He mate noa, he mate e kitea pinepine ana ngā polyp o te koroni i roto i te gastroenterology. E pā ana ēnei ki ngā putanga o roto o te lumen e teitei ake ana i te mucosa o te puku. I te nuinga o te wā, ko te tere kitenga o te colonoscopy he 10% ki te 15% pea te iti rawa. Ka piki ake te tere o te mate i te pakeketanga. Nā te mea neke atu i te 90% o ngā mate pukupuku colorectal e puta mai ana i te huringa kino o ngā polyp, ko te maimoatanga whānui ko te tango endoscopic i te wā tonu e kitea ai ngā polyp.
I roto i te tirotiro koroni o ia rā, 80% ki te 90% o ngā polyp he iti iho i te 1 cm. Mō ngā polyp adenomatous, ngā polyp rānei he ≥ 5 mm te roa (ahakoa he adenomatous, kāore rānei), e taunakihia ana te tango endoscopic whiriwhiri. He tino iti te tūponotanga o ngā micropolyp koroni (te roa diameter ≤5mm) kei roto ngā wāhanga pukupuku (0~0.6%). Mō ngā micropolyp i roto i te rectum me te sigmoid colon, ki te taea e te endoscopist te whakatau tika he polyp ehara i te adenomatous, kāore he take ki te tango, engari he onge te whakamahinga o te tirohanga i runga ake nei i roto i te mahi haumanu i Haina.
Hei tāpiritanga, e 5% o ngā polyp he papatahi, he tipu taha rānei, me te diameter neke atu i te 2 cm, me ngā wāhanga kino, kāore rānei. I tēnei take, me whai tikanga tango polyp endoscopic matatau, pērā iEMRmeESDMe titiro tātou ki ngā mahi taipitopito mō te tango i te polyp.
Te tikanga pokanga
I oti i te tūroro te aromatawai whakamoe i mua i te pokanga, i whakanohoia ki te tūranga decubitus taha maui, ā, i hoatu he whakamoe ā-uaua ki a ia me te propofol. I aroturukitia te toto toto, te tere o te manawa, te electrocardiogram, me te mākū o te hāora toto ā-taha i te wā o te pokanga.
1 Makariri/WeraNgā Kēpi KoioraWehenga
He pai mō te tango i ngā polyp ririki ≤5mm, engari tera pea he raruraru o te tango koretake o ngā polyp 4 ki te 5mm. I runga i te koiora makariri, ka taea e te koiora wera te whakamahi i te iahiko auau teitei hei tahu i ngā whara toenga me te mahi i te maimoatanga hemostasis i runga i te patunga. Heoi, me tupato kia kore ai e pakaru te paparanga serosa o te pakitara whekau nā te nui rawa o te electrocoagulation.
I te wā e mahi ana te pokanga, me whakapūmau te pito o te polyp, me hiki ake kia tika (kia kore ai e pakaru te paparanga uaua), ā, me pupuri kia tawhiti tika mai i te pakitara o te puku. Ina huri mā te anga o te polyp, kati te electrocoagulation ka whakapūmau i te whara. Me mōhio ehara i te mea ngāwari te tango i te polyp nui rawa, ki te kore ka roa ake te wā hiko, ka nui ake te tūponotanga o te kino o te matotoru katoa (Pikitia 1).
2 Mātao/weramahanga polypectomytikanga tango
He pai mō ngā whara kua ara ake o ngā rahi rerekē I momo p, I momo sp me te momo I iti (<2cm) momo s (ka taea e ngā paerewa whakarōpūtanga motuhake te kōrero ki te kitenga endoscopic o te mate pukupuku wawe o te ara nakunaku. He maha rawa ngā momo, ā, kāore au i te mōhio me pēhea te whakatau? Mā tēnei tuhinga e whakamārama) Te tango i ngā whara. Mō ngā whara momo Ip iti, he māmā noa te tango i te mahanga. Ka taea te whakamahi i ngā mahanga makariri, wera rānei mō te tango. I te wā e tangohia ana, me pupuri he roa o te pedicle, he tawhiti rānei mai i te pakitara o te puku, me te whakarite kia tangohia katoatia te whara. I muri i te whakakīkī i te mahanga, me rūrū te mahanga, tirohia mēnā he mucosa puku noa e karapoti ana, ka whakauru tahi kia kore ai e kino te pakitara o te puku.
Pikitia 1 Kauwhata hoahoa o te tango i ngā kukupa koiora wera, A i mua i te tango i ngā kukupa, B te patunga i muri i te tango i ngā kukupa. CD: Ngā whakatūpato mō te werangā kukupa koiorate tango. Ki te nui rawa te polyp, ka roa ake te wā electrocoagulation, ā, ka pāngia hoki te pūnaha whakawhiti.
Pikitia 2 Kauwhata hoahoa o te tangohanga mahanga wera o ngā whara momo I sp iti
3 EMR
■Ngā whara p
Mō ngā whara I p nui, hei tāpiri atu ki ngā mahi whakatūpato i runga ake nei, me whakamahi ngā mahanga wera mō te tango. I mua i te tango, me werohia he werohanga raro i te kiriuhi i te pūtake o te waewae (2 ki te 10 mL o te 10,000 waeine o te epinephrine + methylene blue + physiological). Ka werohia te ranunga tote ki raro i te kiriuhi (werohia i a koe e tango ana i te ngira), kia tino ara ake te waewae, kia ngāwari ai te tango (Pikitia 3). I te wā e tangohia ana, me karo te whara i te pa atu ki te pakitara o te puku kia kore ai e hanga he porowhita kati me te wera i te pakitara o te puku.
Pikitia 3 Te hoahoa kauwhata oEMRte maimoatanga o ngā whara momo-lp
Me mōhio, mēnā he matotoru te pedicle o tētahi polyp momo I p nui, tera pea he vasa vasorum nui kei roto, ā, ka ngawari te toto i muri i te tango. I te wā e tangohia ana, ka taea te whakamahi i te tikanga coagulation-cut-coagulation hei whakaiti i te mōrearea o te toto. Ka taea te tango i ētahi polyp nui ake kia wahia kia whakaitihia te uauatanga o te mahi, engari kāore tēnei tikanga e pai mō te aromatawai pathological.
■ngā whara momo lla-c
Mō ngā whara momo Ila-c me ētahi whara Is he nui ake te whānui, ka pā kino pea te matotoru katoa mā te tango tika i te mahanga. Ka taea e te werohanga wai i raro i te kiriuhi te whakanui ake i te teitei o te whara, me te whakaiti i te uaua o te tango me te mahanga. Ko te mea he putanga i te wā pokanga he pūtake nui hei whakatau mena he pai, he kino rānei te adenoma, me te mea he tohu mō te maimoatanga endoscopic. Ka taea e tēnei tikanga te whakanui ake i te tere tango katoa o ngā adenoma.<2cm te whānui.
Pikitia 4EMRtūtohi rere maimoatanga mō ngā polyp momo Il a
4 ESD
Mō ngā adenoma he nui ake i te 2cm te whānui e hiahia ana kia tangohia kotahi te wā me te tohu arai kino, tae atu ki ētahi mate pukupuku tōmua,EMRngā toenga, ngā hokinga mai rānei e uaua ana ki te rongoā,ESDka taea te mahi maimoatanga. Ko ngā mahi whānui ko:
1. Whai muri i te tānga endoscopic, ka mārama te tautuhi i te rohe o te whara, ā, ka tohua te porowhita (tērā pea kāore e tohua te whara mēnā he mārama te rohe o te whara).
2. Werohia ki raro i te kiriuhi o te mangai kia mārama ai te tango atu i ngā whara.
3. Tāia te kiriuhi mucous kia wāhanga, kia porowhita rānei, kia kitea ai te kiriuhi submucosa.
4. Wetekina te kiko honohono i te taha o te kiriuhi raro, ā, tihorea mārire te kiko mate.
5. Mātakitakina te patunga me te rongoā i ngā uaua toto hei ārai i ngā raruraru.
6. I muri i te tukatuka i ngā tauira kua tangohia, tukuna atu kia tirotirohia te mate.
Pikitia 5ESDte maimoatanga o ngā whara nui
Ngā mahi ārai i te wā e pokanga ana
Ko te tango i te polyp o te kōpū endoscopic me whiriwhiri he tikanga tika i runga i ngā āhuatanga o te polyp, te wāhi, te taumata pūkenga o te kaiwhakahaere, me ngā taputapu o nāianei. I taua wā anō, ka whai anō hoki i ngā mātāpono noa, me whai tātou i ngā mea katoa e taea ana kia haumaru ai, kia whai hua ai hoki te tukanga hauora, kia whai hua ai hoki ngā tūroro.
1. Ko te whakarite i mua i te mahere maimoatanga te mea nui ki te otinga angitu o te maimoatanga polyp (ina koa ko ngā polyp nunui). Mō ngā polyp uaua, me whiriwhiri te tikanga tango e tika ana i mua i te maimoatanga, me kōrero ki ngā nēhi, ki ngā kaiwhakamoe me ētahi atu kaimahi i te wā tika, me te whakarite i ngā taputapu maimoatanga. Mena ka taea e ngā āhuatanga, ka taea te whakaoti i raro i te arataki a te taote pokanga matua hei ārai i ngā aituā pokanga maha.
2. Ko te pupuri i te "tohu herekore" pai i runga i te tinana whakaata i te wā e rongoatia ana te mea nui hei whakarite kia tutuki te kaupapa mahi. Ina tomo ki te whakaata, me whai tonu i te "tikanga tiaki me te whakapoto i te tuaka" kia mau tonu te tūranga maimoatanga i roto i te āhua kore-porowhita, e pai ai te rongoa tika.
3. Mā te tirohanga pai o te pokanga ka māmā ake, ka haumaru hoki te tukanga maimoatanga. Me āta whakarite ngā whekau o te tūroro i mua i te maimoatanga, me whakatau te tūranga o te tūroro i mua i te pokanga, ā, me tino kitea ngā polyp e te kaha ā-papa. He pai ake te nuinga o te wā mēnā kei te taha kē atu o te wai e toe ana i roto i te kōhao whekau te whara.
Ko mātou, ko Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., he kaihanga i Haina e tohunga ana ki ngā taonga endoscopic, pērā i tengā kukupa koiora, hemoclip, mahanga poripi, ngira whakaora kiriuhi, pūwero rehu, paraihe cytology, waea ārahi, kete tiki kohatu, te katitere whakaheke wai ihume ētahi atu e whakamahia whānuitia ana i roto iEMR, ESD, ERCPKua whai tiwhikete CE ā mātou hua, ā, kua whai tiwhikete ISO ā mātou whare hanga. Kua kaweakehia ā mātou taonga ki Ūropi, Amerika Te Raki, Te Rawhiti o Waenganui me tētahi wāhanga o Āhia, ā, kua whānuitia te mihi me te whakamoemiti a te kiritaki!
Wā tuku: Akuhata-02-2024