Indwara ya colon ni indwara isanzwe kandi ikunze kugaragara muri gastroenterology. Bavuga intanga zo mu nda ziri hejuru ya mucosa yo munda. Mubisanzwe, colonoscopi ifite igipimo cyo gutahura byibuze 10% kugeza 15%. Umubare w'abanduye ukunze kwiyongera uko imyaka igenda ishira. kuzamuka. Kubera ko kanseri zirenga 90% ziterwa na kanseri yibara iterwa no guhindura nabi polyps, ubuvuzi rusange ni ugukora endoskopique ikuraho polyps ikimara kugaragara.
Muri colonoskopi ya buri munsi, 80% kugeza 90% ya polyps iri munsi ya cm 1. Kuri adenomatous polyps cyangwa polyps ifite uburebure bwa mm 5 mm (yaba adenomatous cyangwa idahari), birasabwa guhitamo endoskopi. Birashoboka ko micropolyps ya colon (uburebure bwa diameter ≤5mm) irimo ibibyimba biri hasi cyane (0 ~ 0,6%). Kuri micropolyps muri rectum na sigmoid colon, niba endoscopiste ishobora kumenya neza ko ari polyps idasanzwe, nta mpamvu yo gukosorwa, ariko ibitekerezo byavuzwe haruguru ntibikunze gushyirwa mubikorwa mubuvuzi mubushinwa.
Mubyongeyeho, 5% ya polyps iringaniye cyangwa ikura kuruhande, hamwe na diametre irenga cm 2, hamwe nibice bibi. Muri iki kibazo, tekinoroji ya endoscopique yateye imbere irakenewe, nkaEMRnaESD. Reka turebe intambwe zirambuye zo gukuraho polyp.
Uburyo bwo kubaga
Umurwayi yarangije gusuzuma anesthesia mbere yo gutangira, ashyirwa mumwanya wibumoso wa decubitus, ahabwa anesthesi yimitsi hamwe na propofol. Umuvuduko w'amaraso, umuvuduko w'umutima, electrocardiogram, hamwe n'amaraso ya ogisijeni ya periferique byakurikiranwe mu gihe cyo kubaga.
1 Ubukonje / BishyushyeImbaraga za BiopsyIgabana
Birakwiye gukuraho polyps ntoya ≤5mm, ariko hashobora kubaho ikibazo cyo gukuraho burundu polyps 4 kugeza 5mm. Hashingiwe kuri biopsy ikonje, biopsy yumuriro irashobora gukoresha umuyaga mwinshi kugirango utere ibikomere bisigaye kandi uvure indwara ya hemostasis ku gikomere. Ariko rero, hakwiye kwitonderwa kugirango wirinde kwangirika kurwego rwa serosa yurukuta rw amara kubera amashanyarazi menshi.
Mugihe cyo kubaga, impera yumutwe wa polyp igomba gufatanwa, kuzamurwa muburyo bukwiye (kugirango wirinde kwangiza imitsi), kandi ikabikwa mumwanya ukwiye kurukuta rw amara. Iyo polyp pedicle ihindutse umweru, hagarika amashanyarazi kandi uhambire igikomere. Twabibutsa ko bitoroshye gukuraho polyp nini cyane, bitabaye ibyo bizongera igihe cyamashanyarazi kandi byongere ibyago byo kwangirika kwuzuye (Ishusho 1).
2 Ubukonje / bushyushyeumutego wa polypectomyuburyo bwo gukuraho
Bikwiranye nibisebe byazamuye bifite ubunini butandukanye I p, Ubwoko bwa sp na buto (<2cm) I s (amahame yihariye yo gutondeka ashobora kwerekeza kuri endoskopique gutahura kanseri hakiri kare yinzira yigifu. Hariho ubwoko bwinshi kandi sinzi guca imanza? Iyi ngingo Byumvikane neza) Kwanga ibikomere. Kubwoko buto Ip ibisebe, kwanga umutego biroroshye. Imitego ikonje cyangwa ishyushye irashobora gukoreshwa mukwanga. Mugihe cyo kwanga, uburebure runaka bwa pedicle bugomba kugumana cyangwa intera runaka kuva kurukuta rw amara mugihe hagomba gukurwaho burundu igikomere. Nyuma yo gukaza umutego, igomba kunyeganyezwa Umutego, ukareba niba hari mucosa usanzwe wo munda hanyuma ukayishyiramo hamwe kugirango wirinde kwangirika kurukuta rw amara.
Igishushanyo 1 Igishushanyo mbonera cyo gukuraho ingufu za biopsy yumuriro, A mbere yo gukuraho ingufu, B igikomere nyuma yo gukuraho ingufu. CD: Kwirinda ubushyuhebiopsy imbaragagukuraho. Niba polyp ari nini cyane, izongera igihe cyamashanyarazi kandi yangize kwangirika.
Igishushanyo cya 2 Igishushanyo mbonera cyumutego wumuriro wibintu bito I sp
3 EMR
■ I p
Kubinini binini I p, usibye ingamba zavuzwe haruguru, imitego yubushyuhe igomba gukoreshwa mukwanga. Mbere yo kwangwa, inshinge zihagije zigomba gukorwa munsi ya pedicle (2 kugeza 10 mL ya 10,000 ya epinephrine + methylene ubururu + physiologique Imvange ya saline yatewe munsi ya mucosa (inshinge mugihe ukuramo urushinge), kugirango pedicle izamuke byuzuye kandi byoroshye kuyikuramo (Igicapo cya 3).
Igishushanyo cya 3 Igishushanyo cyaEMRkuvura ibikomere byubwoko bwa lp
Twabibutsa ko niba ubwoko bunini bwa I p polyp bufite pedicle yuzuye, bushobora kuba burimo vasorum nini, kandi bizava amaraso byoroshye nyuma yo kuyikuraho. Mugihe cyo kwanga, uburyo bwa coagulation-gukata-coagulation burashobora gukoreshwa kugirango bigabanye ibyago byo kuva amaraso. Hafi ya polyps nini irashobora gutondekwa mubice kugirango bigabanye ingorane zikorwa, ariko ubu buryo ntabwo bujyanye no gusuzuma indwara.
Ubwoko bwa lla-c
Kubwoko bwa Ila-c ibikomere na bimwe Nibisebe bifite diametero nini, kwanga umutego utaziguye bishobora kwangiza byuzuye. Gutera insimburangingo yamazi birashobora kongera uburebure bwigisebe kandi bikagabanya ingorane zumutego no kwanga. Niba haribisohoka mugihe cyo kubagwa ni ishingiro ryingenzi ryo kumenya niba adenoma ari nziza cyangwa mbi kandi niba hari ibimenyetso byerekana imiti ya endoskopi. Ubu buryo burashobora kongera igipimo cyuzuye cyo kwanga adenoma<2cm muri diameter.
Igicapo 4EMRimbonerahamwe yo kuvura ubwoko bwa Il polyps
4 ESD
Kuri adenoma ifite diameter irenze 2cm isaba kwakirwa inshuro imwe n'ikimenyetso cyo kuzamura nabi, kimwe na kanseri kare,EMRibisigisigi cyangwa ibisubiramo bigoye kuvura,ESDkuvura birashobora gukorwa. Intambwe rusange ni:
1.
2. Gutera inshinge kugirango ibikomere bigaragara.
3. Igice kimwe cyangwa kizengurutse gukurura mucosa kugirango ugaragaze subucosa.
4.
5. Itegereze igikomere witonze kandi uvure imiyoboro y'amaraso kugirango wirinde ingorane.
6. Nyuma yo gutunganya ingero zasubitswe, ohereza kubisuzumisha.
Igicapo 5ESDkuvura ibikomere binini
Kwirinda ibikorwa
Endoscopic colon polyp resection isaba uburyo bukwiye bwo guhitamo hashingiwe kubiranga polyp, aho biherereye, urwego rwubuhanga bwabakozi, nibikoresho bihari. Muri icyo gihe, kuvanaho polyp nabyo bikurikiza amahame asanzwe, tugomba gukurikiza ibishoboka byose kugirango gahunda yubuvuzi itekane kandi neza kandi abarwayi babyungukiramo.
1. Mbere yo gushyiraho gahunda yo kuvura nurufunguzo rwo kurangiza neza kuvura polyp (cyane cyane polyps nini). Kuri polyps igoye, birakenewe guhitamo uburyo bukwiranye mbere yo kuvurwa, kuvugana nabaforomo, anesthesiologiste nabandi bakozi mugihe gikwiye, no gutegura ibikoresho byo kuvura. Niba ibintu bibyemerewe, birashobora kurangizwa bayobowe numubaga mukuru wo kubaga kugirango hakumirwe impanuka zitandukanye zo kubaga.
2. Kugumana "urwego rwubwisanzure" bwiza kumubiri windorerwamo mugihe cyo kuvura nicyo gisabwa kugirango intego yo kubaga igerweho. Mugihe winjiye mu ndorerwamo, kurikiza byimazeyo "uburyo bwo gufata neza no kugabanya uburyo" kugirango ukomeze umwanya wokuvurwa muburyo budafite aho buhurira, bufasha kuvura neza.
3. Icyerekezo cyiza cyo gukora gituma inzira yo kuvura yoroshye kandi itekanye. Amara y’umurwayi agomba gutegurwa neza mbere yo kuvurwa, umwanya wumurwayi ugomba kugenwa mbere yo kubagwa, na polyps igomba kugaragara neza nuburemere. Akenshi nibyiza niba igikomere giherereye kuruhande rwamazi asigaye mumyanya yo mara.
Twebwe, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., Ni uruganda mu Bushinwa ruzobereye mu gukoresha endoskopi, nkabiopsy imbaraga, hemoclip, umutego, inshinge, spray catheter, cytology, kuyobora, igitebo cyo kugarura amabuye, izuru rya biliary drainage catheternibindi bikoreshwa cyane muriEMR, ESD, ERCP. Ibicuruzwa byacu byemewe na CE, kandi ibihingwa byacu byemewe na ISO. Ibicuruzwa byacu byoherejwe mu Burayi, Amerika y'Amajyaruguru, Uburasirazuba bwo hagati ndetse no muri Aziya, kandi bigera ku bakiriya bamenyekana kandi bashimwe!
Igihe cyo kohereza: Kanama-02-2024