Kuvura endoscopic yo kuvura submucosal yinzira ya dismuve: Ingingo 3 zingenzi zavuganye muri make mu ngingo imwe

Ibibyimba byitsinda (SMT) byo gukurikiranwa gastrointestinal birasambanijwe bituruka kuri Mucosa Mucosa, Sundmucosa, cyangwa umucungamutungo wa Plapta, kandi ashobora kandi kuba ibikomere. Hamwe niterambere ryikoranabuhanga ryubuvuzi, amahitamo gakondo yo kubaga buhoro buhoro yinjiye buhoro buhoro ubuvuzi budahuye, nka L.Kubaga Imyuga no kubaga Robo. Ariko, mumyitozo yubuvuzi, urashobora kuboneka ko "kubaga" bidakwiriye abarwayi bose. Mu myaka yashize, agaciro k'imiti ya endoscopic yagiye yitaho buhoro buhoro. Impinduramatwara yinzoshya zumvikane mu Bushinwa ku isuzuma rya Endoscopic no kuvura SMT ryasohotse. Iyi ngingo izakwiga muri make ubumenyi bujyanye.

1.Ibyo epideccectionabivanye

(1) INGARUKA ZA SMT ntabwo ari mu bice bitandukanye by'ububiko bw'igifu, kandi igifu ni urubuga rusanzwe kuri Smt.

INTEGO ZA VARLIUs ibice byumurongo wigifu ntabwo aringaniye, hamwe na tract yo hejuru yifu ikunze kubaho. Muri bo, 2/3 bibaho mu nda, hakurikiraho Esofagus, Duodenum, na colon.

(2) HOTOTHOLOGINAl Ubwoko bwa SMT bugoye, ariko benshi smt ni ibikomere bya benign, kandi bike gusa ni bibi.

A.SMT ikubiyemo oyaibikomere n-neoplastique nka patcreatike ya patopitique hamwe nibikomere bya neoplasti.

B.among igikomere cya neoplastiS, Gastrointestinal Leomyomas, lipoma, ibibyimba bya granorimas, Schwannomas, Schwannomas, kandi ibibyimba bitandukanye biragaragara, kandi munsi ya 15% birashobora kugaragara nka tissue wige nabi.

C.Gastastrointestinal StromaIbibyimba (rist) hamwe nibibyimba bya neuroendontone (net) muri smt ni ibibyimba bifite ubushobozi bubi, ariko ibi biterwa nubunini bwayo, ariko ibi biterwa nubunini bwayo, aho.

D. Aho smt ifitanye isanoKuri Pathologiya: a. LeomyMomas ni ubwoko busanzwe bwa smphagus muri Esophagusi, ubarura kuri 60% kuri 80% by'ibicutsi bya Esofage, kandi birashoboka cyane ko bibaho mu gice cya Esofagus; B.Ibintu bya pato ya patrike ya SMTR biragoye cyane, hamwe na rust, leomyoMa na Patcreas ya ectopic ikunze kugaragara. Mu gipimo cya S. Lipoma nyinshi muri antrum ya gastric; c. Lipoma na cststs birasanzwe mu bice bimanuka kandi bisukuye bya duodenum; d. Muri SMT yo hepfo ya Gastrointestinal, Lipomas yiganje muri colon, mugihe inshundura ziganje muri rectum.

(3) Koresha CT na MRI kugeza kurwego, gufata, no gusuzuma ibibyimba. Kuri smts bakekwaho kuba mubi cyangwa bafite ibibyimba binini (birebireDiameter> cm 2), CT na MRI birasabwa.

Ubundi buryo bwo gutekereza, harimo na CT na MRI, nabo bafite akamaro gakomeye kugirango basuzume Smt. Birashobora kwerekana bitaziguye ahantu h'ibibyimba, uburyo bwo gukura, ingano ya lesion, imiterere, ubucucike, ubukungu, kandi bushobora kubona niba urwego rw'umugerekaKumenyekanisha urukuta rukora gastrointestinal. Noneho cyane, ibizamini byamatekerugero birashobora gutahura niba hari intera yinzego zegeranye kandi niba hari umubare munini mubidukikije, lymph Nodes nizindi nzego. Nuburyo nyamukuru bwo gutanga amanota yubuvuzi, kuvura no gusuzuma ibibyimba.

(4) tissu speeling ntabwo ari recoMmeje kuri Bennign Shts ishobora gusuzumwa na endoscopi isanzwe yahujwe na eus, nka lipoma, amavuta, na pancreas.

Kubintu byinshi bikekwa ko ari bibi cyangwa mugihe sogoscopi isanzwe yahujwe na eus ntishobora gusuzuma ibikomere cyangwa ibibyimba byiza, biringaniyeEEDLE Aspiration / biopsy, eus-fna / fnb), mucosal igabanya biopsy (biopsy-aicosaliccionsion (ifasha biopsy, Miab Urebye imbogamizi ya Eus-FNA n'ingaruka zakurikiyeho kuri Endoscopic

Uburyo ubwo aribwo bwose bwo kubona ingero za patologiya mbere yo kubagwa iratera kandi izangiza Uruganda rutangiraration, no gukwirakwiza ibibyimba. Kubwibyo, ibyo biopsy byanze bikunze ntabwo ari ngombwa. Birakenewe, cyane cyane kuri SMT zishobora gusuzumwa na endoscopi isanzwe yahujwe na eus, nka lipoma, na pascts, na pancreas ya ectopic, nta cyitegererezo cya tissue gisabwa.

2.SMT Endoscopic Disment

(1) Amahame yo kuvura

Ibibyimba bitagira lymph node metastasis cyangwa ibyago bike bya lymph node metastasis, kandi bifite ibyago bike byo gusiba endoscopique niba bikenewe. Gukuraho byuzuye ikibyimba bigabanya ikibyimba gisigaye hamwe ningaruka zo kwisubiramo. TheIhame ryo kuvura ibibyimba rigomba gukurikizwa mugihe cya endoscopic, kandi ubusugire bwa capsule yigifu igomba kugengwa mugihe cyo gutangwa.

(2) ibimenyetso

I.FUMUMBARA NUBUNTU BUKORESHEJWE BIKORESHEJWE N'IKIZAMWE CY'UBUNTU CYANGWA Byemezwa na Biopsy Pathology, cyane cyane abakekwaho GiSt hamwe no gusuzuma mbere yuburebure bwa ≤2CM hamwe ningaruka nke zo kongera kubaho na metastasis, hamwe nibishoboka byo gusakuza, birashobora kumenyekana neza; Kubyibumba hamwe na diameter ndende kubakekwaho ingaruka zitari zo> 2cm, niba lymph node cyangwa kuri metoscopis yakuwe mu isuzumabumenyi rya Endoscopitiste mu gice n'ikoranabuhanga rya Endoscopic. gutabwa.

II. Ibimenyetso (urugero, kuva amaraso, kubura) smt.

III .Abarwayi b'ibirobyi bakekwaho kuba beza n'ibizamini byateganijwe mbere cyangwa byemejwe na patology, ariko ntibishobora gukurikiranwa buri gihe cyangwa ibibyimba byagura buri gihe mugihe gito mugihe cyo gukurikirana kandi bafite debur ikomeyee kubiti bya endoscopic.

(3) Kumenyekanisha

Njye. Menya ibisebe bifiteTastaged to lymph node cyangwa imbuga za kure.

II. Kuri bamwe smt hamwe na lymphnodeCyangwa metastasis ya kure, biyongereye bisabwa kugirango ibone patipologiya, ishobora gufatwa nkumuntu ufitanye isano.

III. Nyuma yo kurangiza ibisobanuro birambuyeIsuzuma, biyemeje ko ubusanzwe busanzwe kubaga abakene kandi Endoscopic bidashoboka.

Gukomeretsa Byendaben nka lipoma na potipique muri rusange ntabwo bitera ibimenyetso nkububabare, kuva amaraso, no kubahiriza. Iyo sMT igaragaza nk'isuri, ibisebe, cyangwa byiyongera vuba mugihe gito, ibishoboka byo kuba ibitambo bibi.

(4) Guhitamo uburyo bwo gukuramod

Inkomoko ya Endoscopic: KuriSmt ugereranyije, usohoka mu kayira nkuko byagenwe na Eus na CT ibizamini, kandi birashobora gutangwa burundu ibizamini, kandi birashobora gukoreshwa neza mu mutego, hashobora gukoreshwa.

Ubushakashatsi bwo murugo kandi bwamahanga bwemeje ko umutekano kandi bifite akamaro muri ent <2cm, hamwe nibyago biva amaraso kuri 4% kugeza 13% hamwe no kugorekaibyago byo kuri 2% kugeza 70%.

Endoscopic Ubucukuzi bwa Submucosal, ese: kuri smts hamwe na diameter ndende ≥2 cm cyangwa niba ibizamini byambere nka eus na ct byemeza thKubyibumba bisohora mu cyuho, ese birashoboka kuri endoscopic yo hasi ya endoscopic igasimburana nabi.

Ese ikurikira ingeso za tekiniki yaGutandukana Endoscopic (Esd) no muri Endoscopic ya Endoscopic, kandi mubisanzwe akoresha uruziga "flip-Top" hejuru kugirango ukureho mubyimba kugirango ukureho uruziga rutwikiriye smt kandi ugaragaze byimazeyo ikibyimba. , kugirango ugere kubuyobozi bwo kubungabunga ubusumbabukira, utezimbere igicapo cyo kubaga, no kugabanya ibibazo byukuri. Kubibyimba ≤1.5 cm, igipimo cyo gusakuza cyuzuye cya 100% birashobora kugerwaho.

Submucosal Tunneling EndoscopicIon, Ster: Kubwa SMT bikomoka kuri Plapta ya Musculis muri Esophagus, Hilum, umuto wo kugabanuka k'umubiri wa gastri, antrum ya diamer, kandi byoroshye kuri tm, kandi byoroshye kuri tm, kandi byoroshye kuri tm, kandi byoroshye kuri cm, kandi byoroshye kuri cm, kandi byoroshye kuri cm, kandi byoroshye kuri cm, na cm, ster irashobora kuba uburyo bwo kuvura buke.

Ster ni ikoranabuhanga rishya ryatejwe imbere kuri piroscopic esophagecopic esophagerototom (igisigo) kandi ni kwagura tekinoroji ya esdnologiya. Igipimo cya en Bloc Igipimo cya Ster cyo kuvura SMT kigera kuri 84.9% kugeza 97.59%.

Endoscopic yuzuye-yuzuyeIon, EFTR: Irashobora gukoreshwa kuri SMT aho bigoye gushiraho umuyoboro cyangwa aho diames nziza ya diameter ifite ≥3.5 cm kandi ntabwo ikwiriye ster. Niba ikibyimba gisohoka munsi yigituba cyijimye cyangwa gikura hanze yigitereko, kandi ikibyimba gisanga gihuye neza na serosa igice cya serosa mugihe cyo kubagwa kandi ntigishobora gucibwa, birashobora gukoreshwa. EFTR ikora ubuvuzi bwa endoscopic.

Gusunika nezaurubuga nyuma ya eftr nurufunguzo rwo gutsinda eftr. Kugirango usuzume neza ibyago byo kwidagadura bisubiramo kandi ukagabanya ibyago byo gukwirakwiza ibibyimba, ntibisabwa gutema no gukuraho ibibyimba byaciwe mugihe cya Eftr. Niba ari ngombwa gukuraho ikibyimba, izobogamizi zigomba gusanwa mbere kugirango ugabanye ibyago byo kwibigirana imbuto no gukwirakwira. Uburyo bwo kwinezeza burimo: Clip Clip Suture, Kunywa-Clip Sdip Suture

(5) Ingorabahizi

Amaraso ahinnye: Kuva amaraso bitera hemoglobin umurwayi guta inshuro zirenga 20 g / l.
Kurinda amaraso menshi yo kuva amaraso,Gutera inkunga bihagije bigomba gukorwa mugihe cyo gushyiramo imiyoboro minini y'amaraso no koroshya amashanyarazi kugirango uhagarike kuva amaraso. Kuva amaraso hashobora kuvurwa hamwe nicyuma gitandukanye, imyenda igeratike cyangwa amashusho yicyuma, kandi ikibuza hestasis yo kwerekana amaraso yagaragaye mugihe cyo gutandukana.

Amaraso yasubiye inyuma: Amaraso yasubiye inyuma agaragaza nkamaraso, Melena, cyangwa amaraso mu ntebe. Mu bihe bikomeye, ihungabana rya hemorrorhagique rishobora kubaho. Ahanini bibaho mugihe cyicyumweru 1 nyuma yo kubagwa, ariko birashobora kandi kubaho ibyumweru 2 kugeza 4 nyuma yo kubagwa.

Amaraso yasubiye inyuma akunze kuba ifitanye isanoIbintu nkibibi byamaraso yamaraso nyuma yo kugenzura no kugaburira imiyoboro y'amaraso isigaye na acide ya gastric. Mubyongeyeho, kuva amaraso nyuma bigomba kandi bijyanye n'aho indwara, kandi birasanzwe muri Antrum Gastric na Rectum.

Gutinda gutobora: Mubisanzwe bigaragarira nkibitekerezo byo munda, ububabare bwo munda, ibimenyetso bya peritonite, umuriro, hamwe nibizamini byo kwirundanya cyangwa kongera ubwinshi bwa gaze ugereranije na mbere.

Ahanini bifitanye isano nibintu nkibi bikabije bikabije ibikomere, hakiri kare cyane, kubyuka kare kugirango uzenguruke, kurya cyane, kugenzura isukari nkeya, hamwe nisuki yibikomere bya aside gistri. a. Niba igikomere ari kinini cyangwa cyimbitse cyangwa igikomere gifite fisneza-nkimpinduka zo kuruhuka umwanya no kwiyiriza ubusa bigomba kwagurwa neza kandi bigakorwa neza kandi bigakorwa nyuma yo kubagwa (abarwayi nyuma yo kubagwa b. Abarwayi ba diyabete bagomba kugenzura byimazeyo isukari yamaraso; Abafite aho batonganya kandi indwara zoroheje kandi yo munda zigomba guhabwa ubuvuzi nko kwiyiriza ubusa, kurwanya indwara, no guhagarika imisoro; c. Kubafite ibirango, igituza cyafunzwe kandi cyoroshye cyo munda gishobora gukorerwa imiyoboro igomba gushyirwaho kugirango ikomeze imiyoboro myiza; d. Niba kwandura bidashobora guhorwa nyuma yo kuvura ibihakanyi cyangwa bihujwe no kwandura Thoracoabhinal, laparoscopy yo kubaga ya Thoranoandation, kandi laparoscopy ishobora gukorwa vuba, kandi gusana byo gusana no guterana no kubyara no kumurika yo munda bigomba gukorwa.

Ingorabahizi zijyanye na gaze: harimo na subcutaEphysema, pnemoumestiusUm, Pneumothorax na Pnemoperitoneum.

Kugaragaza Ububiko bwa Emphhysema (yerekanwe nka Emphysema mumaso, ijosi, urukuta rwo mu gatuza, na scrotum) hamwe na mediostinal pneumophysema (sIbyiza bya epiglottis murashobora kuboneka mugihe cya gastroscopy) mubisanzwe ntibisaba kuvurwa bidasanzwe, kandi emphysema muri rusange izakemura wenyine.

Umusonga ukabije ubaho dus kubaga [umuvuduko windege urenze 20 MMHG mugihe cyo kubagwa

(1Mhhg = 0.133 kpa), ikipe2 <90%Uruhu.

Ku barwayi bafite pnemoperitoneUm mugihe cyo kubaga, koresha urushinge rwa PNEOUMopeneitom rwo gucumbika Mcfarland PointMu nda yo hepfo yo hasi kugirango ahindure umwuka, kandi usige urushinge urushinge mu mwanya kugeza igihe cyo gukora, hanyuma ukureho nyuma yo kwemeza ko gaze igaragara isezererwa.

Gastrointestinal fistula: Amazi yo gusya yatewe na endoscopic ya Endoscopic yatemba mu gatuza cyangwa munda munda binyuze mu kumeneka.
Fisofasal medistal fisdula hamwe nibisanzwe bya esophaothoracique birasanzwe. Iyo fistula ibaye, kora igituza gifunze kuri Maintamuburyo bworoshye kandi utange inkunga ihagije. Niba bibaye ngombwa, amashusho yicyuma nibikoresho bitandukanye byo gusoza birashobora gukoreshwa, cyangwa igifuniko cyuzuye kirashobora gukoreshwa. Stents nubundi buryo bukoreshwa muguhagarikaFistula. Imanza zikomeye zisaba gutabara byihuse.

3. Imiyoborere (F.ollow-up)

(1) ibikomere bya Benign:Pathologiya sUggests ibikomere nka lipoma na leiommango ntibisaba gukurikira buri gihe gukurikirana.

(2) SMT nta mabiIbikubiyemo:Kurugero, urukirange rwa GIST 2cm, nubusitani buciriritse- kandi bukabije, gutondekanya byuzuye bigomba gukorwa hamwe nubuvuzi bwinyongera (kubaga, kwivuza) bigomba gusuzumwa cyane. Kuvura). Gushiraho gahunda bigomba gushingira ku nama nyinshicike itandukanye no ku giti cye.

(3) Ibishobora kuba bibi,Kurugero, Gist-ibyago bike bigomba gusuzumwa na eus cyangwa gutekereza buri megi 6 kugeza 12 nyuma yo kuvurwa, hanyuma bifatwa hakurikijwe amabwiriza ya kavukire.

(4) SMT hamwe nubushobozi buciriritse kandi bukabije:Niba pathologiya ya nyuma yemeza ubwoko 3 urushundura rwamabara 3, urushundura rwa 2cm hamwe na 2cm, ruciriritse rugomba gukorwa hamwe nubuvuzi bwuzuye. Kuvura). Gushiraho gahunda bigomba gushingira kuri[Ibyerekeye Amerika 0118.Docx] Kugisha inama nyinshi kandi kugiti cyawe.