Daga cikin sanannun ilimin da ake da shi game da ciwon daji na ciki na farko, akwai wasu fannoni na ilimi game da cututtuka da ba kasafai ake samun su ba waɗanda ke buƙatar kulawa ta musamman da koyo. Ɗaya daga cikinsu shine ciwon daji na ciki wanda ba shi da cutar HP. Manufar "ciwon epithelial marasa kamuwa" yanzu ta fi shahara. Za a sami ra'ayoyi daban-daban kan batun suna. Wannan ka'idar abun ciki ta dogara ne akan abubuwan da suka shafi mujallar "Ciki da Hanji", kuma sunan yana amfani da "Ciwon daji na ciki wanda ba shi da cutar HP".
Wannan nau'in raunuka yana da halaye kamar ƙarancin faruwa, wahalar ganowa, ilimin ka'ida mai rikitarwa, kuma tsarin MESDA-G mai sauƙi ba ya aiki. Koyon wannan ilimin yana buƙatar fuskantar ƙalubalen.
1. Ilimin asali game da ciwon ciki na HP-negative
Tarihi
A da, an yi imanin cewa abin da ke haifar da kamuwa da cutar kansar ciki shine kamuwa da cutar HP, don haka samfurin ciwon daji na gargajiya shine HP - atrophy - metaplasia na hanji - ƙarancin ƙari - babban ƙari - ciwon daji. Tsarin gargajiya koyaushe ana san shi sosai, ana karɓuwa kuma ana yarda da shi sosai. Ciwo yana tasowa tare bisa ga atrophy kuma ƙarƙashin aikin HP, don haka ciwon daji galibi yana girma a cikin hanyoyin hanji na atrophic da mucosa na ciki wanda ba na atrophic ba.
Daga baya, wasu likitoci sun gano cewa ciwon ciki na iya faruwa ko da babu kamuwa da cutar HP. Duk da cewa yawan kamuwa da cutar yana da ƙasa sosai, hakika yana yiwuwa. Wannan nau'in ciwon ciki ana kiransa ciwon ciki na HP-negative.
Da fahimtar wannan nau'in cuta a hankali, an fara zurfafa bincike da taƙaitawa a tsarin, kuma sunayen suna canzawa koyaushe. Akwai wani kasida a shekarar 2012 mai suna "Ciwon daji na ciki bayan hana haihuwa", wani kasida a shekarar 2014 mai suna "Ciwon daji na ciki na HP-negative", da kuma wani kasida a shekarar 2020 mai suna "Ciwon Epithelial Ba a Kamu da shi da Hp ba". Canjin suna yana nuna zurfafawa da cikakken fahimta.
Nau'in Glandar da Tsarin Girma
Akwai manyan nau'ikan glandan fundic guda biyu da glandan pyloric a cikin ciki:
Glandar fundic (oxyntic glands) suna yaɗuwa a cikin fundus, jiki, kusurwoyi, da sauransu na ciki. Su ne glandar tubular guda ɗaya mai layi ɗaya. Sun ƙunshi ƙwayoyin mucous, manyan ƙwayoyin halitta, ƙwayoyin parietal da ƙwayoyin endocrine, kowannensu yana yin nasa ayyukan. Daga cikinsu, manyan ƙwayoyin halitta. Tarin PGI da MUC6 da aka fitar sun kasance tabbatacce, kuma ƙwayoyin parietal sun fitar da hydrochloric acid da intrinsity factor;
Glandan pyloric suna cikin yankin antrum na ciki kuma sun ƙunshi ƙwayoyin mucous da ƙwayoyin endocrine. Kwayoyin mucus suna da MUC6 positive, kuma ƙwayoyin endocrine sun haɗa da ƙwayoyin G, D da ƙwayoyin enterochromaffin. Kwayoyin G suna fitar da gastrin, ƙwayoyin D suna fitar da somatostatin, kuma ƙwayoyin enterochromaffin suna fitar da 5-HT.
Kwayoyin mucous na ciki na yau da kullun da ƙwayoyin ƙari suna fitar da nau'ikan furotin na mucous daban-daban, waɗanda aka raba zuwa sunadaran mucous na "ciki", "hanji" da "gauraye". Ana kiran bayyanar mucins na ciki da na hanji a matsayin phenotype ba takamaiman wurin da ciki da hanji ke ciki ba.
Akwai nau'ikan ciwace-ciwacen ciki guda huɗu na ƙwayoyin halitta: na ciki gaba ɗaya, na ciki gauraye, na hanji gauraye, da na hanji gaba ɗaya. Ciwace-ciwacen da ke faruwa bisa ga metaplasia na hanji galibi ciwace-ciwacen gauraye ne na ciki. Ciwon daji daban-daban galibi suna nuna nau'in hanji (MUC2+), kuma ciwon daji da ke yaɗuwa galibi suna nuna nau'in ciki (MUC5AC+, MUC6+).
Tabbatar da cutar Hp mara kyau yana buƙatar takamaiman haɗin hanyoyin ganowa da yawa don cikakken tantancewa. Ciwon ciki mai cutar HP mara kyau da ciwon ciki bayan tsaftacewa ra'ayoyi biyu ne daban-daban. Don ƙarin bayani game da bayyanar X-ray na ciwon ciki mai cutar HP mara kyau, da fatan za a duba sashin da ya dace na mujallar "Ciki da Hanji".
2. Bayyanar cututtukan ciki na ciki na HP-negative
Binciken endoscopic shine babban abin da ke haifar da ciwon daji na ciki wanda ba shi da HP. Ya haɗa da ciwon daji na ciki irin na fundic gland, ciwon daji na ciki irin na fundic gland, ciwon daji na ciki, ciwon daji na ciki, ciwon daji na foveolar epithelial na raspberry, ciwon daji na signet ring cell, da sauransu. Wannan labarin ya mayar da hankali kan bayyanar cutar kansar ciki ta HP-negative, da sauransu.
1) Fundic gland shine ciwon daji na ciki
- Farin raunuka da suka taso
fundic gland shine ciwon daji na ciki
◆Shari'a ta 1: Farin raunuka masu tasowa
Bayani:Gastric fundic fornix - lanƙwasa mai girma na zuciya, 10 mm, fari, nau'in O-lia (kamar SMT), ba tare da atrophy ko metaplasia na hanji a bango ba. Ana iya ganin jijiyoyin jini masu kama da arbor a saman (NBI da faɗaɗa kaɗan)
Ganewar asali (tare da cututtuka):U, O-1la, 9mm, fundic gland shine nau'in ciwon daji na ciki, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Fararen raunuka masu lebur
fundic gland shine ciwon daji na ciki
◆Shari'a ta 2: Farin raunuka masu faɗi/masu rauni
Bayani:Bangon gaba na gastrointestinal fundic fornix-cardia greater curvature, 14 mm, fari, nau'in 0-1lc, ba tare da atrophy ko metaplasia na hanji a bango ba, iyakokin da ba a san su ba, da kuma jijiyoyin jini na dendritic da aka gani a saman. (NBI da ƙara girman gajarta)
Ganewar asali (tare da cututtuka):U, 0-Ilc, 14mm, fundic gland shine nau'in ciwon daji na ciki, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
- Raunuka masu ja da suka tashi
fundic gland shine ciwon daji na ciki
◆Shari'a ta 3: Raunuka ja da suka tashi
Bayani:Bangon gaba na babban lanƙwasa na zuciya shine 12 mm, a bayyane yake ja, nau'in 0-1, ba tare da atrophy ko metaplasia na hanji a bango ba, iyakoki bayyanannu, da jijiyoyin jini na dendritic a saman (NBI da faɗaɗa kaɗan)
Ganewar asali (tare da cututtuka):U, 0-1, 12mm, fundic gland shine nau'in ciwon daji na ciki, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
-Raunuka ja, lebur, da kuma raunis
fundic gland shine ciwon daji na ciki
◆Shari'a ta 4: Raunuka ja, lebur/masu rauni
Bayani:Bangon baya na babban lanƙwasa na saman jikin ciki, 18mm, ja mai haske, nau'in O-1Ic, babu atrophy ko metaplasia na hanji a bango, iyaka mara tabbas, babu jijiyoyin jini na dendritic a saman, (Ba a cire NBI da faɗaɗawa ba)
Ganewar asali (tare da cututtuka):U, O-1lc, 19mm, fundic gland shine nau'in ciwon daji na ciki, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
tattauna
Maza masu wannan cutar sun fi mata girmi, inda matsakaicin shekarunsu ya kai shekaru 67.7. Saboda halayen lokaci guda da kuma bambancin jinsi, ya kamata a sake duba marasa lafiya da aka gano suna da ciwon daji na ciki irin na fundic gland sau ɗaya a shekara. Wurin da aka fi sani shine yankin fundic gland a tsakiyar da saman ciki (fundus da tsakiyar da saman jikin ciki). Farin raunuka masu kama da SMT sun fi yawa a cikin haske mai haske. Babban maganin shine gano cutar EMR/ESD.
Ba a ga wani abu da ya shafi lymphatic metastasis ko kuma mamaye jijiyoyin jini ba zuwa yanzu. Bayan magani, ya zama dole a tantance ko za a yi ƙarin tiyata da kuma tantance alaƙar da ke tsakanin yanayin cutar kansa da kuma HP. Ba duk cututtukan ciki na ciki irin na fundic gland ne ke da cutar HP ba.
1) Ciwon daji na ciki na mucosa na glandar fundic
Ciwon ciki na mucosa na glandar fundic
◆Shari'a ta 1
Bayani:Rauni ya ɗan ɗaga, kuma ana iya ganin mucosa na ciki na RAC wanda ba shi da ƙarfi a kusa da shi. Ana iya ganin ƙananan tsarin da ƙananan tasoshin jini masu saurin canzawa a ɓangaren da aka ɗaga na ME-NBI, kuma ana iya ganin DL.
Ganewar asali (tare da cututtuka):Fundic gland mucosal ciwon daji na ciki, U zone, 0-1la, 47*32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Ciwon ciki na mucosa na glandar fundic
◆Shari'a ta 2
Bayani: Rauni mai faɗi a bangon gaba na ƙaramin lanƙwasa na zuciya, tare da canza launi da ja, ana iya ganin jijiyoyin jini masu kama da dendritic a saman, kuma raunin ya ɗan ɗaga.
Ganewar asali (tare da ciwon daji): Fundic gland mucosal ciwon daji na ciki, 0-lla, pT1a/M, ULO, LyOV0, HM0, VMO
tattauna
Sunan "adenocarcinoma na mucosa na ciki" yana da ɗan wahalar furtawa, kuma yawan kamuwa da cutar yana da ƙasa sosai. Yana buƙatar ƙarin ƙoƙari don gane shi da fahimce shi. Adenocarcinoma na mucosa na fundic gland yana da halaye na babban ciwon daji.
Akwai manyan halaye guda huɗu na endoscopy mai haske: ① raunuka masu faɗuwa daga homochromatic; ② ciwon daji na subepithelial SMT; ③ tasoshin jini na dendritic da suka faɗaɗa; ④ ƙananan ƙwayoyin cuta na yanki. Ayyukan ME: DL(+)IMVP(+)IMSP(+)MCE yana faɗaɗa IP kuma yana ƙaruwa. Ta amfani da tsarin da MESDA-G ta ba da shawarar, 90% na cututtukan ciki na mucosal na gland fundic gland sun cika sharuɗɗan ganewar asali.
3) Adenoma na ciki (adenoma na glandar pyloric)
adenoma na ciki
◆Shari'a ta 1
Bayani:An ga wani farin rauni mai faɗi a bangon baya na gastrointestinal fornix wanda ke da iyakoki marasa tabbas. Tabon indigo carmine bai nuna wata iyaka bayyananna ba, kuma an ga bayyanar babban hanji mai kama da LST-G (an ƙara girmansa kaɗan).
Ganewar asali (tare da cututtuka):ƙananan ciwon daji na atypia, O-1la, 47*32mm, adenocarcinoma mai siffar tubular da aka bambanta sosai, pT1a/M, ULO, Ly0, VO, HMO, VMO
adenoma na ciki
◆Shari'a ta 2
Bayani: Rauni mai tasowa tare da ƙuraje a bangon gaba na tsakiyar ɓangaren ciki. Ana iya ganin gastritis mai aiki a bango. Ana iya ganin Indigo Carmine a matsayin iyaka. (NBI da ƙara girma kaɗan)
Cututtuka: An ga bayyanar MUC5AC a cikin epithelium na sama, kuma an ga bayyanar MUC6 a cikin epithelium na sama. Sakamakon ƙarshe shine PGA.
tattauna
Adenomas na ciki galibi glandan mucinous ne da ke ratsa stroma kuma an rufe su da foveolar epithelium. Saboda yaduwar ƙwayoyin glandular, waɗanda suke hemispherical ko nodular, adenomas na ciki da aka gani tare da hasken farin endoscopic duk nodular ne kuma suna fitowa. Ya zama dole a kula da rarrabuwa guda 4 na Jiu Ming a ƙarƙashin gwajin endoscopic. ME-NBI na iya lura da yanayin papillary/villous na PGA. PGA ba cikakkiyar cutar HP ba ce kuma ba ta da ƙarfi, kuma tana da wani haɗarin kamuwa da cutar kansa. Ana ba da shawarar gano cutar da wuri da kuma magani da wuri, kuma bayan an gano cutar, ana ba da shawarar a cire ta da wuri da kuma ƙarin cikakken bincike.
4) (kamar rasberi) ciwon daji na ciki na foveolar epithelial
ciwon daji na ciki na foveolar na rasberi
◆Shari'a ta 2
Bayani:(an cire)
Ganewar asali (tare da ciwon daji): ciwon daji na ciki na foveolar epithelial
ciwon daji na ciki na foveolar na rasberi
◆Shari'a ta 3
Bayani:(an cire)
Ganewar asali (tare da cututtuka):ciwon daji na ciki na foveolar epithelial
tattauna
Raspberry, wanda ake kira "Tuobai'er" a garinmu, 'ya'yan itace ne na daji a gefen hanya lokacin da muke yara. Kwayoyin halittar glandular da gland suna da alaƙa, amma ba su da iri ɗaya. Yana da mahimmanci a fahimci halayen girma da haɓaka ƙwayoyin epithelial. Ciwon daji na ciki na Raspberry epithelial yana kama da polyps na ciki kuma ana iya ɗaukarsa a matsayin polyps na ciki cikin sauƙi. Alamar alama ta epithelium na foveolar ita ce mafi girman bayyanar MUC5AC. Don haka cutar kansa ta foveolar epithelial ita ce kalma ta gabaɗaya ga wannan nau'in. Yana iya wanzuwa a cikin HP negative, positive, ko bayan sterilization. Siffar Endoscopic: zagaye mai haske ja mai kama da strawberry, gabaɗaya tare da iyakoki bayyanannu.
5) Ciwon daji na ƙwayoyin signet zobe
Ciwon daji na ƙwayar signet zobe: bayyanar haske mai haske
Ciwon daji na ƙwayar signet zobe: bayyanar haske mai haske
Ciwon daji na ƙwayar ƙwayar sigina
◆Shari'a ta 1
Bayani:Rauni mai faɗi a bangon baya na vestibule na ciki, 10 mm, ya ɓace, nau'in O-1Ib, babu atrophy a bango, iyaka a bayyane da farko, iyaka ba a bayyane ba lokacin sake dubawa, ME-NBI: ɓangaren interfoveal kawai ya zama fari, IMVP(-)IMSP (-)
Ganewar asali (tare da cututtuka):Ana amfani da samfuran ESD don gano cutar sankarar ƙwayar signet ring cell carcinoma.
Bayyanar cututtuka
Ciwon daji na Signet ring cell shine nau'in da ya fi muni. A cewar rarrabuwar Lauren, ciwon daji na signet ring cell carcinoma ana rarraba shi azaman nau'in ciwon daji da ya yaɗu kuma nau'in ciwon daji ne wanda ba a bambanta shi ba. Ya fi faruwa a cikin jikin ciki, kuma ya fi yawa a cikin raunuka masu faɗi da suka nutse tare da launuka masu canzawa. Raunuka masu tasowa ba su da yawa kuma suna iya bayyana a matsayin zaizayar ƙasa ko ulcers. Yana da wuya a gano shi yayin gwajin endoscopic a farkon matakai. Maganin na iya zama cirewa ta hanyar warkarwa kamar endoscopic ESD, tare da tsauraran bin diddigin bayan tiyata da kimanta ko za a yi ƙarin tiyata. Dole ne cirewa ba tare da magani ba ya buƙatar ƙarin tiyata, kuma likitan tiyata ne zai yanke shawarar hanyar tiyatar.
Ka'idar rubutun da hotuna da ke sama sun fito ne daga "Ciki da Hanji"
Bugu da ƙari, ya kamata a kuma mai da hankali kan ciwon daji na esophagogastric, ciwon zuciya, da kuma adenocarcinoma mai bambanci sosai da ake samu a asalin HP-negative.
3. Takaitawa
A yau na koyi ilimin da ya dace da kuma bayyanar cututtukan ciki na HP-negative. Ya ƙunshi: ciwon ciki na fundic gland, ciwon ciki na mucosal na fundic gland, ciwon ciki na adenoma na ciki, ciwon epithelial na foveolar (kamar raspberry) da kuma ciwon signet ring cell carcinoma.
Yawan kamuwa da cutar kansar ciki ta HP-negative a asibiti yana da ƙasa, yana da wuya a tantance shi, kuma yana da sauƙin rasa ganewar asali. Abin da ya fi wahala shi ne bayyanar cututtuka masu rikitarwa da na yau da kullun. Ya kamata a fahimci hakan daga mahangar endoscopic, musamman ilimin ka'idar da ke bayansa.
Idan ka duba polyps na ciki, zaizayar ƙasa, da kuma wuraren ja da fari, ya kamata ka yi la'akari da yiwuwar kamuwa da cutar kansar ciki ta Hp. Hukuncin HP mara kyau dole ne ya bi ƙa'idodi, kuma ya kamata a mai da hankali kan rashin lafiyan ƙarya da ke faruwa sakamakon dogaro da sakamakon gwajin numfashi. Masana kimiyyar numfashi masu ƙwarewa sun fi amincewa da idanunsu. Suna fuskantar cikakken ka'idar da ke bayan cutar kansar ciki ta HP mara kyau, dole ne mu ci gaba da koyo, fahimta da kuma aiki don mu ƙware ta.
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Lokacin Saƙo: Yuli-12-2024