I roto i ngā mōhiotanga rongonui mō te mate pukupuku puku wawe, kei reira ētahi tohu mōhiotanga mate onge e hiahia ana kia aro nui atu, kia akohia hoki. Ko tētahi o ēnei ko te mate pukupuku puku HP-negative. Kua piki ake te rongonui o te ariā o "ngā pukupuku epithelial kāore i pangia". Ka rerekē ngā whakaaro mō te take ingoa. Ko tēnei ariā ihirangi e ahu mai ana i ngā ihirangi e pā ana ki te maheni "Stomach and Intestine", ā, e whakamahia ana hoki te ingoa "HP-negative gastric cancer".
Ko ngā āhuatanga o tēnei momo whara ko te iti o te auau, te uaua ki te tautuhi, te uaua o te mātauranga ariā, ā, kāore e taea te whakamahi i te tukanga MESDA-G māmā. Ko te ako i tēnei mātauranga me aro atu ki ngā uauatanga.
1. Ngā mōhiotanga taketake mō te mate pukupuku puku HP-kore
Hītori
I ngā wā o mua, i whakaponohia ko te mate pukupuku HP te take kotahi o te putanga mai me te whanaketanga o te mate pukupuku puku, nō reira ko te tauira mate pukupuku matarohia ko HP - atrophy - metaplasia puku - pukupuku iti - pukupuku teitei - mate pukupuku. Ko te tauira matarohia kua mōhiotia whānuitia, kua whakaaetia, kua tino whakaponohia. Ka whanake ngātahi ngā pukupuku i runga i te atrophy me te mahi a HP, nō reira ko te nuinga o ngā mate pukupuku ka tipu i roto i ngā ara puku atrophy me ngā mucosa puku kāore i te atrophy.
Nō muri mai, ka kitea e ētahi tākuta ka taea te mate pukupuku puku ahakoa kāore he mate HP. Ahakoa he iti rawa te auau o te mate, tera pea ka taea. Ka kiia tēnei momo mate pukupuku puku he mate pukupuku puku HP-negative.
I te mārama haere o te tangata ki tēnei momo mate, kua tīmata ngā tirotiro hohonu me ngā whakarāpopototanga pūnaha, ā, kei te huri haere tonu ngā ingoa. I te tau 2012, i puta he tuhinga ko "Te Mate Pukupuku o te Kōpū i muri i te Whakahoromatatanga", i te tau 2014, i puta ko "Te Mate Pukupuku o te Kōpū HP-negative", me te tuhinga i te tau 2020, ko "Ngā Pūngāwerewere Epithelial Kāore i Pāngia e te Hp". Ko te panonitanga ingoa e whakaatu ana i te hohonutanga me te whānui o te māramatanga.
Ngā Momo Repe me ngā Tauira Tipu
E rua ngā momo matua o ngā repe fundic me ngā repe pyloric i roto i te puku:
Kei roto i te fundus, te tinana, ngā kokonga, me ērā atu o te puku ngā repe fundic (ngā repe oxyntic). He repe ngongo kotahi te rārangi. He mea tito mai i ngā pūtau mucous, ngā pūtau matua, ngā pūtau parietal me ngā pūtau endocrine, ā, e mahi ana ia i ā rātou ake mahi. I roto i a rātou, ko ngā pūtau matua. He pai te tae o te PGI me te MUC6 i tukuna, ā, i tukuna e ngā pūtau parietal te waikawa hydrochloric me te intrinsic factor;
Kei te rohe antrum puku ngā repe pyloric, ā, he mea tito mai i ngā pūtau hūpē me ngā pūtau endocrine. He pai te MUC6 o ngā pūtau hūpē, ā, ko ngā pūtau endocrine kei roto ko ngā pūtau G, D me ngā pūtau enterochromaffin. Ka huna e ngā pūtau G te gastrin, ka huna e ngā pūtau D te somatostatin, ā, ka huna e ngā pūtau enterochromaffin te 5-HT.
Ka whakaputahia e ngā pūtau kiriuhi puku noa me ngā pūtau pukupuku ngā momo pūmua hūpē rerekē, e wehea ana ki ngā pūmua hūpē "puku", "whekau" me te "whakaranu". Ko te whakaaturanga o ngā hūpē puku me te whekau ka kiia he momo āhua, ehara i te wāhi motuhake o te puku me ngā whekau.
E whā ngā momo pūtau o ngā pukupuku puku: te puku katoa, te puku whakauru, te puku whakauru, me te puku katoa. Ko ngā pukupuku e puta mai ana i runga i te metaplasia puku he pukupuku whakauru momo puku te nuinga. Ko ngā matepukupuku kua wehewehea e whakaatu ana i te momo puku (MUC2+), ā, ko ngā matepukupuku horapa e whakaatu ana i te momo puku (MUC5AC+, MUC6+).
Ko te whakatau i te Hp kino me whakamahi i tētahi huinga motuhake o ngā tikanga kimi maha hei whakatau whānui. He ariā rerekē ngā mate pukupuku puku HP-kino me te mate pukupuku puku i muri i te whakahoromata. Mō ētahi atu pārongo e pā ana ki ngā whakaaturanga X-ray o te mate pukupuku puku HP-kino, tirohia te wāhanga e tika ana o te maheni "Puku me te Whekau".
2. Ngā whakaaturanga endoscopic o te mate pukupuku puku HP-kino
Ko te tātaritanga endoscopic te arotahi o te mate pukupuku puku HP-negative. Kei roto i tēnei ko te mate pukupuku puku momo fundic repe, te mate pukupuku puku momo fundic repe mucosal, te adenoma puku, te pukupuku epithelial raspberry foveolar, te mate pukupuku pūtau mowhiti signet, me ētahi atu. E arotahi ana tēnei tuhinga ki ngā whakaaturanga endoscopic o te mate pukupuku puku HP-negative.
1) Te mate pukupuku pekiti momo repe putea
-Ngā whara mā e ara ake ana
mate pukupuku puku momo repe putea
◆Tēhi 1: Ngā whara mā, kua ara ake
Whakaahuatanga:Fornix fundic gastric - he piko nui ake o te cardia, 10 mm, mā, momo O-lia (rite ki te SMT), kāore he mimiti, he metaplasia puku rānei i muri. Ka kitea ngā oko toto rite ki te arbor i runga i te mata (NBI me te paku whakanui)
Te tātaritanga (me te mate pāwera):U, O-1la, 9mm, mate pukupuku puku momo repe moni, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Ngā whara papatahi mā
mate pukupuku puku momo repe putea
◆Tēhi 2: Ngā whara mā, papatahi/pōturi
Whakaahuatanga:Ko te pakitara o mua o te fornix-cardia fundic gastric he piko nui ake, 14 mm, mā, momo 0-1lc, kāore he atrophy, he metaplasia puku rānei i te papamuri, kāore i te mārama ngā rohe, me ngā oko toto dendritic e kitea ana i te mata. (NBI me te whakanui whakapoto)
Te tātaritanga (me te mate pāwera):U, 0-Ilc, 14mm, mate pukupuku puku momo repe moni, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Ngā whara whero kua ara ake
mate pukupuku puku momo repe putea
◆Tēhi 3: Ngā whara whero me te piki ake
Whakaahuatanga:Ko te pakitara o mua o te piko nui o te cardia he 12 mm, he whero mārama, momo 0-1, kāore he mimiti, he metaplasia puku rānei i muri, he mārama ngā rohe, me ngā oko toto dendritic i runga i te mata (NBI me te paku whakanui).
Te tātaritanga (me te mate pāwera):U, 0-1, 12mm, mate pukupuku puku momo repe moni, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
-Whero, papatahi, pōturi te wharas
mate pukupuku puku momo repe putea
◆Tēhi 4: Ngā whara whero, papatahi/pōturi
Whakaahuatanga:Pakitara o muri o te piko nui o te taha whakarunga o te tinana puku, 18mm, whero mārama, momo O-1Ic, kāore he mimiti, he horapa rānei o te puku i muri, kāore i te mārama te rohe, kāore he oko toto dendritic i te mata, (kāore i kitea te NBI me te whakanui)
Te tātaritanga (me te mate pāwera):U, O-1lc, 19mm, mate pukupuku pereti momo repe putea, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
kōrero
He pakeke ake ngā tāne e pāngia ana e tēnei mate i ngā wāhine, ko te tau toharite he 67.7 tau. Nā ngā āhuatanga o te ōritetanga me te heterochrony, me arotakehia ngā tūroro kua tātaitia he mate pukupuku puku momo repe fundic kotahi i te tau. Ko te wāhi tino kitea ko te rohe repe fundic i te wāhanga waenga me te wāhanga o runga o te puku (te fundus me te wāhanga waenga me te wāhanga o runga o te tinana puku). Ko ngā whara ma e rite ana ki te SMT-ahua he mea noa ake i roto i te mārama ma. Ko te maimoatanga matua ko te EMR/ESD tātaritanga.
Kāore anō kia kitea he horapa o te toto lymphatic, he whakaekenga rānei ki ngā oko toto. Whai muri i te maimoatanga, me whakatau mēnā me mahi pokanga anō, me aromatawai hoki i te whanaungatanga i waenga i te āhua kino me te HP. Ehara i te mea ko ngā mate pukupuku puku katoa o te repe fundic he HP kino.
1) Matepukupuku puku o te repe fundic
Te mate pukupuku puku o te repe fundic
◆Tēhi 1
Whakaahuatanga:Kua paku piki ake te whara, ā, ka kitea te kiriuhi puku RAC kore-atrophic huri noa. Ka kitea te hanganga moroiti me ngā oko toto moroiti e tere huri ana i te wāhanga kua piki ake o te ME-NBI, me te DL.
Te tātaritanga (me te mate pāwera):Te mate pukupuku puku mucosal repe moni, rohe U, 0-1la, 47*32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Te mate pukupuku puku o te repe fundic
◆Tēhi 2
WhakaahuatangaHe whara papatahi kei te pakitara o mua o te piko iti o te cardia, me te rerekētanga o te tae me te whero, ka kitea ngā oko toto dendritic i runga i te mata, ā, kua paku ara ake te whara.
Te tātaritanga (me te pathology): Te mate pukupuku puku mucosal repe moni, 0-lla, pT1a/M, ULO, LyOV0,HM0,VMO
kōrero
He uaua te whakahua i te ingoa o te "gastric repe mucosal adenocarcinoma", ā, he iti noa iho te auau o te mate. Me nui ake te kaha ki te kite me te mārama ki tēnei ingoa. He nui ngā āhuatanga o te fundic repe mucosal adenocarcinoma, arā, he nui te mate pukupuku.
E whā ngā āhuatanga matua o te endoscopy mārama mā: ① ngā whara homochromatic-fading; ② te pukupuku subepithelial SMT; ③ ngā oko toto dendritic kua whānui; ④ ngā matūriki iti ā-rohe. Te mahi ME: Ka whānui ake te IP i te DL(+)IMVP(+)IMSP(+)MCE, ā, ka piki ake. Mā te whakamahi i te tukanga i tūtohutia e MESDA-G, e 90% o ngā mate pukupuku puku o te repe fundic e tutuki ana i ngā paearu tātaritanga.
3) Adenoma puku (adenoma repe pyloric PGA)
adenoma puku
◆Tēhi 1
Whakaahuatanga:I kitea he whara mā, papatahi, e ara ake ana i te pakitara o muri o te fornix puku, kāore i te mārama ngā rohe. Kāore i kitea he rohe mārama i te tae indigo carmine, ā, i kitea te āhua rite ki te LST-G o te whekau nui (kua paku whakanuia).
Te tātaritanga (me te mate pāwera):te mate pukupuku atypia iti, O-1la, 47*32mm, te adenocarcinoma ngongo kua rerekē pai, pT1a/M, ULO, Ly0, VO, HMO, VMO
adenoma puku
◆Tēhi 2
WhakaahuatangaHe whara kua ara ake me ngā pona i te pakitara o mua o te wāhanga waenga o te tinana puku. Ka kitea te gastritis kaha i muri. Ka kitea te indigo carmine hei rohe. (NBI me te whakanui paku)
Mate pāweraI kitea te whakaaturanga MUC5AC i roto i te epithelium o waho, ā, i kitea te whakaaturanga MUC6 i roto i te epithelium o waho. Ko te tātaritanga whakamutunga ko PGA.
kōrero
Ko ngā adenoma puku he repe mucinous e uru ana ki te stroma, ā, e kapi ana i te epithelium foveolar. Nā te nui haere o ngā putunga o te repe, he hemispherical, he nodular rānei, ko ngā adenoma puku e kitea ana me te mārama mā endoscopic he nodular katoa, ā, e putunga ana. Me aro ki ngā whakarōpūtanga e 4 o Jiu Ming i raro i te tirotiro endoscopic. Ka taea e te ME-NBI te kite i te āhua papillary/villous o te PGA. Kāore te PGA i te HP kino rawa atu, ā, kāore hoki e ngoikore, ā, he tūponotanga kei te mate pukupuku. E taunakihia ana te tātaritanga wawe me te maimoatanga wawe, ā, i muri i te kitenga, me tango kaha te en bloc me te rangahau taipitopito anō.
4) mate pukupuku puku epithelial foveolar (rite ki te rāhipere)
mate pukupuku puku foveolar raspberry
◆Tēhi 2
Whakaahuatanga:(kāore i whakaurua)
Te tātaritanga (me te pathology)mate pukupuku puku epithelial foveolar
mate pukupuku puku foveolar raspberry
◆Tēhi 3
Whakaahuatanga:(kāore i whakaurua)
Te tātaritanga (me te mate pāwera):mate pukupuku puku epithelial foveolar
kōrero
Ko te rāhipere, e kiia nei ko "Tuobai'er" i tō mātou kāinga, he hua ngahere i te taha o te rori i a mātou e tamariki ana. He hononga te epithelium repe me ngā repe, engari he rerekē te ihirangi. He mea tika kia mārama ki ngā āhuatanga tipu me te whanaketanga o ngā pūtau epithelial. He tino rite te mate pukupuku puku epithelial rāhipere ki ngā polyp gastric, ā, ka taea te pohehe he polyp gastric. Ko te āhuatanga matua o te epithelium foveolar ko te whakaaturanga matua o te MUC5AC. Nō reira, ko te carcinoma epithelial foveolar te kupu whānui mō tēnei momo. Ka taea te noho i roto i te HP kino, pai, i muri rānei i te whakahoromata. Te āhua endoscopic: he pupuhi porowhita whero kanapa, he rite ki te rōpere, he mārama ngā rohe.
5) Mate pukupuku pūtau mowhiti waitohu
Te mate pukupuku pūtau mowhiti waitohu: te āhua o te mārama mā
Te mate pukupuku pūtau mowhiti waitohu: te āhua o te mārama mā
mate pukupuku pūtau mowhiti waitohu
◆Tēhi 1
Whakaahuatanga:He whara papatahi kei te pakitara o muri o te tomokanga puku, 10 mm, memeha, momo O-1Ib, kāore he mimiti i muri, ka kitea te rohe i te tīmatanga, kāore i te kitea te rohe i te tirotiro anō, ME-NBI: ko te wāhanga interfoveal anake ka mā, IMVP(-)IMSP (-)
Te tātaritanga (me te mate pāwera):E whakamahia ana ngā tauira ESD hei tātaritanga i te mate pukupuku mowhiti pūtau.
Ngā whakaaturanga mate pukupuku
Ko te mate pukupuku pūtau mowhiti waitohu te momo tino kino. E ai ki te whakarōpūtanga a Lauren, ko te mate pukupuku pūtau mowhiti waitohu puku he momo mate pukupuku horapa, ā, he momo mate pukupuku kore-whakarerekētanga. He maha te puta i roto i te tinana o te puku, ā, he maha ake te kitea i roto i ngā whara papatahi me ngā whara totohu me ngā tae kua rerekē. He onge noa iho ngā whara kua whakaarahia, ā, ka puta mai anō hoki hei horo, hei mate pukupuku rānei. He uaua ki te kite i te wā o te tirotiro endoscopic i ngā wāhanga tōmua. Ko te maimoatanga ka taea te tango whakaora pērā i te endoscopic ESD, me te aroturuki pakari i muri i te pokanga me te aromatawai mēnā me mahi pokanga tāpiri. Me hiahia he pokanga tāpiri mō te tango kore-whakaora, ā, ko te tikanga pokanga ka whakatauhia e te taote pokanga.
Nō "Stomach and Intestine" te ariā tuhinga me ngā pikitia o runga ake nei.
Hei tāpiritanga, me aro nui hoki ki te mate pukupuku hononga esophagus, te mate pukupuku cardia, me te adenocarcinoma kua wehewehea pai e kitea ana i roto i te papamuri HP-negative.
3. Whakarāpopototanga
I tēnei rā i ako ahau i ngā mōhiotanga e tika ana me ngā whakaaturanga endoscopic o te mate pukupuku puku HP-negative. Kei roto i ēnei ko: te mate pukupuku puku momo fundic repe, te mate pukupuku puku momo fundic repe mucosal, te adenoma puku, te pukupuku epithelial foveolar (rite ki te rāhipere) me te mate pukupuku pūtau mowhiti signet.
He iti te auau haumanu o te mate pukupuku puku HP-negative, he uaua ki te whakatau, ā, he ngāwari ki te hē te tautuhi. Ko te mea uaua ake ko ngā whakaaturanga endoscopic o ngā mate uaua me ngā mate onge. Me mārama hoki mai i te tirohanga endoscopic, inā koa ko te mātauranga ariā kei muri.
Ki te tirohia ngā polyp o te puku, ngā horo, me ngā wāhi whero me te mā, me whakaaro koe ki te tūponotanga o te mate pukupuku puku Hp-negative. Me tutuki te whakatau mō te HP negative ki ngā paerewa, ā, me aro nui ki ngā hua kino teka i puta mai i te whakawhirinaki nui ki ngā hua whakamātautau manawa. He nui ake te whakawhirinaki o ngā endoscopists mātau ki ō rātou ake kanohi. I te aroaro o te ariā taipitopito i muri i te mate pukupuku puku HP-negative, me haere tonu tātou ki te ako, ki te mārama me te mahi kia mōhio ai tātou ki tēnei.
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, te kātene rehu, paraihe cytology,waea ārahi,kete tiki kohatu, te katitere rerenga wai ihu me ētahi atue whakamahia whānuitia ana i roto iEMR,ESD,ERCP.He tiwhikete CE ā mātou hua, ā, he tiwhikete ISO ā mātou wheketere. Kua kaweakehia ā mātou taonga ki Ūropi, Amerika Te Raki, Te Rawhiti o Waenganui me tētahi wāhanga o Āhia, ā, he whānuitia te whiwhinga o te kiritaki i te mihi me te whakamoemiti!
Wā tuku: Hurae-12-2024