(1). Dabarun asali Dabarun asali na EMR sune kamar haka:
Jerin dabaru
①Yi allurar maganin allurar gida kusa da raunin.
② Sanya tarko a kusa da raunin.
③An danne tarkon don kamawa da shake raunin.
④ Ci gaba da ɗaure tarko yayin amfani da wutar lantarki don yanke raunin.
⑤ A dawo da samfurin da aka cire.
(2). Tips
1.Tips don zaɓin matsayi na jiki da matsayi na endoscope
Saboda raunin yana buƙatar kulawa yayin da dukkanin hoton ke bayyane, matsayi na mai haƙuri yana da mahimmanci. Yi ƙoƙarin karkatar da iyakokin don raunin ya kasance kusa da buɗewar ƙarfin biopsy, wato, daga karfe 5 zuwa 7 akan allon.
Kafin jiyya, ragowar pigment da yawa suna buƙatar wanke su sannan a cire su ta hanyar tsotsa.
Alal misali, idan an cire raunin da ke cikin sigmoid colon na kusa a cikin madaidaicin ko hagu na gefen decubitus, samfurin zai sau da yawa ya motsa zuwa ga mai saukowa, yana da wuya a dawo da shi , don haka matsayi na decubitus na dama ya fi kyau don resection.
Hakazalika, ta fuskar farfadowar samfurin, an fi son matsayin decubitus na gefen hagu don sake juyar da raunin hanji.
2.Tips don alluran gida
Za a iya yin allurar allurar gida mai kauri a ƙananan matsa lamba, amma ba ta da kaifi sosai kuma ramin allurar ya yi girma sosai, don haka marubucin yana amfani da allurar allurar gida ta 25G.
Ba ƙari ba ne a ce nasara ko gazawar EMR ya dogara ne akan alluran gida.
Don ƙananan raunuka, ana yin huda daga gefen tsuliya na raunin zuwa kusa da raunin.
Ga raunin da ke cikin lanƙwasa ko a gefen folds, idan an yi allurar gida daga gefen tsuliya, a mafi yawan lokuta raunukan ba su da tabbas saboda suna fuskantar gefen baki, don haka a fara allurar gida daga gefen baki.
Mahimmanci ga masu fasaha na Endoscopy
Idan ruwa ya zubo, ko kuma akwai juriya mai yawa a lokacin allura, ko kuma babu juriya a lokacin da ruwa ya shiga amma ba a samu kumbura ba, dole ne a dakatar da allurar kuma a sanar da ma'aikaci halin da ake ciki a kan lokaci don tattauna matakan da za a dauka.
Ƙarar ƙarar allura, mafi kyau.
Dabarar ita ce a ci gaba da yin allura kamar yadda zai yiwu ta hanyar huda guda har sai an ɗaga dukkan raunin.
3.Tips don zabar tarko
Idan tarkon yana cikin siffar oval mai tsayi, ƙwayar mucosa na yau da kullun akan bakin rauni da gefen dubura na iya kasancewa cikin sauƙi kuma ba dole ba.
Tarkon ya fi dacewa da madauwari, mai sauƙin buɗewa a gefe, ba sauƙin zamewa ba, kuma yana da ƙayyadaddun tauri don danna kan rauni don ɗaukar raunin.
Girman tarkon ya kamata a daidaita shi da girman raunin.
Tarkon Polypectomy da za a iya zubarwa
Misalai na EMR
a. Hoton haske fari
Wani nau'in IIa nau'in mm 25 tare da wani yanki na tsakiya mai rauni.
b. Hotunan Narrow Band Hoto (NBI).
c. Fesa indigo carmine don faɗaɗa hoton
An gano cewa bakin ciki da aka tsinkayi ta hanyar lura da al'ada a zahiri ramuka ne tsakanin ganye.
d. Girman hoton kristal violet tabo
Tsarin rami na bututun glandular budewa a gefen raunin shine nau'in IV.
e. Girman hoton kristal violet tabo
a tsakiyar raunin ya kasance VI, dan kadan ba bisa ka'ida ba, kuma ba a sami infiltration na submucosal ba.
f. Allurar gida
An yi huda da allura na gida a tsakiyar rauni, yana haifar da kumburi mai kyau.
g. Bude tarkon
Danna titin tarko a bangon hanji don buɗe tarkon.
h. Rufe tarkon
Rufe tarkon ka kama raunin.
i.Ikon cirewa
Ba a sami huda, zubar jini ko ragowar ƙari ba.
j. Gyaran samfur
An haɗe samfurin da aka cire a kan takardar roba.
Ganewar cututtuka na ƙarshe:Intramucosal carcinoma (Tis)
4.Tips don aikin tarko
Ana sanya tip ɗin tarkon a hankali akan mucosa na baka na rauni, sannan a buɗe a hankali kuma ana danna tushen tarkon a gefen tsuliya na raunin. Don hana ƙaddamarwar gefe daga kasancewa mai kyau, ya kamata a saka ƙaramin adadin mucosa na al'ada.
Ya kamata a lura cewa lokacin da ba a iya ganin tip ɗin tarkon, yana yiwuwa an shigar da mucosa na al'ada fiye da yadda ake tsammani. Bayan an danne tarkon sosai, turawa da ja da hannun waje na tarkon don lura da motsin raunin. Idan an saka shi a cikin ƙwayar tsoka, za a rage motsi na rauni.
Nasiha ga electroresection
Kada a danna tarko a bangon hanji, amma dan kadan daga rauni don sake farfadowa. Haɗarin jinkirin ɓarna yana da ƙasa kaɗan lokacin amfani da resection electrosurgical , amma yana da haɗari ga intraoperative (da wuri bayan resection) zubar jini.
Fitar da ke da sauri na iya haifar da zubar jini, yayin da ficewar da aka yi a hankali zai iya haifar da jinkiri. Idan mai haƙuri ya ji zafi, ko mataimaki ya ji cewa nama yana da roba kamar roba kuma yana da wuya a yanke, yana yiwuwa cewa nama yana cikin ƙwayar tsoka, kuma ya kamata a dakatar da cirewa nan da nan.
Mahimmanci ga masu fasaha na Endoscopy
Idan likitan endoscopy yana jin cewa nama yana da ƙarfi kamar roba kuma yana da wahalar yankewa, ya kamata ya sanar da ma'aikaci nan da nan don tattauna matakan da za a ɗauka.
Nasihu don Sharding EMR
Don manyan raunuka, wani lokacin yana da aminci don yin ɓangarorin yanki maimakon tilastawa gaba ɗaya lokaci-lokaci. Koyaya, yawancin guntuwar akwai, mafi girman yuwuwar sake dawowa na gida. Ko da tare da EMR na yanki, ya kamata a yi resections na farko girma gwargwadon yiwuwa tare da babban tarko don rage yawan adadin.
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Hemoclip
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allurar sclerotherapy
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kwandon dawo da dutse
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hanci biliary drainage catheter
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EMR
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ESD
https://www.zrhendoscopy.com/emresd/
ERCP
https://www.zrhendoscopy.com/ercp/
Lokacin aikawa: Fabrairu-13-2025