobo lomdlavuza wendlala ye-fundac, uhlobo lomdlavuza wendlala ye-fundac ye-mucosal, i-gastric adenoma, (i-raspberry-like) i-foveolar epithelial tumor kanye ne-signet ring cell carcinoma.
Izehlakalo emtholampilo zomdlavuza wesisu we-HP-negative ziphansi, kunzima ukwehlulela, futhi kulula ukuphuthelwa ukuxilongwa. Okunzima nakakhulu ukubonakaliswa kwe-endoscopic kwezifo eziyinkimbinkimbi nezingavamile. Kufanele futhi iqondwe ngombono we-endoscopic, ikakhulukazi ulwazi lwethiyori ngemuva kwayo.
Uma ubheka ama-polyps esiswini, ukuguguleka, nezindawo ezibomvu nezimhlophe, kufanele ucabangele amathuba okuba nomdlavuza wesisu we-Hp-negative. Isinqumo se-HP esinegethivu kufanele sihambisane nezindinganiso, futhi kufanele kuqashelwe ukungalungi okubangelwa ukuthembela ngokweqile emiphumeleni yokuhlolwa kokuphefumula. Ama-endoscopists anolwazi athemba amehlo awo kakhulu. Sibhekene nethiyori enemininingwane mayelana nomdlavuza wesisu we-HP-negative, kufanele siqhubeke nokufunda, ukuqonda nokuzijwayeza ukuze siphumelele.
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Isikhathi sokuthumela: Jul-12-2024