He maʻi maʻamau a pinepine nā polyp o ka colon i ka gastroenterology. Pili lākou i nā puka intraluminal i ʻoi aku ke kiʻekiʻe ma mua o ka mucosa ʻōpū. Ma ke ʻano laulā, ʻo ka colonoscopy ka helu ʻike ma ka liʻiliʻi he 10% a 15%. Hoʻonui pinepine ka nui o ka hanana me ka makahiki. piʻi. ʻOiai ʻoi aku ma mua o 90% o nā maʻi ʻaʻai colorectal i hoʻokumu ʻia e ka hoʻololi ʻino o nā polyps, ʻo ka lāʻau lapaʻau maʻamau ka hana ʻana i ka endoscopic resection i ka wā e ʻike ʻia ai nā polyps.
I ka colonoscopy i kēlā me kēia lā, ʻoi aku ka liʻiliʻi o 80% a 90% o nā polyp ma mua o 1 cm. No nā polyp adenomatous a i ʻole nā polyp me ka lōʻihi ≥ 5 mm (inā he adenomatous a ʻaʻole paha), ua ʻōlelo ʻia ka resection endoscopic koho. ʻO ka hiki ke loaʻa nā micropolyps colon (lōʻihi ke anawaena ≤5mm) i loaʻa nā ʻāpana tumor he haʻahaʻa loa (0 ~ 0.6%). No nā micropolyps i loko o ka rectum a me ka sigmoid colon, inā hiki i ka endoscopist ke hoʻoholo pololei he mau polyp non-adenomatous lākou, ʻaʻohe pono e Resection, akā ʻaʻole i hoʻokō pinepine ʻia ka manaʻo ma luna nei i ka hana lapaʻau ma Kina.
Eia kekahi, he pālahalaha a ulu paha ka 5% o nā polyp ma ka ʻaoʻao, me ke anawaena ma mua o 2 cm, me a ʻole nā mea ʻino. I kēia hihia, pono kekahi mau ʻano hana wehe polyp endoscopic holomua, e like meEMRa meESDE nānā kākou i nā ʻanuʻu kikoʻī no ka wehe ʻana i ka polyp.
Kaʻina hana ʻoki kino
Ua hoʻopau ka mea maʻi i ka loiloi anesthesia ma mua o ke ʻoki ʻana, ua kau ʻia ma ke kūlana decubitus ʻaoʻao hema, a ua hāʻawi ʻia iā ia ka anesthesia intravenous me ka propofol. Ua nānā ʻia ke koko, ka helu o ka puʻuwai, ka electrocardiogram, a me ka saturation oxygen koko peripheral i ka wā o ke ʻoki ʻana.
1 Anuanu/WelaNā Forceps BiopsyMāhele
He kūpono ia no ka wehe ʻana i nā polyps liʻiliʻi ≤5mm, akā aia paha ka pilikia o ka wehe piha ʻole ʻana o nā polyps 4 a 5mm. Ma ke kumu o ka biopsy anu, hiki i ka biopsy wela ke hoʻohana i ke au alapine kiʻekiʻe e hoʻopau i nā ʻeha i koe a hana i ka mālama hemostasis ma ka ʻeha. Eia nō naʻe, pono e akahele e pale aku i ka hōʻino ʻana i ka papa serosa o ka paia ʻōpū ma muli o ka electrocoagulation nui.
I ka wā o ke ʻoki ʻana, pono e hoʻopaʻa ʻia ke poʻo o ka polyp, e hāpai pono ʻia (i ʻole e hōʻino i ka papa ʻiʻo), a mālama ʻia ma kahi mamao kūpono mai ka paia o ka ʻōpū. Ke lilo ka pedicle polyp i keʻokeʻo, e hoʻōki i ka electrocoagulation a hoʻopaʻa i ka ʻeha. Pono e hoʻomaopopo ʻia ʻaʻole maʻalahi ka wehe ʻana i kahi polyp nui loa, inā ʻaʻole e hoʻolōʻihi ia i ka manawa electrification a hoʻonui i ka pilikia o ka hōʻino ʻana i ka mānoanoa piha (Kiʻi 1).
2 Anuanu/welapahele polypectomyʻano wehe
Kūpono no nā ʻeha i hāpai ʻia o nā nui like ʻole I ʻano p, ʻano I sp a me ke ʻano liʻiliʻi (<2cm) I s (hiki i nā kūlana hoʻokaʻawale kikoʻī ke kuhikuhi i ka ʻike endoscopic o ke kanesa mua o ka ʻōpū digestive. Nui loa nā ʻano a ʻaʻole maopopo iaʻu pehea e hoʻoholo ai? E wehewehe pono kēia ʻatikala) ʻO ka ʻoki ʻana i nā ʻeha. No nā ʻeha Ip ʻano liʻiliʻi, he maʻalahi ka ʻoki ʻana o ka pahele. Hiki ke hoʻohana ʻia nā pahele anu a wela paha no ka ʻoki ʻana. I ka wā o ka ʻoki ʻana, pono e mālama ʻia kahi lōʻihi o ka pedicle a i ʻole kahi mamao mai ka paia o ka ʻōpū me ka hōʻoia ʻana i ka wehe piha ʻana o ka ʻeha. Ma hope o ka hoʻopaʻa ʻana i ka pahele, pono e lulu ʻia. Pahele, e nānā inā he mucosa ʻōpū maʻamau e hoʻopuni ana a hoʻokomo pū iā ia e pale aku i ka hōʻino ʻana i ka paia o ka ʻōpū.
Kiʻi 1 Kiʻikuhi kiʻikuhi o ka wehe ʻana i nā forceps biopsy thermal, A ma mua o ka wehe ʻana i nā forceps, B ka ʻeha ma hope o ka wehe ʻana i nā forceps. CD: Nā hana palekana no ka thermalnā forceps biopsyka wehe ʻana. Inā nui loa ka polyp, e hoʻonui ia i ka manawa electrocoagulation a hōʻino i ka transmural.
Kiʻi 2 Kiʻikuhi hoʻolālā o ka ʻoki ʻana i ka ʻāpana pahele wela o nā ʻeha ʻano I sp liʻiliʻi
3 EMR
■ʻO nā ʻeha p
No nā ʻeha I p nui, ma waho aʻe o nā hana palekana i luna, pono e hoʻohana ʻia nā pahele wela no ka resection. Ma mua o ka resection, pono e hana ʻia ka injection submucosal lawa ma ke kumu o ka pedicle (2 a 10 mL o 10,000 mau ʻāpana o ka epinephrine + methylene blue + physiological. Hoʻokomo ʻia ka hui saline ma lalo o ka mucosa (e hoʻokomo i ka wā e huki ana i ka nila), i hāpai piha ʻia ka pedicle a maʻalahi hoʻi e wehe (Kiʻi 3). I ka wā o ke kaʻina hana resection, pono e pale ka lesion i ka hoʻopili ʻana me ka paia ʻōpū i ʻole e hana i kahi loop pani a puhi i ka paia ʻōpū.
Kiʻi 3 Kiʻikuhi hoʻolālā oEMRka mālama ʻana i nā ʻeha ʻano lp
Pono e hoʻomaopopo ʻia inā he pedicle mānoanoa ko kahi polyp ʻano I p nui, hiki iā ia ke loaʻa nā vasa vasorum nui, a e kahe maʻalahi ke koko ma hope o ka wehe ʻana. I ka wā o ke kaʻina hana resection, hiki ke hoʻohana ʻia ke ʻano coagulation-cut-coagulation e hōʻemi i ka pilikia o ke kahe ʻana o ke koko. Hiki ke ʻoki ʻia kekahi mau polyp nui i nā ʻāpana e hōʻemi i ka paʻakikī o ke hana, akā ʻaʻole kūpono kēia ʻano hana no ka loiloi pathological.
■nā ʻeha ʻano lla-c
No nā ʻeha ʻano Ila-c a me kekahi mau ʻeha Is me nā anawaena nui aʻe, hiki i ka ʻoki pololei ʻana o ka pahele ke hōʻino i ka mānoanoa piha. Hiki i ka hoʻokomo ʻana o ka wai ma lalo o ka mucosa ke hoʻonui i ke kiʻekiʻe o ka ʻeha a hōʻemi i ka paʻakikī o ka pahele a me ka ʻoki ʻana. Inā he puka i waho i ka wā o ke ʻoki ʻana he kumu koʻikoʻi ia no ka hoʻoholo ʻana inā he maikaʻi ʻole a ʻino paha ka adenoma a inā he mau hōʻailona no ka mālama ʻana i ka endoscopic. Hiki i kēia ʻano hana ke hoʻonui i ka helu ʻoki piha o nā adenomas<2 kenimika ke anawaena.
Kiʻi 4EMRka pakuhi kahe lapaʻau no nā polyps ʻano Il a
4 ESD
No nā adenomas me ke anawaena ʻoi aku ka nui ma mua o 2cm e koi ana i ka resection hoʻokahi manawa a me ka hōʻailona hāpai maikaʻi ʻole, a me kekahi mau maʻi kanesa mua,EMRnā koena a i ʻole nā hoʻi hou ʻana i paʻakikī ke mālama ʻia,ESDhiki ke hana ʻia ka lāʻau lapaʻau. Eia nā ʻanuʻu maʻamau:
1. Ma hope o ke kaha ʻana o ka endoscopic, ua wehewehe pono ʻia ka palena o ka lesion a ua hōʻailona ʻia ke anapuni (ʻaʻole paha e hōʻailona ʻia ka lesion inā ua maopopo iki ka palena o ka lesion).
2. E hoʻokomo ma lalo o ka mucosa e wehe maopopo ai nā ʻeha.
3. E ʻoki hapa a puni paha i ka mucosa e hōʻike i ka submucosa.
4. E hoʻokuʻu i ke kino pili ma ka submucosa a ʻili mālie i ke kino maʻi.
5. E nānā pono i ka ʻeha a mālama i nā kīʻaha koko e pale aku i nā pilikia.
6. Ma hope o ka hana ʻana i nā hāpana i ʻoki ʻia, e hoʻouna iā lākou no ka hoʻokolokolo pathological.
Kiʻi 5ESDka mālama ʻana i nā ʻeha nui
Nā hana palekana intraoperative
Pono ke koho ʻana o ka endoscopic colon polyp resection i kahi ʻano kūpono e pili ana i nā ʻano polyp, kahi, ka pae akamai o ka mea hana, a me nā lako hana o kēia manawa. I ka manawa like, hahai pū ka wehe ʻana i ka polyp i nā loina maʻamau, kahi e pono ai mākou e hahai i ka hiki ke hōʻoia i ka palekana a me ka pono o ke kaʻina hana lapaʻau a loaʻa i nā mea maʻi ka pōmaikaʻi mai ia mea.
1. ʻO ka hoʻonohonoho mua ʻana o ka hoʻolālā lapaʻau ke kī i ka hoʻopau pono ʻana o ka mālama ʻana i ka polyp (ʻoi aku hoʻi nā polyp nui). No nā polyp paʻakikī, pono e koho i ke ʻano hana resection kūpono ma mua o ka mālama ʻana, e kamaʻilio me nā kahu maʻi, nā anesthesiologists a me nā limahana ʻē aʻe i ka manawa kūpono, a hoʻomākaukau i nā lako lapaʻau. Inā ʻae nā kūlana, hiki ke hoʻopau ʻia ma lalo o ke alakaʻi ʻana a ke kauka lapaʻau kiʻekiʻe e pale aku i nā ulia pōpilikia like ʻole.
2. ʻO ka mālama ʻana i kahi "kekelē o ke kūʻokoʻa" maikaʻi ma ke kino aniani i ka wā o ka mālama ʻana, ʻo ia ka mea mua e hōʻoia ai i ka hoʻokō ʻia ʻana o ka manaʻo hana. I ke komo ʻana i ke aniani, e hahai pono i ke "ʻano mālama a me ka hoʻopōkole ʻana o ke axis" e mālama i ke kūlana mālama i kahi kūlana loop-free, kahi e kūpono ai i ka mālama pololei.
3. ʻO ka ʻike hana maikaʻi e maʻalahi a palekana hoʻi ke kaʻina hana. Pono e hoʻomākaukau pono ʻia nā ʻōpū o ka mea maʻi ma mua o ka mālama ʻana, pono e hoʻoholo ʻia ke kūlana o ka mea maʻi ma mua o ke ʻoki ʻana, a pono e hōʻike piha ʻia nā polyp e ka umekaumaha. ʻOi aku ka maikaʻi inā aia ka ʻeha ma ka ʻaoʻao ʻē aʻe o ke koena o ke wai i loko o ka lua ʻōpū.
ʻO mākou, ʻo Jiangxi Zhuoruihua Medical Instrument Co., Ltd., he mea hana ma Kina e loea ana i nā mea hoʻopau endoscopic, e like menā forceps biopsy, hemoclip, ʻūpā polyp, nila sclerotherapy, ʻaukā pīpī, nā palaki cytology, uea alakaʻi, hīnaʻi kiʻi pōhaku, catheter hoʻokahe wai biliary ihua pēlā aku i hoʻohana nui ʻia maEMR, ESD, ERCPUa hōʻoia ʻia kā mākou huahana e CE, a ua hōʻoia ʻia kā mākou mau mea kanu e ISO. Ua hoʻokuʻu ʻia aku kā mākou waiwai i ʻEulopa, ʻAmelika ʻĀkau, Hikina Waena a me kekahi ʻāpana o ʻAsia, a ua loaʻa nui ka ʻike a me ka hoʻomaikaʻi ʻia e ka mea kūʻai aku!
Ka manawa hoʻouna: Aug-02-2024