Mu bumenyi buzwi cyane ku bijyanye na kanseri y'igifu yo mu ntangiriro, hari ingingo zimwe na zimwe zidasanzwe z'ubumenyi ku ndwara zisaba kwitabwaho no kwigwaho byihariye. Imwe muri zo ni kanseri y'igifu idafite HP. Igitekerezo cy'"ibibyimba byo mu jisho bitanduye" ubu kirakunzwe cyane. Hazabaho ibitekerezo bitandukanye ku kibazo cy'izina. Iyi nyigisho ishingiye ahanini ku bikubiye mu kinyamakuru "Inda n'Amara", kandi izina rinakoresha "kanseri y'igifu idafite HP".
Ubwo bwoko bw'ibisebe bufite imiterere yo kuba bike, bigoye kumenya, ubumenyi bugoye bw'imitekerereze, kandi inzira yoroshye ya MESDA-G ntabwo ikoreshwa. Kwiga ubu bumenyi bisaba guhangana n'ingorane.
1. Ubumenyi bw'ibanze ku ndwara ya kanseri y'igifu idafite HP
Amateka
Mu bihe byashize, byari byitezwe ko ikintu kimwe mu byateye kanseri y'igifu no kuyitera ari ubwandu bwa HP, bityo uburyo bwa kera bwo kuvura kanseri ni HP - kugabanuka kw'amaraso - kugabanuka kw'amara - kugabanuka kw'ibibyimba - kugabanuka kw'ibibyimba - kugabanuka kw'ibibyimba. Uburyo bwa kera bwagiye buzwi cyane, bwemerwa kandi bwemerwa cyane. Ibibyimba bikura hamwe bishingiye ku kugabanuka kw'amabara no ku bikorwa bya HP, bityo kanseri zikunze gukura mu nzira z'amara zitagira imiterere isanzwe n'aho zitari zisanzwe.
Nyuma, abaganga bamwe bavumbuye ko kanseri yo mu gifu ishobora kubaho nubwo nta bwandu bwa HP buhari. Nubwo igipimo cyo kuyirwara kiri hasi cyane, birashoboka koko. Ubwo bwoko bwa kanseri yo mu gifu bwitwa kanseri y'igifu idafite HP.
Hamwe n'uburyo bugenda busobanuka buhoro buhoro ku bijyanye n'ubu bwoko bw'indwara, hatangiye gutangwa isuzuma ryimbitse n'incamake, kandi amazina ahora ahinduka. Hari ingingo mu 2012 yitwaga "Kanseri yo mu Gifu nyuma yo Gutera Indwara", ingingo mu 2014 yitwaga "Kanseri yo mu Gifu idakira HP", n'inyandiko mu 2020 yitwaga "Ibibyimba byo mu Gifu bitandura Hp". Ihinduka ry'izina rigaragaza uburyo bwo gusobanukirwa byimbitse kandi byuzuye.
Ubwoko bw'uturemangingo n'uburyo bwo gukura
Hari ubwoko bubiri bw'ingenzi bw'uturemangingo tw'imfu n'uturemangingo tw'imfu mu gifu:
Uturemangingo tw’udukoko (oxyntic glands) dukwirakwira mu gice cy’umugongo, umubiri, mu mfuruka, n’ibindi by’igifu. Ni uturemangingo tw’umuyoboro umwe ugororotse. Tugizwe n’uturemangingo tw’umuhogo, uturemangingo tw’ingenzi, uturemangingo tw’umuhogo n’uturemangingo tw’imisemburo, buri turemangingo dukora imirimo yatwo. Muri two, uturemangingo tw’ingenzi. Ibara rya PGI na MUC6 ryavuyemo ryari ryiza, naho uturemangingo tw’umuhogo twavuyemo aside hydrochloric na factor y’imbere;
Uturemangingo twa pyloric duherereye mu gace k'igifu kandi tugizwe n'uturemangingo tw'umusemburo n'uturemangingo tw'imisemburo. Uturemangingo tw'umusemburo dufite MUC6 positive, naho uturemangingo tw'imisemburo tugizwe n'uturemangingo twa G, D n'uturemangingo twa enterochromaffin. Uturemangingo twa G dusohora gastrin, uturemangingo twa D dusohora somatostatin, n'uturemangingo twa enterochromaffin dusohora 5-HT.
Uturemangingo dusanzwe tw’igifu n’uturemangingo twa kanseri bisohora ubwoko butandukanye bwa poroteyine z’urumogi, zigabanyijemo poroteyine z’urumogi “mu gifu”, “mu mara” n’ “zivanze”. Igaragara ry’urumogi rw’igifu n’urw’amara ryitwa phenotype ntabwo ari ahantu hihariye mu gifu n’amara.
Hari ubwoko bune bw'uturemangingo tw'ibibyimba byo mu gifu: igifu cyose, igifu cyose, igifu cyose, n'igifu cyose. Ibibyimba bibaho hashingiwe ku guhinduka kw'amara ahanini ni ibibyimba byo mu gifu bivanze. Kanseri zitandukanye zigaragaza ubwoko bw'amara (MUC2+), naho kanseri zikwirakwira zigaragaza ubwoko bw'igifu (MUC5AC+, MUC6+).
Kumenya Hp negative bisaba uburyo bwihariye bwo gupima kugira ngo hamenyekane neza. Kanseri y'igifu idafite HP na kanseri y'igifu nyuma yo gucibwa burundu ni ibitekerezo bibiri bitandukanye. Kugira ngo umenye byinshi ku bimenyetso bya kanseri y'igifu idafite HP muri X-ray, reba igice kijyanye n'iki kinyamakuru "Inda n'Amara".
2. Ibimenyetso bya kanseri y'igifu idafite HP mu nyigo ya endoscope
Gusuzuma kanseri y'igifu ikoresheje endoskopi ni cyo kintu cyibandwaho cyane cyane na kanseri y'igifu yo mu bwoko bwa fundic gland, kanseri y'igifu yo mu bwoko bwa fundic gland mucosal, adenoma y'igifu, kanseri y'impyiko ya raspberry foveolar, kanseri y'impeta ya signalet, n'ibindi. Iyi nkuru yibanda ku bimenyetso bya kanseri y'igifu ikoresheje endoskopi.
1) Kanseri yibanze ya kanseri yo mu gifu
-Ibisebe byera byazamutse
kanseri yo mu bwoko bwa kanseri yo mu gifu
◆Urubanza rwa 1: Ibisebe byera, byazamutse
Ibisobanuro:Igifu cya fundic fornix - curvature ya cardia, 10 mm, yera, ubwoko bwa O-lia (SMT-like), nta gucika cyangwa metaplasia y'amara inyuma. Imitsi y'amaraso isa na arbor igaragara hejuru (NBI no kwaguka gato)
Isuzuma (rihujwe n'indwara):U, O-1la, 9mm, ubwoko bwa kanseri yo mu bwoko bwa kanseri yo mu gifu, pT1b / SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Ibisebe by'umweru birebire
kanseri yo mu bwoko bwa kanseri yo mu gifu
◆Urubanza rwa 2: Ibisebe by'umweru, birambuye/byihebye
Ibisobanuro:Urukuta rw'imbere rwa fornix-cardia yo mu nda rurerure, uburebure bwa mm 14, umweru, ubwoko bwa 0-1lc, nta gucika intege cyangwa metaplasia y'amara inyuma, imipaka idasobanutse neza, n'imitsi y'amaraso ya dendritic igaragara hejuru. (NBI na amplification muri make)
Isuzuma (rihujwe n'indwara):U, 0-Ilc, 14mm, ubwoko bwa gland bwubwoko bwa kanseri yigifu, pT1b / SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Ibisebe bitukura byazamutse
kanseri yo mu bwoko bwa kanseri yo mu gifu
◆Urubanza rwa 3: Ibisebe bitukura n'ibibyimba byazamutse
Ibisobanuro:Urukuta rw'imbere rw'inyuma rw'umutima rungana na mm 12, bigaragara ko ari umutuku, ubwoko bwa 0-1, nta gucika intege cyangwa metaplasia y'amara inyuma, imipaka isobanutse neza, n'imitsi y'amaraso ya dendritic hejuru (NBI no kwaguka gato)
Isuzuma (rihujwe n'indwara):U, 0-1, 12mm, ubwoko bwa gland bwubwoko bwa kanseri yigifu, pT1b / SM1 (200μm), ULO, LyO, VO, HMO, VMO
-Igisebe gitukura, giteye ubwoba, kandi giteye agahindas
kanseri yo mu bwoko bwa kanseri yo mu gifu
◆Urubanza rwa 4: Ibisebe bitukura, birambuye/byihebye
Ibisobanuro:Urukuta rw'inyuma rw'inyuma rw'inyuma rw'igice cyo hejuru cy'igifu, 18mm, umutuku woroshye, ubwoko bwa O-1Ic, nta gucika intege cyangwa guhinduka kw'amara inyuma, nta mupaka udasobanutse neza, nta mitsi y'amaraso ya dendritic ku buso, (NBI no kwiyongera kwayo ntibyigeze bikurwaho)
Isuzuma (rihujwe n'indwara):U, O-1lc, 19mm, ubwoko bwa kanseri yo mu bwoko bwa kanseri yo mu gifu, pT1b / SM1 (400μm), ULO, LyO, VO, HMO, VMO
kuganira
Abagabo barwaye iyi ndwara bakuze kurusha abagore, aho imyaka yabo isanzwe ari imyaka 67.7. Bitewe n'imiterere y'indwara ifata igihe kimwe n'iy'ubugari, abarwayi barwaye kanseri y'igifu yo mu bwoko bwa fundic gland bagomba gusuzumwa rimwe mu mwaka. Ahantu hakunze kugaragara cyane ni agace k'udukoko tw'igifu hagati no hejuru (fundus n'igice cyo hagati n'icyo hejuru cy'umubiri w'igifu). Ibisebe byera bisa na SMT bikunze kugaragara cyane mu rumuri rw'umweru. Uburyo bw'ingenzi bwo kuvura ni EMR/ESD yo gusuzuma indwara.
Kugeza ubu nta ndwara ya lymphatic metastasis cyangwa ikwirakwira ry'imitsi y'amaraso ryagaragaye. Nyuma yo kuvurwa, ni ngombwa kumenya niba hakorwa ubundi buryo bwo kubaga no gusuzuma isano iri hagati y’indwara mbi na HP. Si kanseri zose zo mu gifu zo mu bwoko bwa fundic gland zigaragaza ko nta HP zifite.
1) Kanseri y'igifu yo mu bwoko bwa Fundic gland mucosal
Kanseri y'igifu yo mu bwoko bwa fundic gland mucosal
◆Urubanza rwa 1
Ibisobanuro:Igisebe cyazamutse gato, kandi uturemangingo tw’igifu tutari atrophic twa RAC dushobora kugaragara hafi yacyo. Imiterere y’uturemangingo n’imitsi mito bihinduka vuba bishobora kugaragara mu gice cyazamutse cya ME-NBI, na DL irashobora kugaragara.
Isuzuma (rihujwe n'indwara):Indwara ya gland mucosal kanseri yo mu gifu, U zone, 0-1la, 47 * 32mm, pT1a / SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Kanseri y'igifu yo mu bwoko bwa fundic gland mucosal
◆Urubanza rwa 2
Ibisobanuro: Igisebe kiri ku rukuta rw'imbere rw'umutima ugoramye, hamwe n'amabara atandukanye n'umutuku, imiyoboro y'amaraso ya dendritic igaragara hejuru, kandi igisebe kizamuka gato.
Gusuzuma indwara (bivanze n'indwara): Inkunga ya gland mucosal kanseri yo mu gifu, 0-lla, pT1a / M, ULO, LyOV0, HM0, VMO
kuganira
Izina "gastric gland mucosal adenocarcinoma" riragoye kurivuga, kandi igipimo cy'indwara ni gito cyane. Bisaba imbaraga nyinshi kugira ngo umuntu ayimenye kandi ayisobanukirwe. Fundic gland mucosal adenocarcinoma ifite imiterere y'indwara ya kanseri nyinshi.
Hari ibintu bine by'ingenzi biranga endoscopy y'urumuri rwera: ① ibisebe bishira mu mubiri; ② SMT y'ikibyimba cyo mu gice cy'imbere cy'inyuma; ③ imiyoboro y'amaraso ya dendritic yagutse; ④ uduce duto tw'uturemangingo. Imikorere ya ME: DL(+)IMVP(+)IMSP(+)MCE yongera IP kandi ikongera. Hakoreshejwe uburyo bwa MESDA-G, 90% bya kanseri y'igifu ya fundic gland mucosal yujuje ibisabwa byo gusuzuma.
3) Adenoma yo mu gifu (adenoma ya pyloric gland PGA)
adenoma yo mu gifu
◆Urubanza rwa 1
Ibisobanuro:Hari igisebe cyera cyazamutse ku rukuta rw'inyuma rw'igifu gifite imbibi zidasobanutse neza. Ibara rya Indigo carmine nta mbibi ryagaragaje, kandi amara manini asa na LST-G yagaragaye (yagutse gato).
Isuzuma (rihujwe n'indwara):kanseri yo mu bwoko bwa atypia iri hasi, O-1la, 47 * 32mm, adenocarcinoma y'imiyoboro y'amaraso itandukanye neza, pT1a / M, ULO, Ly0, VO, HMO, VMO
adenoma yo mu gifu
◆Urubanza rwa 2
Ibisobanuro: Igisebe cyazamutse gifite utubyimba ku rukuta rw'imbere rw'igice cyo hagati cy'igifu. Gastritis ikora ishobora kugaragara inyuma. Indigo carmine ishobora kugaragara nk'umupaka. (NBI na magnification gato)
Indwara: Isura ya MUC5AC yagaragaye mu gice cyo hejuru cy'inyuma, naho isura ya MUC6 igaragara mu gice cyo hejuru cy'inyuma. Isuzuma rya nyuma ryabaye PGA.
kuganira
Adenoma zo mu gifu ni imiterere y’uturemangingo tw’igifu mu by’ukuri ni imiterere y’uturemangingo twinjira muri stroma kandi tugatwikirwa na epithelium ya foveolar. Bitewe n’ubwiyongere bw’uturemangingo tw’uturemangingo, ari two dusa n’uturemangingo, adenoma zo mu gifu zigaragara hakoreshejwe urumuri rw’umweru rwa endoscopic zose ziba zifite uturemangingo kandi zigaragara. Ni ngombwa kwita ku byiciro bine bya Jiu Ming mu isuzumwa rya endoscopic. ME-NBI ishobora kubona ishusho iranga papillary/villous ya PGA. PGA ntabwo ari HP negative rwose kandi ntabwo ari atrophic, kandi ifite ibyago bimwe na bimwe byo kwandura kanseri. Gusuzuma hakiri kare no kuvurwa hakiri kare birasabwa, kandi nyuma yo kuvumburwa, gucibwamo imikorere no kwiga byimbitse birasabwa.
4) (nk'icyatsi kibisi) kanseri y'igifu ya foveolar epithelial
kanseri y'igifu ya raspberry foveolar
◆Urubanza rwa 2
Ibisobanuro:(byasibwe)
Gusuzuma indwara (bivanze n'indwara): kanseri y'igifu yo mu jisho rya foveolar
kanseri y'igifu ya raspberry foveolar
◆Urubanza rwa 3
Ibisobanuro:(byasibwe)
Isuzuma (rihujwe n'indwara):kanseri y'igifu yo mu jisho ry'umura
kuganira
Imbuto ya Raspberry, yitwa "Tuobai'er" mu mujyi wacu, ni imbuto zo mu gasozi ku muhanda tukiri abana. Imbuto ya Glandular Epithelium n'uturemangingo birahujwe, ariko ntabwo ari bimwe. Ni ngombwa gusobanukirwa imiterere y'imikurire n'imikurire y'uturemangingo twa epithelium. Kanseri ya Raspberry Epithelium isa cyane na polyps zo mu gifu kandi ishobora kwitiranywa na polyps zo mu gifu. Ikiranga epithelium ya foveolar ni ikimenyetso cyiganje cya MUC5AC. Rero foveolar epithelial carcinoma ni ijambo rusange ry'ubu bwoko. Ishobora kubaho muri HP negative, positive, cyangwa nyuma yo kuvanga. Isura ya endoscopic: ikibyimba cyuzuye gitukura nk'icy'isukari, muri rusange gifite imipaka isobanutse.
5) Kanseri y'impeta y'inyuguti z'umukono (signet ring cell carcinoma)
Kanseri y'impeta y'inyuguti: isura y'urumuri rwera
Kanseri y'impeta y'inyuguti: isura y'urumuri rwera
kanseri y'uturemangingo tw'impeta y'umukono
◆Urubanza rwa 1
Ibisobanuro:Igisebe cyoroshye ku rukuta rw'inyuma rw'igifu, 10 mm, cyarazimye, ubwoko bwa O-1Ib, nta gucika inyuma, umupaka ugaragara mbere, nta mupaka ugaragara iyo wongeye gusuzumwa, ME-NBI: igice cyo hagati y'inyuma gusa kiba cyera, IMVP(-)IMSP (-)
Isuzuma (rihujwe n'indwara):Ingero za ESD zikoreshwa mu gusuzuma kanseri y'uruhererekane rw'impeta.
Ibimenyetso by'indwara
Kanseri y'impeta y'inyuguti ya Signet ni yo itera ububabare bwinshi. Dukurikije urwego rwa Lauren, kanseri y'impeta y'inyuguti ya Signet ishyirwa mu cyiciro cya kanseri ikwirakwira kandi ni ubwoko bwa kanseri idahinduka. Ikunze kugaragara mu mubiri w'igifu, kandi ikunze kugaragara cyane mu bisebe birambuye kandi byaguye bifite amabara atandukanye. Ibisebe byazamutse ni bike cyane kandi bishobora no kugaragara nk'isuri cyangwa ibisebe. Biragoye kubimenya mu gihe cyo gusuzuma endoscopic mu ntangiriro. Uburyo bwo kuvura bushobora kuba uburyo bwo kuvura nka endoscopic ESD, hagakurikiranwa neza nyuma yo kubagwa no gusuzuma niba hagomba gukorwa ubundi bubaga. Uburyo bwo kubaga budasaba ubuvuzi bugomba gusaba ubuvuzi bw'inyongera, kandi uburyo bwo kubaga bugenwa n'umuganga ubaga.
Inyigisho n'amashusho byavuzwe haruguru bikomoka kuri "Igifu n'Amara"
Byongeye kandi, hakwiye kwitabwaho kanseri y’imiyoboro y’amaso, kanseri y’umutima, na kanseri y’umutima igaragara neza mu maraso iboneka mu gihe habayeho HP-negative.
3. Incamake
Uyu munsi nize ubumenyi bukenewe n'ibimenyetso bya kanseri y'igifu idafite HP. Muri byo harimo: kanseri y'igifu yo mu bwoko bwa fundic gland, kanseri y'igifu yo mu bwoko bwa fundic gland mucosal, adenoma yo mu gifu, (imeze nk'icyatsi kibisi) na kanseri y'impeta y'inyuma y'umurabyo.
Umubare w’abantu barwara kanseri y’igifu idafite HP uri hasi, biragoye kuyisuzuma, kandi biroroshye kubura kuyisuzuma. Ikigoye kurushaho ni ibimenyetso by’indwara zikomeye kandi zidasanzwe zigaragara mu ikoranabuhanga. Bikwiye kandi kumvikana mu buryo bwa endoscope, cyane cyane ubumenyi bw’imitekerereze buyikubiyemo.
Iyo urebye ku ndwara zo mu gifu, ubushyuhe, n'uduce tw'umutuku n'umweru, ugomba gutekereza ku kuba kanseri y'igifu idafite Hp. Gusuzuma niba HP ari yo igomba kubahiriza amabwiriza, kandi hagomba kwitabwaho ibimenyetso bitari byo biterwa no kwishingikiriza cyane ku bisubizo by'ibizamini byo guhumeka. Abahanga mu by'ubuvuzi bw'indwara zo mu nda bafite uburambe biringira amaso yabo cyane. Duhanganye n'inyigisho irambuye iri inyuma ya kanseri y'igifu idafite HP, tugomba gukomeza kwiga, gusobanukirwa no gukora kugira ngo tuyimenye neza.
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 umwanda, uburoso bwa cytology,insinga y'ubuyobozi,agasanduku ko gukurura amabuye, Catheter yo gusohora amazi mu mazuru n'ibindi. bikoreshwa cyane muriEMR,ESD,ERCP.Ibicuruzwa 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: Nyakanga-12-2024