Polyps na hanji cuta ce da aka saba gani kuma take faruwa akai-akai a fannin ilimin gastroenterology. Suna nufin fitowar ƙwayoyin cuta a cikin jiki waɗanda suka fi mucosa na hanji girma. Gabaɗaya, colonoscopy yana da ƙimar ganowa na akalla 10% zuwa 15%. Yawan kamuwa da cutar yakan ƙaru da shekaru. Tunda fiye da 90% na cututtukan hanji suna faruwa ne sakamakon canjin ƙwayoyin cuta masu haɗari, maganin gabaɗaya shine a yi tiyatar cire ƙwayoyin cuta ta endoscopic da zarar an ga ƙwayoyin.
A cikin binciken colonoscopy na yau da kullun, kashi 80% zuwa 90% na polyps ba su wuce 1 cm ba. Ga polyps na adenomatous ko polyps masu tsayi ≥ 5 mm (ko adenomatous ne ko a'a), ana ba da shawarar cire endoscopic na zaɓi. Yiwuwar micropolyps na hanji (diamita tsawon ≤5mm) wanda ke ɗauke da abubuwan ƙari yana da ƙasa sosai (0~0.6%). Ga micropolyps a cikin dubura da sigmoid colon, idan likitan endoscope zai iya tantance daidai cewa polyps ɗin ba adenomatous ba ne, babu buƙatar cire su, amma ra'ayin da ke sama ba kasafai ake aiwatar da shi a aikin asibiti a China ba.
Bugu da ƙari, kashi 5% na polyps suna da faɗi ko girma a gefe, tare da diamita fiye da 2 cm, tare da ko ba tare da abubuwan da ke haifar da lahani ba. A wannan yanayin, ana buƙatar wasu dabarun cire polyp na endoscopic na zamani, kamarEMRkumaESDBari mu dubi cikakkun matakai don cire polyp.
Hanyar tiyata
Majinyacin ya kammala gwajin maganin sa barci kafin tiyata, an sanya shi a matsayin gefen hagu na decubitus, sannan aka ba shi maganin sa barci ta hanyar amfani da propofol. An lura da hawan jini, bugun zuciya, electrocardiogram, da kuma iskar oxygen da ke cikin jini a lokacin tiyatar.
1 Sanyi/ZafiNa'urorin ɗaukar hoto na BiopsySashe
Ya dace da cire ƙananan ƙwayoyin polyps ≤5mm, amma akwai yiwuwar samun matsalar cire ƙananan ƙwayoyin polyps 4 zuwa 5mm ba tare da cikakken bayani ba. Dangane da biopsy na sanyi, biopsy na zafi zai iya amfani da wutar lantarki mai yawan mita don magance sauran raunuka da kuma yin maganin hemostasis a kan raunin. Duk da haka, ya kamata a yi taka tsantsan don guje wa lalacewar layin serosa na bangon hanji saboda yawan amfani da electrocoagulation.
A lokacin aikin, ya kamata a manne ƙarshen kan polyp ɗin, a ɗaga shi yadda ya kamata (don guje wa lalata layin tsoka), sannan a ajiye shi a nesa da bangon hanji. Idan polyp ɗin ya zama fari, a dakatar da electrocoagulation kuma a matse raunin. Ya kamata a lura cewa ba abu ne mai sauƙi a cire polyp ɗin da ya yi girma ba, in ba haka ba zai tsawaita lokacin lantarki kuma ya ƙara haɗarin lalacewar kauri gaba ɗaya (Hoto na 1).
2 Sanyi/zafitarkon cire polypectomyhanyar cirewa
Ya dace da raunuka masu girma dabam-dabam na nau'in I p, nau'in I sp da ƙanana (<2cm) nau'in I s (ƙa'idodin rarrabuwa na musamman na iya nufin gano ciwon daji na farko na hanyar narkewar abinci. Akwai nau'ikan da yawa kuma ban san yadda zan yi hukunci ba? Wannan labarin Faɗa a sarari) Rage raunuka. Ga ƙananan raunuka na Ip, Rage tarko abu ne mai sauƙi. Ana iya amfani da tarko mai sanyi ko mai zafi don cirewa. A lokacin cirewa, ya kamata a riƙe wani tsawon ƙafa ko wani tazara daga bangon hanji yayin da ake tabbatar da cire raunin gaba ɗaya. Bayan matse tarkon, ya kamata a girgiza Tarko, a lura ko akwai mucosa na hanji na yau da kullun da ke kewaye kuma a saka shi tare don hana lalacewa ga bangon hanji.
Hoto na 1. Zane-zanen tsarin cirewar sinadaran biopsy na zafi, A kafin cirewar sinadaran forceps, B raunin bayan cirewar sinadaran forceps. CD: Gargaɗi game da maganin zafiƙarfin biopscirewar. Idan polyp ɗin ya yi girma sosai, zai ƙara lokacin electrocoagulation kuma ya haifar da lalacewar transmural.
Hoto na 2 Tsarin zane na yanke tarkon zafi na ƙananan raunuka na nau'in I sp
3 EMR
■Raunuka masu tsanani
Ga manyan raunukan Ip, ban da matakan kariya da ke sama, ya kamata a yi amfani da tarkunan zafi don cirewa. Kafin a cirewa, ya kamata a yi isasshen allurar submucosal a gindin pedicle (2 zuwa 10 mL na raka'a 10,000 na epinephrine + methylene blue + physiological. Ana allurar cakuda saline a ƙarƙashin mucosa (a yi allurar yayin cire allurar), don haka pedicle ɗin ya tashi gaba ɗaya kuma ya kasance mai sauƙin cirewa (Hoto na 3). A lokacin aikin cirewa, ya kamata raunin ya guji taɓa bangon hanji don guje wa ƙirƙirar madauki a rufe da ƙone bangon hanji.
Hoto na 3 Tsarin zane naEMRmaganin raunuka irin na lp
Ya kamata a lura cewa idan babban polyp na I p yana da kauri mai kauri, yana iya ƙunsar babban vasorum na vasa, kuma zai zubar da jini cikin sauƙi bayan an cire shi. A lokacin aikin cirewa, ana iya amfani da hanyar coagulation-cut-coagulation don rage haɗarin zubar jini. Wasu manyan polyps za a iya cire su gunduwa-gunduwa don rage wahalar aikin tiyata, amma wannan hanyar ba ta da amfani ga kimanta cututtuka.
■ raunukan nau'in lla-c
Ga raunukan nau'in Ila-c da kuma wasu raunukan Is masu girman diamita, cirewar tarko kai tsaye na iya haifar da lalacewar kauri gaba ɗaya. Allurar ruwa ta ƙarƙashin mucosa na iya ƙara tsayin raunin da kuma rage wahalar tarko da cirewa. Ko akwai fitowar fitsari yayin tiyata muhimmin tushe ne na tantance ko adenoma ba shi da lahani ko kuma yana da lahani, da kuma ko akwai alamun maganin endoscopic. Wannan hanyar na iya ƙara cikakken saurin cire adenomas.diamita na ƙasa da 2 cm.
Hoto na 4EMRJadawalin kwararar magani don polyps na nau'in Il A
4 ESD
Ga adenomas masu diamita fiye da 2cm waɗanda ke buƙatar cirewa sau ɗaya da alamar ɗagawa mara kyau, da kuma wasu cututtukan daji na farko,EMRsauran ko sake dawowa da ke da wahalar magani,ESDAna iya yin magani. Matakan gabaɗaya sune:
1. Bayan an yi wa endoscopic tabo, an fayyace iyakar raunin a sarari kuma an yi alama da kewaye (ba za a iya yi wa raunin alama ba idan iyakar raunin a bayyane take).
2. A yi allurar submucosal domin a ga cewa raunukan sun tashi.
3. A yi amfani da wani ɓangare ko kuma a yi zagaye da mucosa don fallasa submucosa.
4. Saki nama mai haɗin gwiwa tare da submucosa sannan a hankali a cire nama mai cutar.
5. A kula da raunin sosai sannan a yi wa jijiyoyin jini magani domin hana rikitarwa.
6. Bayan an gama sarrafa samfuran da aka cire, a aika su don gwajin cututtuka.
Hoto na 5ESDmaganin manyan raunuka
Rigakafin tiyata a lokacin tiyata
Sake cire polyp ɗin hanjin endoscopic yana buƙatar a zaɓi hanyar da ta dace bisa ga halayen polyp, wurin da ake aiki, matakin ƙwarewar mai aiki, da kayan aikin da ake da su. A lokaci guda, cire polyp ɗin yana bin ƙa'idodi gama gari, waɗanda muke buƙatar bi gwargwadon iyawa don tabbatar da cewa tsarin lafiya yana da aminci kuma yana da tasiri kuma marasa lafiya suna amfana da shi.
1. Tsarin riga-kafi na maganin shine mabuɗin nasarar kammala maganin polyp (musamman manyan polyps). Ga polyps masu rikitarwa, ya zama dole a zaɓi hanyar yankewa daidai kafin magani, a yi magana da ma'aikatan jinya, likitocin sa barci da sauran ma'aikata cikin lokaci, sannan a shirya kayan aikin magani. Idan yanayi ya ba da dama, ana iya kammala shi ƙarƙashin jagorancin babban likitan tiyata don hana haɗurra daban-daban na tiyata.
2. Kiyaye kyakkyawan "matakin 'yanci" a jikin madubi yayin jiyya shine sharadin tabbatar da cewa an cimma manufar tiyatar. Lokacin shiga madubi, a bi "hanyar kulawa da rage girman axis" sosai don kiyaye matsayin magani a cikin yanayi mara madauki, wanda ke da amfani ga ingantaccen magani.
3. Kyakkyawan hangen nesa na aiki yana sa tsarin magani ya zama mai sauƙi kuma mai aminci. Ya kamata a shirya hanjin majiyyaci a hankali kafin a yi masa magani, a tantance matsayin majiyyacin kafin a yi masa tiyata, sannan a fallasa polyps ɗin gaba ɗaya ta hanyar nauyi. Sau da yawa yana da kyau idan raunin yana gefen akasin ruwan da ya rage a cikin ramin hanji.
Mu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., kamfani ne da ke kera kayayyaki a China wanda ya ƙware a fannin amfani da endoscopic, kamar suƙarfin biops, hemoclip, tarkon polyp, allurar sclerotherapy, feshi catheter, gogewar cytology, waya mai jagora, Kwandon ɗaukar dutse, catheter na magudanar ruwa ta hancida sauransu waɗanda ake amfani da su sosai a cikinEMR, ESD, ERCPKayayyakinmu an ba su takardar shaidar CE, kuma masana'antunmu an ba su takardar shaidar ISO. An fitar da kayayyakinmu zuwa Turai, Arewacin Amurka, Gabas ta Tsakiya da wani ɓangare na Asiya, kuma yana sa abokin ciniki ya yaba da kuma yaba masa sosai!
Lokacin Saƙo: Agusta-02-2024