Maganin Endoscopic na ciwace-ciwacen submucosal na fili mai narkewa: manyan abubuwan 3 da aka taƙaita a cikin labarin ɗaya.

Ciwon daji na submucosal (SMT) na gastrointestinal tract sune manyan raunuka da suka samo asali daga muscularis mucosa, submucosa, ko muscularis propria, kuma yana iya zama raunuka na waje.Tare da haɓaka fasahar likitanci, zaɓuɓɓukan jiyya na tiyata na gargajiya sun shiga sannu a hankali zamanin jiyya kaɗan, kamar ltiyata aeroscopic da aikin tiyata na mutum-mutumi.Duk da haka, a cikin aikin asibiti, ana iya gano cewa "fida" bai dace da duk marasa lafiya ba.A cikin 'yan shekarun nan, darajar maganin endoscopic ya sami hankali a hankali.An fito da sabon sigar ƙwararrun ƙwararrun ƙwararrun Sinawa game da ganewar endoscopic da jiyya na SMT.Wannan labarin zai ɗan koyi ilimin da ya dace.

1.SMT annoba haliilimin lissafi

(1) Abubuwan da suka faru na SMT ba daidai ba ne a sassa daban-daban na tsarin narkewa, kuma ciki shine wurin da aka fi sani da SMT.

Abubuwan da suka faru daban-dabans sassa na tsarin narkewar abinci ba daidai ba ne, tare da mafi yawan sashin narkewar abinci.Daga cikin waɗannan, 2/3 suna faruwa a cikin ciki, sannan kuma esophagus, duodenum, da colon.

(2) Histopathologyl nau'ikan SMT suna da rikitarwa, amma yawancin SMT raunuka ne marasa kyau, kuma kaɗan ne kawai suke da cutarwa.

A.SMT ya hada da non-neoplastic raunuka irin su ectopic pancreatic tissue da neoplastic raunuka.

B.Daga cikin raunin neoplastics, gastrointestinal leiomyomas, lipomas, Brucella adenomas, granulosa cell ciwace-ciwacen daji, schwannomas, da kuma glomus ciwace-ciwacen daji yawanci m, kuma kasa da 15% na iya bayyana azaman nama Koyi mugunta.

C. Ciwon cikil ciwace-ciwacen daji (GIST) da ciwace-ciwacen neuroendocrine (NET) a cikin SMT ciwace-ciwacen ciwace-ciwace ne tare da wasu yuwuwar m, amma wannan ya dogara da girmansa, wurinsa da nau'insa.

D. Wurin SMT yana da alaƙazuwa ga rarrabuwar kawuna: a.Leiomyomas wani nau'i ne na SMT na kowa a cikin esophagus, yana lissafin 60% zuwa 80% na SMTs na esophageal, kuma suna iya faruwa a tsakiya da ƙananan sassa na esophagus;b.Nau'o'in cututtukan cututtuka na SMT na ciki suna da ɗan rikitarwa, tare da GIST, leiomyoma da ectopic pancreas sune suka fi yawa.Daga cikin SMT na ciki, GIST an fi samunsa a cikin fundus da jikin ciki, leiomyoma yawanci yana cikin zuciya da na sama na jiki, kuma ectopic pancreas da ectopic pancreas sun fi yawa.Lipomas sun fi yawa a cikin antrum na ciki;c.Lipomas da cysts sun fi yawa a cikin sassa masu saukowa da bulbous na duodenum;d.A cikin SMT na ƙananan ƙwayar gastrointestinal, lipomas sun fi yawa a cikin hanji, yayin da NETs suka fi girma a cikin dubura.

(3) Yi amfani da CT da MRI don ƙididdigewa, bi da, da kimanta ciwace-ciwacen daji.Ga SMTs waɗanda ake zargin suna da yuwuwar cutarwa ko suna da manyan ciwace-ciwace (dogondiamita> 2 cm), CT da MRI ana ba da shawarar.

Sauran hanyoyin hoto, ciki har da CT da MRI, suna da mahimmanci ga ganewar asali na SMT.Za su iya kai tsaye nuna wurin da ya faru na ƙari, ƙirar girma, girman rauni, siffar, kasancewa ko rashi na lobulation, density, homogeneity, matakin haɓakawa, da kwandon iyaka, da dai sauransu, kuma za su iya gano ko kuma matakin lokacin farin ciki.Mahimmanci, waɗannan gwaje-gwajen hoto na iya gano ko akwai mamayewar sifofin da ke kusa da raunin da kuma ko akwai metastasis a kewayen peritoneum, ƙwayoyin lymph da sauran gabobin.Su ne babban hanyar da za a yi gwajin gwaji na asibiti, jiyya da kima na ciwace-ciwace.

(4) Samfurin nama ba reco ba neAn tsara don SMTs marasa kyau waɗanda za a iya gano su ta hanyar endoscopy na al'ada tare da EUS, kamar lipomas, cysts, da pancreas ectopic.

Don raunukan da ake zargi da zama m ko lokacin da endoscopy na al'ada hade tare da EUS ba zai iya tantance raunuka mara kyau ko marasa kyau ba, ana iya amfani da buƙatun allura mai kyau / biopsy na jagorancin EUS (endoscopic ultrasonography guided fine nEedle aspiration/biopsy, EUS-FNA/FNB), biopsy incision na mucosal (mucosalincision-assisted biopsy, MIAB), da dai sauransu. yi samfurin biopsy don tantance cututtuka na farko.Dangane da iyakokin EUS-FNA da kuma tasirin da ya biyo baya akan endoscopic resection, ga waɗanda suka cancanci yin aikin tiyata na endoscopic, a kan yanayin tabbatar da cewa za'a iya cire ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar kuma za a iya bi da ita ta hanyar kwarewa ta hanyar kwarewa. Endoscopist yana yin resection na endoscopic kai tsaye ba tare da samun ganewar asali ba.

Duk wata hanyar samun samfuran cututtukan cututtuka kafin a yi aikin tiyata yana da ɓarna kuma zai lalata mucosa ko haifar da mannewa ga nama na submucosal, ta haka yana ƙara wahalar tiyata da yuwuwar ƙara haɗarin zubar jini, perfo.rabon abinci, da kuma yada cutar.Don haka, biopsy kafin tiyata ba lallai ba ne.Dole ne, musamman ga SMTs waɗanda za a iya gano su ta hanyar endoscopy na al'ada tare da EUS, irin su lipomas, cysts, da ectopic pancreas, ba a buƙatar samfurin nama.

2.SMT endoscopic maganint

(1)Ka'idojin magani

Raunin da ba shi da ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar kuma za a iya daidaita shi gaba daya ta hanyar amfani da fasaha na endoscopic, kuma yana da ƙananan haɗari na saura da sake dawowa sun dace da endoscopic resection idan magani ya zama dole.Cikewar ciwan gabaɗaya yana rage ragowar ƙari da haɗarin sake dawowa.TheDole ne a bi ka'idar maganin ciwon ƙwayar cuta a lokacin gyaran endoscopic, kuma ya kamata a tabbatar da amincin ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar kuma kuma ya kamata a tabbatar.

(2) Alamu

Ciwon daji tare da mummunan yuwuwar da ake tuhuma ta hanyar gwajin farko ko kuma an tabbatar da su ta hanyar ƙwayoyin cuta, musamman waɗanda ake zargi da GI.St 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 daji mai tsayi mai tsayi Don waɗanda ake zargi da ƙarancin haɗarin GIST> 2cm, idan an cire kumburin lymph ko metastasis mai nisa daga kimantawa kafin a fara aiki, a kan yanayin tabbatar da cewa za a iya gyara ƙwayar cutar gaba ɗaya, ana iya yin aikin tiyata na endoscopic ta hanyar ƙwararrun endoscopists. naúrar da balagagge endoscopic jiyya fasahar.resection.

ii.Alamun (misali, zubar jini, toshewa) SMT.

iii.Masu ciwon da ake zargin ciwace-ciwacen da ba su da kyau ta hanyar bincike kafin a yi aiki ko kuma an tabbatar da su ta hanyar ilimin cututtuka, amma ba za a iya bin diddigin su akai-akai ba ko kuma ciwace-ciwacen da ke kara girma cikin kankanin lokaci a lokacin da ake bi da su kuma suna da sha'awar gaske.e don maganin endoscopic.

(3) Contraindications

i.Gano raunukan da ke da nitastasized zuwa Lymph nodes ko wurare masu nisa.

ii.Ga wasu SMT tare da tsabtataccen lymphnodeko metastasis mai nisa, ana buƙatar biopsy mai girma don samun ilimin cututtuka, wanda za'a iya ɗaukarsa a matsayin ƙin yarda.

iii.Bayan daki-daki daki-dakikimantawa, an ƙaddara cewa yanayin gaba ɗaya ba shi da kyau kuma aikin tiyata na endoscopic ba zai yiwu ba.

Launuka masu laushi irin su lipoma da ectopic pancreas gabaɗaya ba sa haifar da alamu kamar zafi, zubar jini, da toshewa.Lokacin SMT yana bayyana kamar yashwa, ulcer, ko da sauri yana ƙaruwa a cikin ɗan gajeren lokaci, yuwuwar ya zama mummunan rauni yana ƙaruwa.

(4)Zabin hanyar resectiond

Endoscopic tarkon resection: DonSMT wanda ba shi da ɗan ƙaranci, yana fitowa cikin rami kamar yadda aka ƙaddara ta hanyar gwajin EUS da CT na farko, kuma ana iya sake su gaba ɗaya a lokaci ɗaya tare da tarko, ana iya amfani da resection na tarko na endoscopic.

Nazarin gida da na waje sun tabbatar da cewa yana da aminci da tasiri a cikin SMT na zahiri <2cm, tare da haɗarin zubar jini na 4% zuwa 13% da perforationkasadar 2% zuwa 70%.

Endoscopic submucosal tono, ESE: Don SMTs masu tsayin diamita ≥2 cm ko kuma idan gwaje-gwajen hoto na farko kamar EUS da CT sun tabbatar da th.a cikin ƙari yana fitowa cikin rami, ESE yana yiwuwa don ƙaddamar da hannun rigar endoscopic na SMTs masu mahimmanci.

ESE yana bin dabi'un fasaha naendoscopic submucosal dissection (ESD) da endoscopic mucosal resection, kuma akai-akai amfani da madauwari "flip-top" incision kewaye da ƙari don cire mucosa rufe SMT da cikakken fallasa da ƙari., don cimma manufar kiyaye mutuncin ƙwayar cuta, inganta radicalness na tiyata, da rage matsalolin ciki.Don ciwace-ciwacen ciwace-ciwacen daji ≤1.5 cm, ana iya samun cikakkiyar adadin 100% na resection.

Submucosal Tunneling Endoscopic Resection, STER : Don SMT wanda ya samo asali daga muscularis propria a cikin esophagus, hilum, ƙananan lanƙwasa na jikin ciki, antrum na ciki da dubura, waɗanda suke da sauƙi don kafa tunnels, kuma diamita mai jujjuyawa shine ≤ 3.5 cm, STER na iya zama wanda aka fi so. hanyar magani.

STER sabuwar fasaha ce da aka ƙera bisa tushen endoscopic esophageal sphincterotomy (POEM) kuma ƙari ne na fasahar ESD.nology.Matsakaicin resection na STER don maganin SMT ya kai 84.9% zuwa 97.59%.

Endoscopic Cikakken Kauri Resection, EFTR: Ana iya amfani dashi don SMT inda yake da wuya a kafa rami ko inda matsakaicin matsakaicin diamita na ƙwayar cuta shine ≥3.5 cm kuma bai dace da STER ba.Idan ciwace ta fito a ƙarƙashin maɓalli mai launin shuɗi ko kuma ta girma a waje da ɓangaren rami, kuma an gano ƙwayar ƙwayar cuta tana manne da layin serosa yayin tiyata kuma ba za a iya raba shi ba, ana iya amfani da shi.EFTR yana yin maganin endoscopic.

Dace suturing na perforationsite bayan EFTR shine mabuɗin nasarar EFTR.Don yin la'akari daidai da haɗarin sake dawowa da ƙwayar cuta da kuma rage haɗarin yaduwar ƙwayar cuta, ba a ba da shawarar yankewa da cire ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta a lokacin EFTR ba.Idan har ya zama dole a cire ciwan a gunduwa-gunduwa, ana bukatar a fara gyara huda domin a rage hadarin kamuwa da kamuwa da cutar.Wasu hanyoyin dinkin sun hada da: dinkin karfen karfe, dinkin tsotsa-clip, dabarar suture ta omental, "hanyar jakar jaka" hanyar igiya ta nailan hade da shirin karfe, tsarin rufewa na karfen rake (a kan gunkin shirin, OTSC) Suture OverStitch da sauran su. sababbin fasahohi don gyara raunin ciki da kuma magance zubar jini, da dai sauransu.

(5) Matsalolin bayan aiki

Zubar da jini na ciki: Jinin da ke sa haemoglobin majiyyaci ya ragu da fiye da 20 g/L.
Don hana zubar jini mai yawa na intraoperative.isasshen allurar submucosal yakamata a yi yayin aikin don fallasa manyan hanyoyin jini da sauƙaƙe electrocoagulation don dakatar da zubar jini.Za a iya bi da zub da jini ta ciki da wuƙaƙe daban-daban, ƙarfin hemostatic ko shirye-shiryen ƙarfe, da rigakafin hemostasis na tasoshin jini da aka fallasa da aka samu yayin aikin rarrabawa.

Zubar da jini bayan tiyata: Zubar da jini bayan tiyata yana bayyana azaman jini mai amai, melena, ko jini a cikin stool.A lokuta masu tsanani, bugun jini na iya faruwa.Yawanci yana faruwa a cikin mako 1 bayan tiyata, amma kuma yana iya faruwa makonni 2 zuwa 4 bayan tiyata.

Zubar da jini bayan tiyata yawanci yana da alaƙa daabubuwa kamar rashin kulawa da hawan jini bayan tiyata da lalata ragowar tasoshin jini ta acid na ciki.Bugu da ƙari, zubar jini bayan tiyata shima yana da alaƙa da wurin da cutar ta kasance, kuma ya fi yawa a cikin antrum na ciki da ƙananan dubura.

Rashin jinkiri: Yawancin lokaci yana bayyana azaman kumburin ciki, daɗaɗa ciwon ciki, alamun peritonitis, zazzabi, da kuma nazarin hoto yana nuna tarin iskar gas ko ƙarar iskar gas idan aka kwatanta da baya.

Yawanci yana da alaƙa da abubuwa kamar sutuwar raunuka, wuce gona da iri na electrocoagulation, tashi da wuri don motsawa, cin abinci da yawa, rashin kula da sukarin jini, da yashe raunuka ta hanyar acid na ciki.a.Idan raunin yana da girma ko zurfi ko raunin yana da fistabbatacce kamar canje-canje, lokacin hutun gado da lokacin azumi ya kamata a tsawaita yadda ya kamata kuma a yi tabarbarewar gastrointestinal bayan tiyata (masu lafiya bayan tiyatar ƙananan hanji ya kamata su sami magudanar tsuliya);b.Masu ciwon sukari yakamata su sarrafa sukarin jininsu sosai;wadanda ke da kananan hushiyoyi da masu ciwon ciki da kuma ciwon ciki, sai a ba su magunguna irin su azumi, rigakafin kamuwa da cuta, da hana acid;c.Ga masu fitar da ruwa, za a iya yin magudanar ruwa da ke rufaffiyar ƙirji da huda ciki ya kamata a sanya Tubes don kula da magudanar ruwa;d.Idan ba za a iya gano cutar ba bayan magani na mazan jiya ko kuma an haɗa shi da ciwon thoracoabdominal mai tsanani, za a yi laparoscopy na tiyata da wuri-wuri, kuma a gyara huda da magudanar ciki.

Abubuwan da ke da alaƙa da iskar gas: Ciki har da subcutaneous emphysema, pneumomediastinum, pneumothorax da pneumoperitoneum.

Intraoperative subcutaneous emphysema (wanda aka nuna a matsayin emphysema akan fuska, wuyansa, bangon kirji, da scrotum) da kuma pneumophysema na tsakiya (s)Ana iya samun rijiyar epiglottis a lokacin gastroscopy) yawanci baya buƙatar magani na musamman, kuma emphysema gabaɗaya zai warware kansa.

Tsananin pneumothorax yana faruwa daikin tiyata [matsayin iska ya wuce 20 mmHg yayin tiyata

(1mmHg = 0.133kPa), SpO2 <90%, wanda aka tabbatar ta hanyar X-ray na gefen gado na gaggawa, ana iya ci gaba da tiyata sau da yawa bayan rufewar kirji.rashin haihuwa.

Ga marasa lafiya da ke da pneumoperitoneum a fili yayin aikin, yi amfani da allurar pneumoperitoneum don huda maki McFarland.a cikin kasan ciki na dama don tashe iska, sannan a bar allurar da aka huda a wurin har zuwa karshen aikin, sannan a cire ta bayan tabbatar da cewa ba a fitar da iskar gas ba.

Fistula na hanji: Ruwan narkewar abinci wanda aikin tiyatar endoscopic ya haifar yana gudana zuwa cikin kirji ko rami na ciki ta hanyar zubewa.
Esophageal mediastinal fistulas da esophagothoracic fistulas na kowa.Da zarar ciwon yoyon fitsari ya faru, yi rufaffiyar magudanar ƙirji don kiyayewaa cikin magudanar ruwa mai santsi da samar da isasshen abinci mai gina jiki.Idan ya cancanta, ana iya amfani da faifan ƙarfe da na'urorin rufewa daban-daban, ko kuma ana iya sake yin amfani da cikakken murfin.Ana amfani da Stents da sauran hanyoyin don toshewafistula.Lamurra masu tsanani suna buƙatar sa baki cikin gaggawa.

3. Gudanar da aikin bayan aiki (fbatsa)

(1) Lalacewar cuta:Pathology syana ba da shawarar cewa raunuka marasa kyau irin su lipoma da leiomyoma ba sa buƙatar bibiya ta wajibi na yau da kullun.

(2) SMT ba tare da lalata bayuwuwar tururuwa:Misali, rectal NETs 2cm, da matsakaici- da babban haɗari GIST, ya kamata a yi cikakken tsari kuma a yi la'akari da ƙarin jiyya (fida, chemoradiotherapy, maganin da aka yi niyya) da ƙarfi.magani).Samar da shirin ya kamata a dogara ne akan shawarwari da yawa kuma akan kowane mutum.

(3) Ƙananan yuwuwar SMT:Misali, GIST mai ƙarancin haɗari yana buƙatar kimanta ta EUS ko hoto kowane watanni 6 zuwa 12 bayan jiyya, sannan a bi da shi bisa ga umarnin asibiti.

(4) SMT tare da matsakaici da babban m m:Idan ilimin cututtuka na bayan tiyata ya tabbatar da nau'in 3 na ciki NET, NET colorectal tare da tsawo> 2cm, da kuma matsakaici- da babban haɗari GIST, ya kamata a yi cikakken tsari kuma a yi la'akari da ƙarin jiyya (fida, chemoradiotherapy, maganin da aka yi niyya).magani).Ya kamata a kafa tsarin tsarin[game da mu 0118.docx] shawarwari da yawa da kuma kan daidaikun mutane.