Daga cikin sanannun sani game da ciwon daji na ciki na farko, akwai wasu wuraren ilimin cututtukan da ba kasafai suke buƙatar kulawa ta musamman da koyo ba.Ɗayan su shine ciwon daji na ciki mai cutar HP.Tunanin "cututtukan epithelial marasa kamuwa da cuta" yanzu ya fi shahara.Za a sami ra'ayi daban-daban kan batun suna.Wannan ka'idar abun ciki ta dogara ne akan abubuwan da ke da alaƙa da mujallar "Ciki da Hanji", kuma sunan yana amfani da "HP-negative Cancer Cancer".
Irin wannan nau'in raunuka yana da halaye na ƙananan abubuwan da suka faru, wahalar ganewa, ƙwarewar ilimin ka'idar, kuma tsarin MESDA-G mai sauƙi ba ya aiki.Koyan wannan ilimin yana buƙatar fuskantar matsaloli.
1. Ilimi na asali na HP-negative ciwon ciki
Tarihi
A da, an yi imani da cewa guda mai laifi a cikin abin da ya faru da kuma ci gaban ciwon ciki ciwon daji ne HP kamuwa da cuta, don haka classic canceration model ne HP - atrophy - hanji metaplasia - low ƙari - high ƙari - canceration.Tsarin al'ada ya kasance sananne a ko'ina a ko'ina, karɓu kuma an yarda da shi sosai.Ciwon daji suna tasowa tare bisa tushen atrophy kuma a ƙarƙashin aikin HP, don haka cututtukan daji galibi suna girma a cikin sassan hanji na atrophic da ƙananan mucosa marasa atrophic na ciki.
Daga baya, wasu likitoci sun gano cewa ciwon daji na ciki na iya faruwa ko da babu kamuwa da HP.Ko da yake adadin abin da ya faru ya ragu sosai, hakika yana yiwuwa.Irin wannan ciwon daji na ciki ana kiransa HP-negative cancer na ciki.
Tare da fahimtar irin wannan nau'in cutar a hankali, an fara bincike mai zurfi da taƙaitaccen bayani, kuma sunayen suna canzawa akai-akai.Akwai wata kasida a cikin 2012 mai suna "Cancer Ciwon Ciki Bayan Haihuwa", labarin a cikin 2014 mai suna "HP-negative Gastric Cancer", da wata kasida a cikin 2020 mai suna "Epithelial Tumors Not Infected with Hp".Canjin suna yana nuna zurfafawa da cikakkiyar fahimta.
Nau'in Gland da Tsarin Girma
Akwai manyan nau'ikan nau'ikan fundic glands da pyloric gland a cikin ciki:
Fundic glands (oxyntic glands) suna rarraba a cikin fundus, jiki, sasanninta, da dai sauransu na ciki.Su ne madaidaicin tubular gland.Sun ƙunshi ƙwayoyin mucosa, manyan sel, sel parietal da ƙwayoyin endocrine, kowannensu yana yin ayyukan kansa.Daga cikin su, manyan sel Abubuwan da aka ɓoye PGI da MUC6 sun kasance tabbatacce, kuma sel parietal sun ɓoye acid hydrochloric da intrinsic factor;
Glandan pyloric suna cikin yankin antrum na ciki kuma sun haɗa da ƙwayoyin ƙwayoyin cuta da ƙwayoyin endocrin.Kwayoyin mucus suna da MUC6 tabbatacce, kuma ƙwayoyin endocrin sun haɗa da ƙwayoyin G, D da ƙwayoyin enterochromaffin.Kwayoyin G suna ɓoye gastrin, ƙwayoyin D suna ɓoye somatostatin, kuma ƙwayoyin enterochromaffin suna ɓoye 5-HT.
Kwayoyin mucosal na ciki na al'ada da ƙwayoyin tumo suna ɓoye nau'ikan sunadaran ƙwayoyin cuta iri-iri, waɗanda suka kasu zuwa "na ciki", "hanji" da "gaɗaɗɗen" sunadaran ƙwayoyin cuta.Maganar mucin na ciki da na hanji ana kiransa phenotype kuma ba takamaiman wurin jiki na ciki da hanji ba.
Akwai nau'ikan kwayoyin halitta guda hudu na ciwace-ciwacen ciki: gaba daya na ciki, gauraye-mafi rinjaye, gauraye-mafificin hanji, kuma gaba daya na hanji.Ciwon daji da ke faruwa a kan metaplasia na hanji galibin ciwace-ciwacen ƙwayoyin cuta ne.Ciwon daji daban-daban galibi suna nuna nau'in hanji (MUC2+), kuma cututtukan daji masu yaduwa galibi suna nuna nau'in ciki (MUC5AC+, MUC6+).
Ƙayyade Hp korau yana buƙatar takamaiman haɗin hanyoyin ganowa da yawa don ƙayyadaddun ƙaddara.HP-negative ciwon ciki da ciwon ciki post-haifuwa ciwon ciki ne daban-daban dabaru biyu.Don bayani kan bayyanar X-ray na ciwon daji na ciki na HP, da fatan za a duba sashin da ya dace na mujallar "Ciki da Hanji".
2. Endoscopic bayyanar cututtuka na HP-korau ciwon daji na ciki
Binciken Endoscopic shine mayar da hankali ga ciwon daji na ciki na HP mara kyau.Ya yafi hada da fundic gland shine yake irin ciwon daji na ciki, fundic gland mucosal irin ciwon ciki na ciki, na ciki adenoma, rasberi foveolar epithelial ƙari, sa hannu zobe cell carcinoma, da dai sauransu Wannan labarin mayar da hankali a kan endoscopic manifestations na HP-korau na ciki ciwon daji.
1) Fundic gland shine ciwon daji na ciki
- Farar tashe raunuka
fundic gland shine ciwon daji na ciki
◆Hada ta 1: Fari, raunuka masu tasowa
Bayani:Gastric fundic fornix-mafi girma curvature na zuciya, 10 mm, fari, O-lia irin (SMT-kamar), ba tare da atrophy ko na hanji metaplasia a bango.Ana iya ganin tasoshin jini kamar Arbor a saman (NBI da haɓaka dan kadan)
Ganewa (haɗe da ilimin cututtuka):U, O-1la, 9mm, fundic gland shine nau'in ciwon daji na ciki, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Farin lebur raunuka
fundic gland shine ciwon daji na ciki
◆Case ta 2: Fari, lebur/rauni
Bayani:bangon baya na fundic fornix-cardia mafi girma curvature, 14 mm, fari, nau'in 0-1lc, ba tare da atrophy ko metaplasia na hanji a baya ba, iyakokin da ba a sani ba, da tasoshin jini na dendritic da aka gani a saman.(NBI da kara girman girman)
Ganewa (haɗe da ilimin cututtuka):U, 0-Ilc, 14mm, fundic gland shine nau'in ciwon daji na ciki, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Red tashe raunuka
fundic gland shine ciwon daji na ciki
◆Harka ta uku: Jajaye da tashe
Bayani:bangon baya na babban curvature na cardia shine 12 mm, a fili ja, nau'in 0-1, ba tare da atrophy ko metaplasia na hanji a baya ba, iyakoki bayyanannu, da tasoshin jini na dendritic a saman (NBI da ƙara dan kadan)
Ganewa (haɗe da ilimin cututtuka):U, 0-1, 12mm, fundic gland shine nau'in ciwon daji na ciki, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
- Ja, lebur, rauni mai raunis
fundic gland shine ciwon daji na ciki
◆Case ta 4: Jajaye, lebur/rauni
Bayani:bangon baya na mafi girman curvature na ɓangaren sama na jiki na ciki, 18mm, ja mai haske, nau'in O-1Ic, babu atrophy ko metaplasia na hanji a baya, iyaka mara iyaka, babu tasoshin jini na dendritic a saman, (NBI da haɓakawa da aka tsallake. )
Ganewa (haɗe da ilimin 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 cuta sun girmi mata, yayin da matsakaitan shekarun su ke da shekaru 67.7.Saboda halaye na lokaci-lokaci da heterochrony, marasa lafiya da aka gano tare da fundic gland shine ciwon daji na ciki ya kamata a sake duba su sau ɗaya a shekara.Wurin da aka fi sani shine yankin fundic gland a tsakiya da na sama na ciki (fundus da tsakiya da na sama na jikin ciki).Farar SMT-kamar raunuka masu tasowa sun fi kowa a cikin farin haske.Babban magani shine ganewar EMR/ESD.
Babu metastasis na lymphatic ko mamayewar jijiyoyin jini da aka gani ya zuwa yanzu.Bayan jiyya, ya zama dole don ƙayyade ko yin ƙarin tiyata da kimanta alaƙar da ke tsakanin m matsayi da HP.Ba duk fundic nau'in ciwon daji na ciki ba ne HP korau.
1) Fundic gland mucosal ciwon daji na ciki
Fundic gland mucosal ciwon daji na ciki
◆Kashi na 1
Bayani:An ɗaga raunin da dan kadan, kuma ana iya ganin mucosa na ciki na RAC wanda ba atrophic ba a kusa da shi.Ana iya ganin ƙananan ƙwayoyin cuta masu saurin canzawa da microvessels a cikin ɓangaren haɓakar ME-NBI, kuma ana iya ganin DL.
Ganewa (haɗe da ilimin cututtuka):Fundic gland mucosal ciwon daji na ciki, U zone, 0-1la, 47*32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Fundic gland mucosal ciwon daji na ciki
◆Kashi na 2
Bayani: Rage lebur akan bangon baya na ƙananan lanƙwasa na zuciya, tare da haɗuwa da launin ja da ja, ana iya ganin tasoshin jini na dendritic a saman, kuma raunin ya dan tashi.
Bincike (hade da ilimin cututtuka): Fundic gland mucosal ciwon daji na ciki, 0-lla, pT1a/M, ULO, LyOV0, HM0, VMO
tattauna
Sunan "gastric gland mucosal adenocarcinoma" yana da ɗan wahalar furtawa, kuma adadin abin da ya faru ya ragu sosai.Yana buƙatar ƙarin ƙoƙari don gane shi da fahimtarsa.Fundic gland mucosal adenocarcinoma yana da halaye na babban malignancy.
Akwai manyan halaye guda huɗu na farin endoscopy na haske: ① raunin homochromatic-fading;② subepithelial ciwon daji SMT;③ dilated dendritic jini;④ ƙananan ƙwayoyin cuta na yanki.Ayyukan ME: DL (+) IMVP (+) IMSP (+) MCE yana faɗaɗa IP kuma yana ƙaruwa.Yin amfani da tsarin shawarar MESDA-G, 90% na fundic gland mucosal cancers na ciki sun cika ka'idojin bincike.
3) Adenoma na ciki (pyloric adenoma PGA)
adenoma na ciki
◆Kashi na 1
Bayani:An ga wani farin lebur tashe a bangon baya na fargin ciki wanda ba a san iyakoki ba.Indigo carmine tabo bai nuna iyakoki bayyananne ba, kuma an ga bayyanar LST-G-kamar babban hanji (kara girma kadan).
Ganewa (haɗe da ilimin cututtuka):low atypia carcinoma, O-1la, 47*32mm, da bambance-bambancen tubular adenocarcinoma, pT1a/M, ULO, Ly0, VO, HMO, VMO
adenoma na ciki
◆Kashi na 2
Bayani: Ragewar da aka taso tare da nodules a kan bango na gaba na tsakiya na jiki na ciki.Ana iya ganin gastritis mai aiki a baya.Indigo carmine ana iya gani a matsayin iyaka.(NBI da girma dan kadan)
Pathology: An ga bayanin MUC5AC a cikin epithelium na sama, kuma an ga bayanin MUC6 a cikin epithelium na sama.Sakamakon ƙarshe shine PGA.
tattauna
Adenoma na ciki sune ainihin glandan mucinous da ke shiga cikin stroma kuma an rufe su da foveolar epithelium.Saboda yaduwa na protrusions na glandular, wanda ke da hemispherical ko nodular, adenoma na ciki da aka gani tare da haske mai haske na endoscopic duk suna nodular kuma suna fitowa.Wajibi ne a kula da rarrabuwa 4 na Jiu Ming a ƙarƙashin jarrabawar endoscopic.ME-NBI na iya lura da halayen papillary / villous bayyanar PGA.PGA ba cikakken HP korau ba ne kuma ba atrophic ba, kuma yana da takamaiman haɗarin kamuwa da cutar kansa.Ana ba da shawarar ganewar asali na farko da jiyya na farko, kuma bayan ganowa, an ba da shawarar yin amfani da aikin en block da ƙarin cikakken bincike.
4) (kamar rasberi) ciwon daji na cikin epithelial foveolar
rasberi foveolar epithelial ciwon daji na ciki
◆Kashi na 2
Bayani:(a cire)
Bincike (hade da ilimin cututtuka): foveolar epithelial ciwon daji na ciki
rasberi foveolar epithelial ciwon daji na ciki
◆Kashi na 3
Bayani:(a cire)
Ganewa (haɗe da ilimin cututtuka):foveolar epithelial ciwon daji na ciki
tattauna
Rasberi, wanda ake kira "Tuobai'er" a garinmu, 'ya'yan itacen daji ne a bakin hanya lokacin muna yara.Glandular epithelium da gland suna haɗuwa, amma ba su da abun ciki iri ɗaya.Wajibi ne a fahimci ci gaba da halayen haɓakar ƙwayoyin epithelial.Rasberi epithelial ciwon daji na ciki yana kama da polyps na ciki kuma ana iya kuskuren kuskuren polyps na ciki.Siffar alama ta foveolar epithelium ita ce mafi girman bayanin MUC5AC.Don haka foveolar epithelial carcinoma shine kalmar gaba ɗaya na irin wannan.Yana iya zama a cikin HP korau, tabbatacce, ko bayan haifuwa.Siffar Endoscopic: zagaye mai haske ja strawberry-kamar kumburi, gabaɗaya tare da bayyanan iyakoki.
5) Ciwon daji na zobe
Sa hannu zobe cell carcinoma: farin bayyanar haske
Sa hannu zobe cell carcinoma: farin bayyanar haske
carcinoma ring cell
◆Kashi na 1
Bayani:Lebur rauni a kan bango na baya na ciki vestibule, 10 mm, Faed, irin O-1Ib, babu atrophy a bango, bayyane iyaka a farkon, ba a fili iyaka a kan sake dubawa, ME-NBI: kawai interfoveal part zama fari, IMVP (-) IMSP (-)
Ganewa (haɗe da ilimin cututtuka):Ana amfani da samfuran ESD don tantance ciwon daji na zobe.
Bayyanar cututtuka
Ciwon daji na zobe shine nau'in mafi muni.Bisa ga rabe-raben Lauren, ciwon daji na zobe na ciki an rarraba shi azaman nau'in carcinoma mai yaduwa kuma nau'in carcinoma ne mara bambanci.Yana faruwa sau da yawa a cikin jikin ciki, kuma ya fi zama ruwan dare a cikin lebur da raɗaɗi tare da sautunan launin fata.Launuka da aka taso ba su da yawa kuma suna iya bayyana kamar zaizayewa ko mura.Yana da wuya a gano yayin gwajin endoscopic a farkon matakan.Jiyya na iya zama resection na curative kamar ESD endoscopic, tare da tsauraran bin diddigin aiki da kimanta ko yin ƙarin tiyata.Maganin da ba magani ba dole ne ya buƙaci ƙarin tiyata, kuma hanyar tiyata ta yanke shawara ta hanyar likita.
Ka'idar rubutun da ke sama da hotuna sun fito daga "Ciki da Hanji"
Bugu da ƙari, ya kamata a ba da hankali ga ciwon daji na haɗin gwiwa na esophagogastric, ciwon daji na zuciya, da kuma nau'in adenocarcinoma daban-daban da aka samu a cikin HP-mara kyau.
3. Takaitawa
A yau na koyi ilimin da ya dace da kuma bayyanar endoscopic na HP-negative ciwon daji na ciki.Yawanci ya haɗa da: fundic gland shine nau'in ciwon daji na ciki, fundic gland mucosal nau'in ciwon daji na ciki, adenoma na ciki, (kamar rasberi) kumburin epithelial foveolar da carcinoma cell ring cell.
Abin da ya faru na asibiti na ciwon daji na ciki na HP-negative yana da ƙasa, yana da wuya a yi hukunci, kuma yana da sauƙi a rasa ganewar asali.Abin da ya fi wuya shi ne bayyanar endoscopic na cututtuka masu rikitarwa da ƙananan cututtuka.Hakanan ya kamata a fahimce shi daga hangen nesa na endoscopic, musamman ilimin ka'idar da ke bayansa.
Idan ka dubi polyps na ciki, yashwa, da ja da fari, ya kamata ka yi la'akari da yiwuwar ciwon ciwon ciki na Hp-negative.Hukuncin HP korau dole ne ya bi ka'idodi, kuma yakamata a biya hankali ga abubuwan da ba su dace ba sakamakon dogaro da sakamakon gwajin numfashi.Gogaggen mahalli sun dogara da idanunsu fiye da haka.Fuskantar cikakken ka'idar da ke bayan HP-marasa ciwon ciki, dole ne mu ci gaba da koyo, fahimta da aiki don ƙware ta.
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 catheter da dai 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: Jul-12-2024