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 hiko o te manawa, 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 ingā 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