Polyps zo mu mara ni indwara ikunze kugaragara kandi ikunze kugaragara mu buvuzi bw'indwara z'igifu. Zivuga ku bice by'imbere by'umubiri biri hejuru y'umura. Muri rusange, colonoscopy ifite igipimo cyo kuyimenya kiri hagati ya 10% na 15%. Igipimo cyo kuyirwara kirushaho kwiyongera uko imyaka igenda yiyongera. Kubera ko kanseri zirenga 90% za kanseri yo mu mara ziterwa n'impinduka mbi za polyps, uburyo rusange bwo kuvura ni ugukora endoscopic resection ako kanya polyps zibonetse.
Mu gupima colonoscopy buri munsi, 80% kugeza 90% bya polyps biri munsi ya cm 1. Kuri polyps cyangwa polyps zifite uburebure bwa ≥ 5 mm (zaba ari adenomatous cyangwa zitari zo), ni byiza gupima endoscopic resection. Amahirwe yo gukoresha micropolyps zo mu mara (uburebure bwa ≤5mm) zirimo ibice bya kanseri ni make cyane (0 ~ 0.6%). Kuri micropolyps zo mu mara y'inyuma na sigmoid, niba umuganga w'indwara zo mu mara ashobora kumenya neza ko atari polyps zo mu mara, nta mpamvu yo kuzica, ariko igitekerezo cyavuzwe haruguru ntigikunze gushyirwa mu bikorwa mu buvuzi mu Bushinwa.
Byongeye kandi, 5% bya polyps ziba zirambuye cyangwa zikura ku ruhande, zifite umurambararo urenga cm 2, zifite cyangwa zidafite ibice bya kanseri. Muri iki gihe, hakenewe uburyo bugezweho bwo gukuraho polyps mu buryo bwa endoscopic, nkaEMRnaESDReka turebe intambwe zirambuye zo gukuraho polyp.
Uburyo bwo kubaga
Umurwayi yarangije isuzuma rya anesthesia mbere yo kubagwa, ashyirwa mu mwanya w'ibumoso wa decubitus, maze ahabwa anesthesia yo mu mitsi hamwe na propofol. Mu gihe cyo kubagwa, umuvuduko w'amaraso, umuvuduko w'umutima, electrocardiogram, n'umuvuduko wa ogisijeni mu maraso byagenzuwe.
1 Ubukonje/UbushyuheIngufu zo mu bwonko (Biopsy Forceps)Ishami
Irakwiriye gukuraho utunyangingo duto cyane kurusha milimetero 5, ariko hashobora kubaho ikibazo cyo gukuraho utunyangingo duto cyane cyane milimetero 4 kugeza 5. Hashingiwe kuri biopsy ikonje, biopsy y'ubushyuhe ishobora gukoresha imbaraga nyinshi mu gutwika ibisebe bisigaye no kuvura hemostasis ku gikomere. Ariko, hakwiye kwitonderwa kugira ngo hirindwe kwangirika k'urukuta rw'amara bitewe n'amashanyarazi menshi.
Mu gihe cyo kubagwa, umutwe wa polyp ugomba gufungwa, ugashyirwa hejuru neza (kugira ngo wirinde kwangiza urwego rw'imitsi), kandi ugashyirwa kure ikwiye uvuye ku rukuta rw'amara. Iyo igice cy'imbere cya polyp kibaye umweru, hagarika gukoresha amashanyarazi hanyuma uhambire igisebe. Icyitonderwa ni uko bitari byoroshye gukuraho polyp nini cyane, bitabaye ibyo bizamura igihe cyo gukoresha amashanyarazi kandi byongera ibyago byo kwangirika kuzuye (Ishusho ya 1).
2 Ubukonje/ubushyuheumutego wo kubaga polypectomyuburyo bwo gukuraho
Bikwiriye ku bisebe byazamutse by’ingano zitandukanye I p, I sp n’ibito (<2cm) I s type (amahame yihariye yo gushyira mu byiciro ashobora gusobanura uburyo bwo gusuzuma kanseri y’igogora hakiri kare. Hari amoko menshi cyane kandi sinzi uko nayasuzuma? Iyi ngingo Isobanure neza) Gukuraho ibisebe. Ku bisebe bito bya Ip, gukata snare biroroshye. Imitego ikonje cyangwa ishyushye ishobora gukoreshwa mu gukata. Mu gihe cyo gukata, uburebure runaka bwa pedicle bugomba kugumaho cyangwa intera runaka uvuye ku rukuta rw’amara mu gihe hagomba gukurwaho burundu igisebe. Nyuma yo gukaza snare, igomba kunyeganyezwa Umutego, urebe niba hari mucosa isanzwe y’amara uyikikije hanyuma uyishyire hamwe kugira ngo wirinde kwangirika k’urukuta rw’amara.
Ishusho ya 1 Ishusho y'icyitegererezo cyo gukuraho forceps zo mu bwoko bwa biopsy y'ubushyuhe, A mbere yo gukuraho forceps, B igikomere nyuma yo gukuraho forceps. CD: Amabwiriza yo kwirinda ubushyuheforceps za biopsyGukurwaho. Iyo polyp ari nini cyane, byongera igihe cyo gufungana kw'amashanyarazi kandi bigatera kwangirika kwa transmural.
Ishusho ya 2 Ishusho y'icyitegererezo cy'uburyo ibisebe bito byo mu bwoko bwa I sp byaciwe hakoreshejwe thermal trape resection
3 EMR
■Ibisebe bya I p
Ku bisebe binini bya I p, uretse ingamba zavuzwe haruguru, hagomba gukoreshwa imitego y'ubushyuhe mu gukata. Mbere yo gukata, hagomba gukorwa inshinge zihagije zo mu gice cy'imbere cy'uruti rw'umugongo (2 kugeza kuri 10 mL z'ibice 10.000 bya epinephrine + methylene blue + physiological. Uruvange rwa saline ruterwa munsi y'umuyoboro w'amaraso (rutera mu gihe urimo gukuramo urushinge), kugira ngo uruti rw'umugongo rube rwuzuye kandi rworoshye kurukuraho (Ishusho ya 3). Mu gihe cyo gukata, igisebe kigomba kwirinda kugera ku rukuta rw'amara kugira ngo hirindwe ko habaho umuyoboro ufunze no gutwika urukuta rw'amara.
Ishusho ya 3 Imbonerahamwe y'icyitegererezo yaEMRkuvura ibisebe byo mu bwoko bwa lp
Icyitonderwa ni uko iyo polipu nini yo mu bwoko bwa I p ifite umubyimba munini, ishobora kuba irimo vasorum nini, kandi iva amaraso byoroshye nyuma yo kuyikuraho. Mu gihe cyo kuyikuraho, uburyo bwo kuyigabanya bushobora gukoreshwa mu kugabanya ibyago byo kuva amaraso. Hari polipu nini zishobora gucibwamo ibice kugira ngo bigabanye ingorane zo kubagwa, ariko ubu buryo ntibufasha mu gusuzuma indwara.
■Ibisebe byo mu bwoko bwa lla-c
Ku bisebe byo mu bwoko bwa Ila-c n'ibindi bisebe bya Is bifite umurambararo munini, gukata icyuma gifunganye bishobora kwangiza ubunini bw'igisebe. Gutera amazi mu gice cy'umuyoboro bishobora kongera uburebure bw'igisebe no kugabanya ingorane zo gukata icyuma. Niba hari aho bisohoka mu gihe cyo kubaga ni ishingiro ry'ingenzi ryo kumenya niba adenoma ari mbi cyangwa mbi ndetse niba hari ibimenyetso byo kuvura hakoreshejwe endoscope. Ubu buryo bushobora kongera umuvuduko wose wo gukata adenoma.<2cm z'umurambararo.
Ishusho ya 4EMRImbonerahamwe y'imigendekere y'ubuvuzi bwa polyps zo mu bwoko bwa Il
4 ESD
Ku ndwara zo mu bwoko bwa adenoma zifite umurambararo urenze cm 2 zisaba gucibwa inshuro imwe no kugaragaza ko zitameze neza, ndetse na kanseri zimwe na zimwe zo hakiri kare,EMRibisigazwa cyangwa gusubira inyuma bigoye kuvura,ESDUburyo bwo kuvura bushobora gukorwa. Intambwe rusange ni izi:
1. Nyuma yo gusiga irangi mu jisho, umupaka w'igisebe ugaragazwa neza kandi uruziga rugashyirwa ahagaragara (igisebe gishobora kudashyirwa ahagaragara niba umupaka w'igisebe ugaragara neza).
2. Shyira mu cyuma gikozwe mu buryo bw'umubiri kugira ngo ibisebe bigaragare neza.
3. Gukata igice cy'umura mu gice cyangwa mu nkengero kugira ngo submucosa igaragare.
4. Kuramo ingirangingo zihuza igitsina ku gice cy'umubiri hanyuma ukureho ingirangingo zirwaye buhoro buhoro.
5. Reba neza igikomere kandi uvure imiyoboro y'amaraso kugira ngo wirinde ingorane.
6. Nyuma yo gutunganya ingero zakuwemo, zohereze kugira ngo zisuzumwe indwara.
Igishushanyo cya 5ESDkuvura ibikomere binini
Uburyo bwo kwirinda mu gihe cyo kubagwa
Gukuraho polyp mu mara anini bisaba uburyo bukwiye bwo guhitamo hashingiwe ku miterere ya polyp, aho iherereye, ubuhanga bw'uyikoresha, n'ibikoresho bihari. Muri icyo gihe, gukuramo polyp nabyo bikurikiza amahame asanzwe, tugomba gukurikiza uko bishoboka kose kugira ngo tumenye neza ko inzira y'ubuvuzi ari nziza kandi ikora neza kandi abarwayi bakayungukiramo.
1. Gushyiraho gahunda yo kuvura mbere y’igihe ni ingenzi kugira ngo ubuvuzi bwa polyp bugende neza (cyane cyane polyp nini). Kuri polyp zikomeye, ni ngombwa guhitamo uburyo bwo gucibwa mbere yo kuvurwa, kuvugana n'abaforomo, abaganga b'inzobere mu gutera ikinya n'abandi bakozi ku gihe, no gutegura ibikoresho byo kuvura. Niba ibintu bibyemereye, bishobora kurangizwa ku buyobozi bw'umuganga mukuru kugira ngo hirindwe impanuka zitandukanye zo kubaga.
2. Kugumana "uburebure bw'ubwisanzure" bwiza ku mubiri w'indorerwamo mu gihe cyo kuvurwa ni ngombwa kugira ngo intego yo kubagwa igerweho. Mu gihe winjiye mu ndorerwamo, kurikiza neza "uburyo bwo kubungabunga no kugabanya uruziga" kugira ngo aho uvurirwa hagume nta ruziga, bityo bikaba byiza ku buvuzi bunoze.
3. Kubona neza mu kubaga bituma inzira yo kuvura yoroha kandi ikarangwa n'umutekano. Amara y'umurwayi agomba gutegurwa neza mbere yo kuvurwa, aho umurwayi ahagaze hagomba kumenyekana mbere yo kubagwa, kandi polyps zigomba kugaragara neza bitewe n'imbaraga z'uburemere. Akenshi biba byiza iyo igisebe kiri ku ruhande rutandukanye rw'amazi asigaye mu mara.
Twebwe, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ni uruganda rukora ibikoresho byo mu Bushinwa byihariye mu gukoresha ibikoresho byo mu nda, nkaforceps za biopsy, hemoklip, umutego wa polyp, urushinge rwo kuvura sclerotherapy, katheteri itera umuti, uburoso bwa cytology, insinga y'ubuyobozi, agasanduku ko gukurura amabuye, katheteri itwara amazi mu mazurun'ibindi bikoreshwa cyane muriEMR, ESD, ERCPIbicuruzwa byacu bifite icyemezo cya CE, naho inganda zacu zifite icyemezo cya ISO. Ibicuruzwa byacu byoherejwe mu Burayi, Amerika ya Ruguru, Uburasirazuba bwo Hagati no mu gice kimwe cya Aziya, kandi birushaho kumenyekana no gushimwa n'abakiriya!
Igihe cyo kohereza: Kanama-02-2024