Polyps na hanji cuta ce ta gama-gari kuma da ke faruwa akai-akai a cikin ilimin gastroenterology. Suna nufin fitowar intraluminal waɗanda suka fi mucosa na hanji girma. Gabaɗaya, colonoscopy yana da ƙimar ganowa na aƙalla 10% zuwa 15%. Yawan abin da ya faru sau da yawa yana ƙaruwa da shekaru. tashi. Tun da fiye da 90% na ciwon daji na colorectal suna haifar da mummunan canji na polyps, jiyya na gabaɗaya shine yin maganin endoscopic da zaran an ga polyps.
A cikin colonoscopy na yau da kullum, 80% zuwa 90% na polyps ba su wuce 1 cm ba. Domin adenomatous polyps ko polyps tare da tsawon ≥ 5 mm (ko adenomatous ko a'a), ana ba da shawarar reshewar endoscopic zaɓaɓɓen. Yiwuwar micropolyps na hanji (diamita tsawon ≤5mm) mai ɗauke da abubuwan ƙari yana da ƙarancin ƙarancin (0 ~ 0.6%). Don micropolyps a cikin dubura da sigmoid colon, idan endoscopist zai iya ƙayyade daidai cewa ba su da polyps ba, babu buƙatar Resection, amma ra'ayi na sama da wuya a aiwatar da shi a aikin asibiti a kasar Sin.
Bugu da ƙari, 5% na polyps suna lebur ko girma a gefe, tare da diamita fiye da 2 cm, tare da ko ba tare da abubuwan da ba su da kyau. A wannan yanayin, ana buƙatar wasu dabarun kawar da polyp na ci gaba, kamar suEMRkumaESD. Bari mu dubi cikakkun matakai don cire polyp.
Hanyar tiyata
Majinyacin ya kammala gwajin maganin sa barci, an sanya shi a matsayin decubitus na gefen hagu, kuma an ba shi maganin sa barci tare da propofol. An duba hawan jini, bugun zuciya, electrocardiogram, da jikewar iskar oxygen na gefen jini yayin aikin.
1 Sanyi/ZafiKwayoyin HalittaRarraba
Ya dace da cire ƙananan polyps ≤5mm, amma ana iya samun matsalar rashin cikar cire polyps 4 zuwa 5mm. Dangane da kwayar cutar sanyi, biopsy na thermal na iya amfani da babban mitar halin yanzu don kawar da ragowar raunuka da kuma yin maganin hemostasis akan rauni. Duk da haka, ya kamata a kula don kauce wa lalacewar serosa Layer na bangon hanji saboda wuce haddi na electrocoagulation.
Yayin aikin, ya kamata a matse kan ƙarshen polyp, a ɗaga shi daidai (don guje wa lalata ƙwayar tsoka), kuma a kiyaye shi a nesa mai dacewa daga bangon hanji. Lokacin da polyp pedicle ya zama fari, dakatar da electrocoagulation kuma manne raunin. Ya kamata a lura cewa ba abu ne mai sauƙi don cire polyp mai girma ba, in ba haka ba zai tsawanta lokacin wutar lantarki kuma ya kara haɗarin lalacewa mai zurfi (Figure 1).
2 Sanyi/zafipolypectomy tarkohanyar cirewa
Ya dace da tashe raunuka daban-daban masu girma dabam I p type, I sp type da kuma karami (<2cm) I s type (ƙayyadaddun ka'idodin rarrabuwa na iya komawa ga ganowar endoscopic na ciwon daji na farko na ƙwayar narkewa. Don ƙananan raunukan Ip, tsinkayar tarko yana da sauƙi. Ana iya amfani da tarko mai sanyi ko zafi don resection. A lokacin resection, ya kamata a kiyaye wani tsawon na pedicle ko wani nisa daga bango na hanji yayin da tabbatar da cikakken kawar da rauni. Bayan an danne tarkon, sai a girgiza tarkon, a lura ko akwai kewayen mucosa na hanji na al'ada sannan a saka shi tare don hana lalacewa ga bangon hanji.
Hoto 1 Tsarin tsari na kawar da biopsy mai zafi mai ƙarfi, A kafin cirewar tilastawa, B rauni bayan cirewar tilastawa. CD: Kariya don thermalbiopsy forcepscirewa. Idan polyp ya yi girma sosai, zai ƙara lokacin electrocoagulation kuma ya haifar da lalacewar transmural.
Hoto 2 Tsarin tsari na tarkon tarko na thermal na ƙananan raunuka nau'in I sp
3 EMR
■I p raunuka
Don manyan raunuka na I p, ban da matakan kariya na sama, ya kamata a yi amfani da tarkon thermal don resection. Kafin resection, isa submucosal allura ya kamata a yi a gindi na pedicle (2 zuwa 10 ml na 10,000 raka'a epinephrine + methylene blue + physiological) Saline cakuda da aka allura a karkashin mucosa (allura yayin da janye allura), don haka pedicle ne cikakken taso da kuma sauki cire (Figure 3) a cikin bango a cikin aikin. don kaucewa kafa rufaffiyar madauki da kona bangon hanji.
Hoto na 3 Tsarin tsari naEMRmaganin cututtukan nau'in lp
Ya kamata a lura cewa idan babban nau'in I p polyp yana da pedicle mai kauri, yana iya ƙunsar babban vasa vasorum, kuma zai iya zubar da jini bayan an cire shi. A lokacin aikin resection, ana iya amfani da hanyar coagulation-cut-coagulation don rage haɗarin zubar jini. Za a iya raba wasu manyan polyps guda ɗaya don rage wahalar aikin, amma wannan hanyar ba ta da amfani ga kima.
■lla-c nau'in raunuka
Ga nau'in nau'in Ila-c da wasu raunuka masu girma da diamita, ƙaddamar da tarko kai tsaye na iya haifar da lalacewa mai girma. Submucosal allura na ruwa zai iya ƙara tsawo na rauni da kuma rage wahalar tarko da resection. Ko akwai protrusion a lokacin tiyata shine muhimmin mahimmanci don ƙayyade ko adenoma ba shi da kyau ko rashin lafiya kuma ko akwai alamun magani na endoscopic. Wannan hanya na iya ƙara yawan adadin adenoma<2cm a diamita.
Hoto 4EMRginshiƙi kwararar jiyya don nau'in Il a polyps
4 ESD
Ga adenomas tare da diamita mafi girma fiye da 2cm wanda ke buƙatar resection na lokaci ɗaya da alamar ɗagawa mara kyau, da kuma wasu cututtukan daji na farko.EMRsaura ko maimaituwa da ke da wahalar magani,ESDana iya yin magani. Matakan gaba ɗaya sune:
1. Bayan ƙwanƙwasa endoscopic, iyakar ƙwayar cuta ta bayyana a fili kuma an yi alama da kewaye (lalacewar ba za a yi alama ba idan iyakar raunin ya kasance a fili).
2. Allurar submucosally don sanya raunuka a bayyane ya tashi.
3. Sassan ko dawafi a kaɗa mucosa don fallasa ƙwayar ƙwayar cuta.
4. Sake nama mai haɗi tare da submucosa kuma sannu a hankali cire ƙwayar cuta.
5. Kula da raunin a hankali kuma ku kula da hanyoyin jini don hana rikitarwa.
6. Bayan sarrafa samfurorin da aka cire, aika su don nazarin cututtuka.
Hoto 5ESDmaganin manyan raunuka
Kariyar cikin ciki
Gyaran polyp na endoscopic colon yana buƙatar hanyar da ta dace don zaɓar bisa ga halayen polyp, wuri, matakin ƙwarewar ma'aikaci, da kayan aikin da ake dasu. A lokaci guda kuma, cirewar polyp shima yana bin ka'idodin gama gari, waɗanda muke buƙatar bi gwargwadon iko don tabbatar da cewa tsarin aikin likita yana da aminci da inganci kuma marasa lafiya suna amfana da shi.
1. Tsarin da aka riga aka tsara na tsarin kulawa shine mabuɗin don nasarar nasarar maganin polyp (musamman manyan polyps). Don hadaddun polyps, wajibi ne a zaɓi hanyar da ta dace kafin jiyya, sadarwa tare da ma'aikatan jinya, masu ilimin likitanci da sauran ma'aikata a kan lokaci, da kuma shirya kayan aikin magani. Idan sharuɗɗan sun yarda, ana iya kammala ta ƙarƙashin jagorancin babban likitan fiɗa don hana hatsarori daban-daban na tiyata.
2. Kula da kyakkyawan "digiri na 'yanci" akan jikin madubi yayin jiyya shine abin da ake buƙata don tabbatar da cewa an aiwatar da niyyar aiki. Lokacin shigar da madubi, bi da bi "hanyar kiyaye axis da gajarta" don kiyaye matsayin magani a cikin yanayin da ba shi da madauki, wanda zai dace da ainihin magani.
3. Kyakkyawan hangen nesa mai aiki yana sa tsarin jiyya mai sauƙi da aminci. Ya kamata a shirya hanjin mara lafiya a hankali kafin magani, yakamata a tantance matsayin mara lafiya kafin a yi masa tiyata, sannan polyps ya kamata a fallasa su ta hanyar nauyi. Yawancin lokaci yana da kyau idan raunin ya kasance a gefen gaba na sauran ruwa a cikin rami na hanji.
Mu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., wani manufacturer ne a kasar Sin ƙware a cikin endoscopic consumables, kamarbiopsy forceps, hemoclip, polyp tarko, allurar sclerotherapy, fesa catheter, cytology goge, jagora, kwandon dawo da dutse, hanci biliary drainage catheterda sauransu wadanda ake amfani da su sosai a cikiEMR, ESD, ERCP. Samfuran mu suna da takardar shedar CE, kuma tsire-tsire namu suna da takaddun ISO. An fitar da kayanmu zuwa Turai, Arewacin Amurka, Gabas ta Tsakiya da wani yanki na Asiya, kuma suna samun abokin ciniki yabo da yabo!
Lokacin aikawa: Agusta-02-2024