Endoscopic lura da submucosal ciwan ruwa na narkewar narkewa: 3 manyan abubuwan da aka taƙaita a cikin Labari guda

Submucosal ciwasors (SMT) na gastrointestinal dabarun da aka samo asali daga cutar muscularis, submuculosa, ko kuma mustcrias, kuma na iya zama lalatattun raunuka. Tare da ci gaban fasaha na likita, zaɓuɓɓukan masu tiyata na gargajiya sun shiga zamanin masarauta m jiyya, kamar lAparoscopic tiyata da tiyata robotic. Koyaya, a cikin Aikin asibiti, ana iya samun wannan "tiyata" bai dace da duk marasa lafiya ba. A cikin 'yan shekarun nan, darajar maganin endoscopic ya karbi hankali. Sabon sigar masanin kasar Sin yarjejeniya a kan Endoscopic ganewar asali da magani na SMT an sake shi. A takaice wannan labarin zai koyi ilimin da ya dace.

1.smt masararhankeses

(1) abin da ya faru na smT bai dace da sassan daban-daban na narkewa, kuma ciki shine mafi yawan shafin yanar gizo don SMT.

Abin da ya faru na viotious of sassan narkewa ba daidaito ba, tare da manyan narkewar abinci suna zama gama gari. Daga cikin waɗannan, 2/3 faruwa a ciki, bi da esophagus, duodenum, da ciwon kai.

(2) tarihin tarihinl nau'ikan SMT suna da hadaddun, amma yawancin SMT sune raunukan Benign, kuma kaɗan ne suke cutarwa.

A.smt ya hada da a'an-neoplastic lessions kamar ectopic pancreatic nama da raunin raunin ciki.

B.among The Baron LesionS, gastrointestinal liiomyomas, lipomas adenomas, ciwan sel adenomas, Schwannomosa, ciwan Gromanomosa, da ƙasa da 15% na iya bayyana kamar nama suna koyon mugunta.

C.Gastrointerinal StrashiL Tumors (Gist) da na neurendocrine ciwan jini (net) a cikin smt na fama da wani yuwuwar cutarwa, amma wannan ya dogara da girman sa, wuri da nau'insa.

D.Ke wuri na SMT yana da alaƙaga rarrabuwa ta harshen jini: a. Leiromyomas nau'in nau'in ƙwayar cuta na yau da kullun, lissafin kashi 60 zuwa kashi 80% na SMPs na tsakiya, kuma sun fi faruwa a tsakiyar esophagus; B.The nau'ikan cututtukan cututtukan ruwa na ciki suna da matukar hadaddun, tare da Gister, LeiomyoMa da kuma cututtukan mahaifa na Ma sun zama ruwan dare. Daga cikin SMT SMT, Gister an fi dacewa a cikin funas da jikin ciki, yawanci yana cikin Cardia da ɓangaren ƙwayar ƙwayar ƙwayar ƙwayar cuta, da kuma cututtukan ƙwayar ƙwayar cuta da cututtukan cututtukan cututtukan fata sun fi kowa kowa. Lipomas sun fi kowa gama gari a cikin kayan tastrict; c. Lipomas da Cysts sun fi gama gari a cikin saukowa da sassan bulbous na duodenum; d. A cikin smt na ƙananan gastrointestinal fili, lipomas inigarshin a cikin mulkin, yayin da raga ke da mahimmanci a cikin dubura.

(3) Yi amfani da CT da MRRi don aji, bi da, da kuma kimanta ciwace-ciwacen daji. Don SMTS waɗanda ake zargi da kasancewa masu haɗari ko suna da manyan ciwace-ciwacen daji (dogonDiamita> 2 cm), CT da MRI ana bada shawarar.

Sauran hanyoyin kwaikwayo, gami da CT da MRRI, har ma babban mahimmanci ne ga cutar ta hanyar SMT. They can directly display the location of tumor occurrence, growth pattern, lesion size, shape, presence or absence of lobulation, density, homogeneity, degree of enhancement, and boundary contour, etc., and can find whether and the degree of thickHaɓaka guguwar bango ta ciki, waɗannan gwaje-gwaje na tunanin na iya gano ko an mamaye su na ƙamus na rauni, ko akwai metasasis a cikin kewayen peritoneum, lymph nodes da sauran gabshi. Su ne babbar hanyar ga grading na asibiti, jiyya da kintinkiri na ciwace-ciwacen cuta.

(4) Sotplings Sotpling Ba REYUWAMiyared ga Benign Smts wanda za'a iya gano ta al'ada endoscopy hade da eus, kamar lipomas, kamar lipomas, cysts, da kuma cututtukan cututtukan fata.

Don raunin da ake zargi da kasancewa cutarwa ko lokacin da endoscopy na al'ada tare da eustant na al'ada, eusscopic ultrasonchopic ultrasonograin Guideal kyau nEedle aspiter / biopsy, Eus-fna / FNB), Mucosalction Incopsy (Mucosalationction Incisy, Miab), da sauransu Ganin iyakokin EUS-FNA da kuma tasirin tasiri akan zuci na gaba, a kan tabbatar da mahimmancin magani yana aiwatar da cutar entoscopic.

Duk hanyar samun samfuran cuta kafin tiyata yana da amfani kuma zai lalata mucosa ko haifar da wahalar tiyata kuma yana iya ƙara haɗarin zubar da jini, perforabon abinci, da kuma birgima. Sabili da haka, abubuwan da aka kirkiro ba lallai ba ne su zama dole. Dole, musamman ga SMTS da za a iya gano ta al'ada hanyar endoscopy hade da eus, kamar lipomas ake bukata.

2.smt endoscopic hakanent

(1) Ka'idojin magani

Lessions waɗanda ba su da haɗari ko haɗarin haɗarin lymph node metastasis, kuma suna da ƙarancin haɗarin saiti, kuma suna da ƙarancin resoscopic ne idan magani ya zama dole. Cikakkiyar cirewar ƙwayar ta rage yawan ƙwayar cuta da haɗarin sake dawowa. DaOfi'iyyar tumo - magani mai kyauta ya kamata a bi yayin ganyen endoscopic, da amincin tumo za a tabbatar da shi yayin yin sa.

(2) alamu

i.tumors tare da cutarwa wanda ake zargi da bincike game da bincike ko kuma tabbatar da shi ta hanyar kwayar halittu, musamman wa waɗanda ake zargi da GISt tare da kimantawa da aka riga aka gabatar da ƙari tsawon lokaci na ≤2cm da ƙarancin ƙarfin sake dawowa, kuma tare da yiwuwar zama cikakke; Don ciwace-ciwacen diamita da ake zargi da fuskantar karancin hadarin> 2cm, idan ba za a iya kama shi ba, ana iya aiwatar da tiyata gaba ɗaya, a kan mahimmancin tiyata. bincike.

II. Samilatic (misali, zub da jini, zubar da jini) SMT.

IIIICATIONST wanda aka zartar da ciwanenta da ciwanen da suka faru a kai a kai ko kuma wani shinge na zamani da kuma waɗanda ke da kyawawan dilire don magani mai mahimmanci.

(3) Contraindications

i. Bayyana raunukan da suke da nitastastized zuwa lymph nodes ko distant shafuka.

II. Ga wasu smt tare da bayyananniyar lymphnodeko metastasis distastisis, Briopsy ana buƙatar samun cututtukan lantarki, wanda za'a iya ɗauka azaman dangi.

III. Bayan cikakken bayaniKimantawa, an ƙaddara cewa yanayin gaba ɗaya shine talauci da tiyata na haɓaka ba zai yiwu ba.

Lesign Lesions kamar Lipoma da Ectrocic Ucreas ba su haifar da bayyanar cututtuka kamar zafi, zub da jini, da kuma toshewar jini. Lokacin sMT bayyana, lalacewa, ulcer, ko saurin ƙaruwa a cikin ɗan gajeren lokaci, yiwuwar shi da kasancewa mummunan rauni yana ƙaruwa.

(4) Zabi na Zaman Morod

Matsayin Snare: DonSMT wanda ya zama na sama, protrudes a cikin kogon kamar yadda ya ƙaddara ta hanyar eus da kuma gwajin gwaji, kuma ana iya amfani dashi gaba ɗaya a lokaci guda tare da snare, ana iya amfani da snare guda ɗaya.

Nazarin gida da na waje sun tabbatar da cewa ba lafiya kuma mai tasiri a cikin na sama smt <2cm, tare da hadarin zubar da jini na 4% zuwa 13%Hadarin 2% zuwa 70%.

Endoscopic rami, ese: don SMTS tare da dogon diamita ≥2 ct ko idan gwajin tunani kamar na EUS da CT Tabbatar da ThA tukunyar tumo a cikin rami, esse yana yiwuwa ga tsarin riga sacescopic na smts mai mahimmanci.

Ese ya biyo bayan halayyar fasaha naRashin daidaituwa na Endoscopic na Endoscopic (ESD) da kuma zangon Mucoscopic na Endoscopic, kuma suna amfani da madaidaiciya "Prop-saman. , don cimma manufar kiyaye amincin tumo, haɓaka raguwar tiyata, da kuma rage rikice-rikice na ciki. Don ciwace-ciwacen daji ≤1.5 cm, cikakken tsari na 100% za a iya cimma.

Submucosal wargazaIon Bery Bery: Don SMT Op Propria na Muscularis a cikin EShorus na ciki, wanda ke da sauƙi curvater na jiki, da kuma mai juyawa na iya zama hanyar magani.

Ster sabuwar fasaha ne ta haifar da tushen perofageal spershageal spphateal sphincterotomy sphincterotomy perhincterotomy perhincterotomy perhincterotomy perhincterotomy perhincterotomy perhincterotomy perhincterotomy perhincterotomy perhincterotomy phhincterotomynology. Rage raguwar BLOC na Ster Ster don SMT don SMT zuwa 84.9% zuwa 97.59%.

Zaɓuɓɓuka masu amfani da endoscopicIon, EFRG: Ana iya amfani dashi don SMT inda yake da wahalar kafa rami ko inda matsakaicin juyawa na yawan ƙari ≥3.5 cm kuma bai dace da bakar ba. Idan abin da ya dace da ƙwayar cutar shunayya ko girma a waje na kogon, kuma abin ya kamu da ƙwayar cuta, ana iya rabuwa da shi, ana iya amfani dashi, ana iya amfani dashi. EFRR yana yin maganin endoscopic.

Yawan ya dace da kasheShafin bayan EFR shine mabuɗin nasarar Efrr. Don yin daidai da haɗarin sake dawowa da rage haɗarin rikicewar tumo, ba a ba da shawarar a yanka ba kuma cire samfurin tumo a lokacin Efrr. Idan ya zama dole don cire ƙwayar ciki, ana buƙatar buƙatar gyara da farko don rage haɗarin tumo da yadu da yaduwa. Wasu hanyoyin da suka dace sun hada da: ƙarfe clip dinki, tsotsewar clip dabara "hanya mai rufewa na shimfida ciki da kuma ma'amala da jini, da sauransu.

(5) rikice-rikice na baya

Zubahin ciki: zubar jini wanda ke haifar da hemoglobin mara haƙuri don sauke ta fiye da 20 g / l.
Don hana zubar jiniYa kamata a yi isasshen allurar slmucosal yayin aikin don fallasa manyan hanyoyin jini kuma suna sauƙaƙe na lantarki don hana zub da jini. Za'a iya kula da zub da zub da jini tare da wukake daban-daban incostatic ko shirye-shiryen ƙarfe, da kuma rigakafin labulen jini da aka samo yayin tsarin disction.

Zub da jini: zub da jini ya bayyana kamar jini, Melena, ko jini a cikin matattara. A cikin lokuta masu tsanani, rawar jiki na iya faruwa. Yawanci yana faruwa ne a cikin mako 1 bayan tiyata, har ma yana iya faruwa makonni 2 zuwa 4 bayan tiyata.

Zubar da jini yana da alaƙa daAbubuwan da ke da ƙarancin hawan jini na jini da lalata na jini na jijiyoyin jini ta hanyar ciki. Bugu da kari, zubar da jini kuma yana da alaƙa da wurin cutar, kuma ya kasance gama gari a cikin gastrict da karancin dubura.

Jinkirta yaudara: Yawancin lokaci yana bayyana azaman rudani cikin mahaifa, alamun ciwon ciki, alamun lalata na ciki yana nuna iskar gas ko kuma ƙara haɓakar gas.

Yana da alaƙa da abubuwan da ke da alaƙa da matalauta sun rage raunuka, na lantarki mai yawa, da kuma cin abinci ma ta hanyar motsi, da cin abinci mai sarrafawa, da kuma lalacewa na raunuka ta ciki. a. Idan rauni yayi girma ko zurfi ko rauni yana da fisTabbas-kamar canje-canje, sake hutawa lokacin hutu da lokacin da ya kamata ya kasance daidai da tiyata (marasa lafiya bayan ƙananan gastrointestal na gastrointestinal ya kamata ya sami gastrointestinal factiage ya kamata ya sami gastrointesal tractiage ya kamata ya sami gastrointestinal factiage ya kamata ya sami gastrointestinal factiage ya kamata ya sami gastrointestinal tract na ciki ya kamata a yi na iya samun ruwa na gastrointestinal ya kamata ya sami gastrointestal b. Marasa lafiya masu ciwon sukari yakamata su mallaki sukari na jini; Wadanda ke da ƙananan turare da kuma cututtukan ciki da ciki da ciki ya kamata a ba da magani kamar azumi, haɓakawa; c. Ga waɗanda ke da alaƙa, rufe kirjin kirji da kuma shigar da hasashen ciki da aka sanya su sanya shambura don sanya magudanar ruwa mai laushi; d. Idan ba za a iya sanya kamuwa da cuta bayan maganin ra'ayin mazan jiya ko an haɗa shi da cutar cututtukan daji, tiyata laparoscopy ya kamata a yi da wuri-wuri, da kuma yin gyara da magudanar ciki.

Abubuwan da suka shafi Gas: gami da subcutaMemonhherema, pneumomasasum, pneumothorax da kuma pneumoperitoneum.

Intraopericabi'a mai zurfi (kamar yadda Pephysema a kan fuska, wuya, bango kirji, da scrotum) da kuma scrotum) da kuma scrrotum) da kuma scrusalAna iya samun ingantaccen Liliptis a lokacin gastroscopy) yawanci ba sa buƙatar jiyya na musamman, kuma pefthsema za ta warware kawunanta.

Mai rauni pneumothora yakan faru dMatsakaici mai tiyata [Jirgin saman jirgin sama ya wuce 20 mmhg a lokacin tiyata

(1.13kpa = 0.133kpa), 0.133kpa), <90%, tabbatar da gaggawa gaban kirji x-ray har sau da yawa ana ci gaba bayan rufe kirjiinfa.

Don marasa lafiya a bayyane puniumoperitoneum a lokacin aiki, yi amfani da allura na puniumoperitoneum don tsara ma'anar McFarlandA cikin hannun dama na ciki don lalata iska, ka bar allura allura a cikin wurin har zuwa ƙarshen aikin, sannan ka cire shi bayan ya tabbatar da cewa an fitar da iskar nan.

GastrointestalIsalal Fistula: Ruwan ruwa na narkewa wanda ke gudana a cikin kirji ko rami na ciki ta hanyar leak.
Fasulas na Esophageal Fistulas da Esophagotacic sun zama ruwan dare gama gari. Da zarar Fistula ya faru, ya yi rufe kirji na kirji zuwa arintaA cikin magudanar ruwa mai santsi da kuma samar da ingantacciyar tallafi mai kyau. Idan ya cancanta, ana iya amfani da shirye-shiryen ƙarfe da kuma kayan rufe wurare daban-daban ana iya sake amfani da sutura. Ana amfani da tayar da wasu hanyoyin don toshefistula. Mummunan lokuta suna buƙatar saƙo mai sauri.

3.Soppetopeatiative Gudanarwa (fnomlow-up)

(1) Benign raunuka:Pathology sKuskuren da Benign da Benign Lesions kamar Lipoma da Leieryoma ba sa bukatar M Biye-akai bibiya.

(2) SMT ba tare da zalunci batururuwa:Misali, ma'aurata biyu neds 2cm, da kuma matsakaici-hadarin kare-hade, ya kamata a yi cikakken tiyata) ya kamata a yi la'akari dashi sosai. bi). Tsarin shirin ya kamata ya danganta ne da tattaunawa mai ma'ana da kuma mutum guda.

(3) m m m smt:Misali, Gundarin haɗarin Gundumar yana buƙatar kimantawa ta hanyar eus ko tunanin kowane watanni 6 zuwa 12 bayan jiyya, sannan kuma bi da umarnin asibiti.

(4) SMT tare da matsakaici da kuma m m:Idan pathology patology ya tabbatar da nau'in yanar gizo 3 na ciki, net na Colorectal tare da tsawon> 2cm, da kuma girman kai tsaye, ya kamata a yi la'akari da ƙimar kulawa). bi). Tsarin shirin ya kamata ya dogara ne[Game da mu 0118.docx] Tashoshin Da yawa da kuma a kan wani abu.