ʻO nā colon polyps he maʻi maʻamau a loaʻa pinepine i ka gastroenterology. Hōʻike lākou i nā protrusions intraluminal i ʻoi aku ka kiʻekiʻe ma mua o ka mucosa intestinal. ʻO ka maʻamau, loaʻa i ka colonoscopy ka helu ʻike ma kahi o 10% a 15%. Piʻi pinepine ka nui o ka maʻi me ka makahiki. ala mai. No ka mea, ʻoi aku ma mua o 90% o nā maʻi maʻi colorectal ma muli o ka hoʻololi ʻino ʻana o nā polyps, ʻo ka mālama maʻamau ka hana endoscopic resection i ka wā e ʻike ʻia ai nā polyps.
I kēlā me kēia lā colonoscopy, 80% a 90% o nā polyps i emi iho ma mua o 1 knm. No nā polyps adenomatous a i ʻole polyps me ka lōʻihi ≥ 5 mm (inā paha adenomatous a ʻaʻole paha), ua ʻōlelo ʻia ke koho ʻana i ka endoscopic resection. He haʻahaʻa loa ka hiki ke loaʻa nā micropolyps colon (ka lōʻihi ≤5mm) i loko o nā ʻāpana tumo (0~0.6%). No ka micropolyps i loko o ka rectum a me ka sigmoid colon, ina ka endoscopist hiki pololei ke hoʻoholo 'ole-adenomatous polyps, aole pono e Resection, akā, i ka luna o ka manaʻo i kakaikahi hoʻokō 'ia ma ka lapaʻau hana ma Kina.
Eia kekahi, ʻo 5% o nā polyps he pālahalaha a i ʻole e ulu i ka ʻaoʻao, me ke anawaena o ʻoi aku ma mua o 2 knm, me nā mea ʻino a i ʻole. I kēia hihia, koi ʻia kekahi mau ʻenehana hoʻoneʻe polyp endoscopic holomua, e like meEMRaESD. E nānā i nā ʻanuʻu kikoʻī no ka wehe ʻana i ka polyp.
ʻO ke kaʻina hana
Ua hoʻopau ka mea maʻi i ka loiloi anesthesia preoperative, ua hoʻonoho ʻia ma ke kūlana decubitus ʻaoʻao hema, a ua hāʻawi ʻia i ka anesthesia intravenous me propofol. Ua nānā ʻia ke kahe koko, ka puʻuwai puʻuwai, ka electrocardiogram, a me ka saturation oxygen koko peripheral i ka wā o ka hana.
1 Anu/WhanaBiopsy ForcepsMāhele
He kūpono ia no ka wehe ʻana i nā polyps liʻiliʻi ≤5mm, akā aia paha ka pilikia o ka wehe ʻole ʻana o nā polyps 4 a 5mm. Ma ke kumu o ka biopsy anuanu, hiki i ka biopsy thermal ke hoʻohana i ka manawa kiʻekiʻe e hoʻopau i nā ʻeha koena a hana i ka mālama hemostasis ma ka ʻeha. Eia naʻe, pono e mālama ʻia e pale aku i ka pōʻino i ka papa serosa o ka pā o ka ʻōpū ma muli o ka electrocoagulation nui.
I ka wā o ka hana ʻana, pono e hoʻopaʻa ʻia ke poʻo o ka polyp, e hoʻokiʻekiʻe ʻia (i pale i ka hōʻino ʻana i ka papa ʻiʻo), a mālama ʻia ma kahi mamao kūpono mai ka paia o ka ʻōpū. Ke lilo ka polyp pedicle i keʻokeʻo, hoʻopau 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 i ka manawa electrification a hoʻonui i ka hopena o ka pōʻino piha (Figure 1).
2 Anu/welapahele polypectomyʻano wehe
He kūpono no nā ʻano ʻano like ʻole I p type, I sp type a me ka liʻiliʻi (<2cm) I s type (specific classification standards can refer to endoscopic detection of early cancer tract tract. No nā ʻano liʻiliʻi Ip lesions, maʻalahi ka wehe ʻana i ka pahele. Hiki ke hoʻohana ʻia nā pahele anu a wela paha no ka wehe ʻana. I ka wā o ka wehe ʻana, pono e mālama ʻia kahi lōʻihi o ka pedicle a i ʻole kahi mamao mai ka paia o ka ʻōpū i ka wā e hōʻoiaʻiʻo ana i ka wehe piha ʻana o ka lesion. Ma hope o ka hoʻopaʻa ʻana i ka pahele, pono e hoʻoluliluli ʻia ʻo Snare, e nānā inā e puni ana ka mucosa ʻōpū maʻamau a hoʻokomo pū i mea e pale ai i ka pōʻino o ka paia ʻōpū.
Kiʻi 1 kiʻi kiʻi kiʻi o ka wehe ʻana i nā forceps thermal biopsy, A ma mua o ka wehe ʻana i nā forceps, B ka ʻeha ma hope o ka wehe ʻana i nā forceps. CD: Hoʻomalu no ka welabiopsy forcepska wehe ʻana. Inā nui ka polyp, e hoʻonui ia i ka manawa electrocoagulation a hoʻopilikia i ka transmural.
Kiʻi 2 Kiʻi kiʻi o ka ʻoki ʻana i ka pahele wela o nā ʻano liʻiliʻi I sp
3 EMR
■ I p lesions
No nā ʻeha nui, ma waho aʻe o ka mālama ʻana i luna, pono e hoʻohana ʻia nā pahele wela no ka wehe ʻana. Ma mua o ka wehe ʻana, pono e hana ʻia ka nui o ka submucosal injection ma ke kumu o ka pedicle (2 a 10 mL o 10,000 units o epinephrine + methylene blue + physiological Ua hoʻokomo ʻia ka hui ʻana o ka saline ma lalo o ka mucosa (inject i ka wā e wehe ana i ka nila), no laila e hoʻokiʻekiʻe piha ʻia ka pedicle a maʻalahi hoʻi e hoʻoneʻe. pā ʻōpū e pale aku i ka hana ʻana i kahi puka pani a puhi i ka paia ʻōpū.
Kiʻi 3 kiʻi kiʻi kiʻi oEMRka lapaau ana i na ma'i lp-type
Pono e hoʻomaopopo ʻia inā loaʻa i kahi ʻano nui I p polyp kahi pedicle mānoanoa, aia paha i loko o ka vasa vasorum nui, a e maʻalahi ke koko ma hope o ka wehe ʻana. I ke kaʻina hana hoʻokaʻawale, hiki ke hoʻohana ʻia ke ʻano coagulation-cut-coagulation e hōʻemi i ka pilikia o ke koko. Hiki ke hoʻokaʻawale ʻia kekahi mau polyps nui e hōʻemi i ka paʻakikī o ka hana, akā ʻaʻole kūpono kēia ʻano i ka loiloi pathological.
■ lla-c ano eha
No nā ʻōpala ʻano Ila-c a me kekahi mau ʻeha Is me nā anawaena nui aʻe, hiki i ka ʻoki ʻana pololei ʻana ke hōʻino i ka mānoanoa piha. Hiki i ka submucosal injection o ka wai ke hoʻonui i ke kiʻekiʻe o ka lesion a hoʻemi i ka paʻakikī o ka pahele a me ka wehe ʻana. Inā loaʻa ka protrusion i ka wā o ke kaʻa ʻana he kumu nui ia no ka hoʻoholo ʻana inā he benign a maʻi ʻole paha ka adenoma a inā he mau hōʻailona no ka mālama endoscopic. Hiki i kēia ʻano hana ke hoʻonui i ka helu resection piha o nā adenomas<2cm ka anawaena.
Helu 4EMRʻO ka papa kuhikuhi holoʻokoʻa no ke ʻano Il a polyps
4 ESD
No nā adenomas me ke anawaena ʻoi aku ka nui ma mua o 2cm e koi ana i ka wehe ʻana i hoʻokahi manawa a me ka hōʻailona hāpai maikaʻi ʻole, a me kekahi mau maʻi maʻi maʻi mua,EMRnā koena a i ʻole ka hoʻihoʻi hou ʻana i paʻakikī ke mālama ʻia,ESDhiki ke hana i ka lapaau. ʻO nā ʻanuʻu maʻamau:
1. Ma hope o ka endoscopic staining, ua wehewehe maopopo ʻia ka palena o ka lesion a ʻike ʻia ka pōʻai (ʻaʻole hiki ke hōʻailona ʻia ka lesion inā maopopo ka palena o ka lesion).
2. Inject submucosally i mea e maopopo ai ka hoʻokiʻekiʻe ʻana o nā ʻeha.
3. Hoʻokiʻekiʻe ʻāpana a puni paha i ka mucosa e hōʻike i ka submucosa.
4. E hoʻokuʻu i ka ʻiʻo pili ma ka submucosa a wehe mālie i ka ʻiʻo maʻi.
5. E nānā pono i ka ʻeha a mālama i nā kīʻaha koko e pale ai i nā pilikia.
6. Ma hope o ka hoʻomaʻamaʻa ʻana i nā specimens i koho ʻia, e hoʻouna iā lākou no ka hoʻokolokolo pathological.
Helu 5ESDka mālama ʻana i nā ʻeha nui
ʻO ka mālama ʻana i loko o ka hana
Pono ke koho ʻana i kahi ala kūpono e koho ʻia ma muli o nā ʻano polyp, kahi, ka pae akamai o ka mea hoʻohana, a me nā mea hana e kū nei. I ka manawa like, hahai pū ka wehe ʻana i ka polyp i nā loina maʻamau, pono mākou e hahai e like me ka mea hiki ke hōʻoia i ka palekana a me ka maikaʻi o ke kaʻina hana lapaʻau a loaʻa nā mea maʻi mai ia mea.
1. ʻO ka hoʻonohonoho mua ʻana o ka hoʻolālā lapaʻau ke kī i ka hoʻokō kūleʻa ʻana o ka mālama polyp (ʻoi aku ka polyps nui). No nā polyps paʻakikī, pono e koho i ke ʻano resection kūpono ma mua o ka mālama ʻana, e kamaʻilio me nā kahu hānai, anesthesiologists a me nā limahana ʻē aʻe i ka manawa kūpono, a hoʻomākaukau i nā mea 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.
2. ʻO ka mālama ʻana i kahi "degree o ke kūʻokoʻa" maikaʻi ma ke kino aniani i ka wā o ka mālama ʻana ʻo ia ka mea e pono ai e hōʻoia i ka hoʻokō ʻana i ka manaʻo hana. I ke komo ʻana i ke aniani, e hahai pono i ke ʻano "mālama axis a me ke ala pōkole" e mālama i ke kūlana lapaʻau ma kahi kūlana loop-free, kahi kūpono i ka mālama pololei.
3. ʻO ka ʻike hana maikaʻi e maʻalahi a palekana ke kaʻina hana. Pono e hoʻomākaukau pono ʻia ka 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 polyps e ka umekaumaha. ʻOi aku ka maikaʻi inā loaʻa ka liona ma ka ʻaoʻao ʻē aʻe o ka wai i koe i loko o ka lua o ka ʻōpū.
ʻO mākou, ʻo Jiangxi Zhuoruihua Medical Instrument Co., Ltd., he mea hana ma Kina i mea kūikawā i nā mea hoʻohana endoscopic, e like mebiopsy forceps, hemoclip, pahele polyp, nila sclerotherapy, pāpaʻi pāpaʻi, cytology brushes, uea alakaʻi, hīnaʻi kiʻi pōhaku, ihu biliary drainage catheteretc. i hoohana nui ia maEMR, ESD, ERCP. ʻO kā mākou huahana i hōʻoia ʻia ʻo CE, a ua hōʻoia ʻia kā mākou mea kanu. Ua lawe ʻia kā mākou waiwai i ʻEulopa, ʻAmelika ʻAmelika, Middle East a me kahi hapa o Asia, a loaʻa nui i ka mea kūʻai aku o ka ʻike a me ka hoʻomaikaʻi!
Ka manawa hoʻouna: ʻAukake-02-2024