He aha ka Endoscopic Mucosal Resection? Ke Kumu, nā Pae/Kaʻina Hana & Nā Hopena

ʻO ka endoscopic mucosal resection (EMR) he hana liʻiliʻi e wehe i nā ʻiʻo maʻamau mai ka uhi o kāu ʻōnaehana digestive. E noʻonoʻo iā ia he ala pololei no nā kauka e hāpai a wehe pono i nā wahi pilikia me ka ʻole o ke ʻoki nui. Kōkua kēia ʻenehana i ka mālama ʻana i nā maʻi maʻi mua a me nā ulu mua ʻana i loko o kou esophagus, ʻōpū, a i ʻole colon me ka mālama ʻana i nā ʻiʻo olakino a puni lākou.

He aha ka Endoscopic Mucosal Resection?

ʻO ka endoscopic mucosal resection he ʻenehana kūikawā kahi e hoʻohana ai nā kauka i kahi paipu maʻalahi me kahi kamera (endoscope) e wehe i nā ʻiʻo maʻamau mai loko o kāu ʻōnaehana digestive. Hoʻopili ka hana i ka mucosa wale nō, ʻo ia ka papa o loko loa o nā ʻiʻo e uhi ana i kāu ʻōnaehana digestive.

I ka wā o ka EMR, hoʻokomo kāu kauka i kahi hopena kūikawā ma lalo o nā ʻiʻo maʻamau e hāpai iā ia mai nā papa hohonu. Hana kēia i kahi pale palekana e pale ai i ka paia ʻiʻo ma lalo. A laila, hoʻohana lākou i kahi loop uea a i ʻole nā mea ʻoki ʻē aʻe e wehe pono i nā ʻiʻo i hāpai ʻia.

ʻO ka nani o kēia ala i kona pololei. ʻAʻole like me ke ʻoki kuʻuna e koi ana i nā ʻoki nui, hana ka EMR mai loko mai ma nā puka kino maoli. ʻO ia hoʻi, ʻoi aku ka liʻiliʻi o ka trauma i kou kino a me nā manawa hoʻōla wikiwiki.

No ke aha e hana ʻia ai ka Endoscopic Mucosal Resection?

Hana ka EMR ma ke ʻano he mea diagnostic a me ka therapeutic no nā kūlana like ʻole i loko o kāu ʻōnaehana digestive. Hiki i kāu kauka ke ʻōlelo aku i kēia kaʻina hana ke loaʻa iā lākou nā ʻiʻo maʻamau e pono ai ka wehe ʻana akā ʻaʻole pono ke ʻoki nui.

ʻO ke kumu maʻamau no ka EMR ʻo ka mālama ʻana i nā maʻi maʻi mua i ʻole i laha ma mua o ka mucosa. Aia nō kēia mau maʻi maʻi i ka papa luna, e lilo ana lākou i mau moho kūpono no kēia ala liʻiliʻi. ʻO ka maʻi maʻi ʻōpū mua, ka maʻi maʻi esophageal, a me kekahi mau maʻi maʻi colon e pane maikaʻi i ka EMR.

Ua pōmaikaʻi nō hoʻi nā maʻi ma mua o ka maʻi ʻaʻai mai kēia lapaʻau. Hiki ke mālama pono ʻia ka ʻōpū o Barrett me ka dysplasia kiʻekiʻe, nā polyps kolonui nui, a me nā adenomas gastric me ka EMR. Hiki i kāu kauka ke wehe i kēia mau ulu e pilikia ana ma mua o ka lilo ʻana i maʻi ʻaʻai.

I kekahi manawa, kōkua ka EMR i ka hōʻoia ʻana. Ke hiki ʻole i nā hoʻokolohua kiʻi ke hoʻoholo inā he maʻi ʻaʻai ka ʻiʻo, ʻo ka wehe ʻana iā ia ma o ka EMR e hiki ai ke nānā pono ʻia ma lalo o ka microscope. Hāʻawi kēia i kāu hui lapaʻau i ke kiʻi maopopo loa o ka mea a lākou e hana nei.

He aha ke kaʻina hana no ka Endoscopic Mucosal Resection?

Hana ʻia ke kaʻina hana EMR ma kahi kikowaena endoscopy outpatient a i ʻole ka haukapila. E loaʻa iā ʻoe ka sedation e hōʻoluʻolu a hoʻomaha ʻoe i ke kaʻina hana, e mau ana ma kahi o 30 mau minuke a 2 mau hola e pili ana i ka paʻakikī.

Hoʻomaka kāu kauka ma ka hoʻokomo ʻana i ka endoscope ma kou waha (no ka ʻōpū digestive luna) a i ʻole rectum (no nā kaʻina hana kolonui). Aia i loko o ka paipu maʻalahi kahi kamera e hāʻawi ana i ka ʻike maopopo o ka wahi i manaʻo ʻia. Ke loaʻa iā lākou ka ʻiʻo maʻamau, nānā pono lākou iā ia e hōʻoia he kūpono ia no ka EMR.

A laila hele mai ka pae injection. Hoʻokomo kāu kauka i kahi hopena kūikawā i loaʻa ka saline, i kekahi manawa me ka epinephrine a i ʻole methylene blue, ma lalo pono o ka ʻiʻo maʻamau. Hoʻokumu kēia injection i kahi uluna wai e hāpai i ka ʻiʻo mai nā papa ʻiʻo hohonu, e palekana ai ka wehe ʻana.

Hiki i kekahi mau ʻenehana ke hoʻopau i ka wehe maoli. Hoʻohana ka hana maʻamau i kahi pahele, he loop uea lahilahi e hoʻopuni ana i ka ʻiʻo i hāpai ʻia. Hoʻopaʻa kāu kauka i ka loop a hoʻopili i ka uila e ʻoki maʻemaʻe i ka ʻiʻo. No nā lesions liʻiliʻi, hiki iā lākou ke hoʻohana i nā forceps kūikawā a i ʻole nā pahi.

Ma hope o ka wehe ʻana, e nānā pono kāu kauka i ka wahi no ke kahe ʻana o ke koko a mālama iā ia inā pono. Hiki iā lākou ke hoʻopili i nā kiʻi a i ʻole e hoʻohana i ka uila e sila i nā kīʻaha koko. E hele ana ka ʻiʻo i wehe ʻia i kahi hale hana pathology no ka loiloi kikoʻī.

Pehea e hoʻomākaukau ai no kāu Endoscopic Mucosal Resection?

He ʻokoʻa ka hoʻomākaukau ʻana no ka EMR ma muli o ka ʻāpana o kāu ʻōnaehana digestive e pono ai ka mālama ʻana. E hāʻawi kāu kauka i nā ʻōlelo kikoʻī i kūpono i kāu kūlana, akā pili kekahi mau alakaʻi maʻamau i ka hapa nui o nā kaʻina hana.

Pono ka ʻai wikiwiki ma mua o ka EMR. No nā kaʻina hana digestive luna, pono ʻoe e hooki i ka ʻai ʻana a me ka inu ʻana ma kahi o 8 mau hola ma mua. E hōʻoia kēia i ka ʻole o kou ʻōpū, e hāʻawi ana i ka ʻike maopopo a me ka hōʻemi ʻana i ka pilikia o nā pilikia.

Inā loaʻa iā ʻoe kahi colon EMR, lilo ka hoʻomākaukau ʻana i ka ʻōpū i mea nui. Pono ʻoe e hahai i ka meaʻai kūikawā a lawe i nā lāʻau lapaʻau e hoʻomaʻemaʻe loa i kou colon. Hoʻomaka maʻamau kēia kaʻina hana 1-2 mau lā ma mua o ke kaʻina hana a pili i ka inu ʻana i nā hoʻonā kikoʻī e kōkua i ka hoʻopau ʻana i nā mea ʻōpala a pau.

Pono paha nā hoʻoponopono lāʻau lapaʻau. Pono paha e hoʻōki ʻia nā mea lahilahi koko e like me ka warfarin a i ʻole aspirin i kekahi mau lā ma mua o ke kaʻina hana e hōʻemi i ka pilikia o ke kahe ʻana. Eia naʻe, mai hooki i nā lāʻau lapaʻau me ka ʻole o nā ʻōlelo kuhikuhi mai kāu kauka, no ka mea, pono kekahi mau maʻi i ka mālama mau.

He mea nui nā hoʻonohonoho kaʻa mai ka mea e loaʻa iā ʻoe ka sedation. E hoʻolālā i kekahi e hoʻokele iā ʻoe i ka home ma hope o ke kaʻina hana, no ka mea, hiki i nā lāʻau lapaʻau ke hoʻopilikia i kāu hoʻoholo a me nā reflexes no kekahi mau hola.

Pehea e heluhelu ai i kāu Endoscopic Mucosal Resection Results?

ʻO ka hoʻomaopopo ʻana i kāu mau hopena EMR e pili ana i nā mea nui ʻelua: nā mea i loaʻa i ke kaʻina hana a me ka hōʻike pathology e hiki mai ana. E wehewehe kāu kauka i nā mea ʻelua e kōkua iā ʻoe e hoʻomaopopo i ka mea i hoʻokō ʻia a me ka mea e hiki mai ana.

ʻO nā hopena koke e kālele ana i ka holomua ʻenehana. E haʻi aku kāu kauka iā ʻoe inā ua loaʻa iā lākou ka wehe piha ʻana o ka ʻiʻo maʻamau me nā palena maopopo. ʻO ka wehe piha ʻana, ʻo ia hoʻi, ua wehe ʻia nā ʻiʻo maʻamau i ʻike ʻia a pau, aʻo nā palena maopopo e hōʻike ana i ka ʻiʻo olakino e hoʻopuni ana i kahi i wehe ʻia.

Hāʻawi ka hōʻike pathology i ka ʻike kikoʻī e pili ana i ka ʻiʻo i wehe ʻia. Lawe pinepine kēia loiloi i nā lā 3-7 a hōʻike i ke ʻano pololei o nā cell i loaʻa, inā he maʻi ʻaʻai, a pehea ka hohonu o nā loli maʻamau e laha ai. Hōʻoia pū ka pathologist inā maopopo maoli nā palena i ka maʻi.

He mea nui ka ʻike staging inā loaʻa ka maʻi ʻaʻai. E wehewehe ka hōʻike pathology i ka hohonu o ka maʻi ʻaʻai a inā ua laha i nā moku lymph a i ʻole nā moku koko. Kōkua kēia ʻike i ka hoʻoholo inā pono ka mālama hou.

E hoʻonohonoho kāu kauka i kahi manawa e hahai ai e kūkākūkā i nā hopena piha a hana i kahi hoʻolālā nānā. ʻOiai me ka EMR kūleʻa, ua ʻōlelo pinepine ʻia nā endoscopies surveillance maʻamau e nānā i nā wahi maʻamau hou a i ʻole nā wahi maʻamau hou.

He aha nā Kumu Pilikia no ka Pono ʻana i ka Endoscopic Mucosal Resection?

Hiki i kekahi mau mea ke hoʻonui i kou hiki ke hoʻomohala i nā kūlana e koi ai i ka EMR. ʻO ka hoʻomaopopo ʻana i kēia mau kumu pilikia e kōkua iā ʻoe e hana i nā hoʻoholo i ʻike ʻia e pili ana i ka nānā ʻana a me ka pale ʻana.

He hana nui ka makahiki i nā maʻi ʻaʻai digestive tract a me nā kūlana precancerous. ʻO ka hapa nui o nā kaʻina hana EMR e hana ʻia ma nā maʻi ma luna o 50, no ka mea, ʻoi aku ka maʻamau o ka ulu ʻana o ka ʻiʻo maʻamau me ka makahiki e holomua ana. Eia naʻe, pono paha nā maʻi ʻōpio me nā kumu pilikia kikoʻī i kēia lapaʻau.

Hāʻawi nui nā kumu ola i nā pilikia digestive tract. Hoʻonui nui ka puhi ʻana a me ka inu ʻana i ka waiʻona i kou pilikia o ka maʻi ʻaʻai esophageal a me ka maʻi ʻaʻai gastric. Hiki i kēia mau mea ke kumu i ka mumū mau a me ka pōʻino cellular e hiki ke koi i ka hana EMR.

He pinepine nā maʻi ʻōpū mau ma mua o ka pono no ka EMR. Hiki i ka esophagus o Barrett, e ulu ana mai ka waikawa reflux lōʻihi, ke holomua i ka dysplasia a me ka maʻi kanesa mua. Hoʻonui pū nā maʻi ʻōpū mumū e like me ka ulcerative colitis i ka pilikia o ka maʻi kanesa ma nā wahi i hoʻopilikia ʻia.

Hoʻopilikia ka mōʻaukala ʻohana a me nā mea genetic i kāu ʻikepili pilikia. ʻO ka loaʻa ʻana o nā ʻohana me nā maʻi kanesa ʻōpū e hoʻonui paha i kou hiki ke hoʻomohala i nā maʻi like. Hoʻonui nui kekahi mau maʻi genetic, e like me ka familial adenomatous polyposis, i ka hana polyp a me ka pilikia o ka maʻi kanesa.

Hoʻopilikia nā ʻano meaʻai i ke olakino ʻōpū lōʻihi. ʻO nā meaʻai kiʻekiʻe i nā meaʻai i hana ʻia, ka ʻiʻo ʻulaʻula, a me ka haʻahaʻa i nā hua a me nā mea kanu e kōkua paha i nā maʻi e koi ana i ka EMR. Ma ka ʻaoʻao ʻē aʻe, hiki i nā meaʻai waiwai i ka fiber a me nā antioxidants ke hāʻawi i kekahi pale.

He aha nā pilikia hiki ke loaʻa o ka Endoscopic Mucosal Resection?

ʻOiai palekana ka EMR, ʻo ka hoʻomaopopo ʻana i nā pilikia hiki ke kōkua iā ʻoe e hana i nā hoʻoholo i ʻike ʻia a ʻike i nā hōʻailona hōʻailona. He kakaikahi a hiki ke mālama ʻia ka hapa nui o nā pilikia ke hiki mai.

ʻO ke kahe koko ka pilikia maʻamau, e hana ana ma kahi o 1-5% o nā kaʻina hana. ʻO ke kahe koko liʻiliʻi e kū pinepine ana ma kāna iho a i ʻole me nā lāʻau lapaʻau maʻalahi i ka wā o ke kaʻina hana. Eia naʻe, hiki i ke kahe koko nui ke koi i nā hana hou e like me nā kiʻi, ka lāʻau lapaʻau injection, a i ʻole, i kekahi manawa, ke ʻoki.

ʻO ka perforation, ʻoiai he mea maʻamau, he pilikia nui aʻe. Hana kēia i ka wā e hana ai ke kaʻina hana wehe i kahi lua ma ka paia o ka ʻōpū. ʻOkoʻa ka pilikia ma kahi, me nā perforation colon e ʻoi aku ka maʻamau ma mua o nā perforation ʻōpū luna. Hiki ke mālama ʻia ka hapa nui o nā perforation liʻiliʻi me nā kiʻi i ka wā o ke kaʻina hana.

Hiki wale ka maʻi ma hope o ka EMR, akā hiki nō ke hiki i ka wā e komo ai ka bacteria i ke kahe koko a i ʻole nā ʻiʻo a puni. Hiki i kāu kauka ke kau i nā lāʻau antibiotic inā loaʻa iā ʻoe kekahi mau maʻi puʻuwai a i ʻole nā pilikia ʻōnaehana pale e hoʻonui ai i ka pilikia o ka maʻi.

Hiki ke hana ʻia ka hana ʻana i ka stricture ma hope o nā pule a i ʻole nā mahina ma hope o ka EMR, ʻoiai ke wehe ʻia nā wahi nui o ka ʻiʻo. Hiki i kēia hoʻopaʻa ʻana o ka ʻōnaehana digestive ke hana i nā pilikia ʻana a i ʻole ka pale ʻana o ka ʻōpū. ʻO ka hapa nui o nā strictures e pane maikaʻi i nā kaʻina hana e hohola mālie.

ʻAʻole i pau ka wehe ʻana i kekahi manawa me nā maʻi nui a i ʻole nā mea paʻakikī. Ke hana kēia, hiki i kāu kauka ke ʻōlelo i nā kau EMR hou, nā lāʻau lapaʻau ʻē aʻe, a i ʻole ka nānā ʻana i ka pili ʻana i nā hopena pathology.

I ka manawa hea e ʻike ai au i ke kauka ma hope o ka Endoscopic Mucosal Resection?

ʻO ka ʻike ʻana i ka manawa e hoʻopili ai i kāu hui mālama ola ma hope o ka EMR e kōkua i ka hōʻoia ʻana i ka hoʻōla kūpono a me ka ʻike mua ʻana i nā pilikia. Hoʻōla maʻalahi ka hapa nui o nā maʻi, akā pono kekahi mau hōʻailona i ka nānā koke.

Pono ka ʻeha nui o ka ʻōpū e hoʻonui a ʻaʻole hoʻomaikaʻi me nā lāʻau lapaʻau i kuhikuhi ʻia i ka loiloi wikiwiki. ʻOiai he maʻamau kekahi ʻoluʻolu ma hope o ka EMR, hiki i ka ʻeha nui a i ʻole ka hoʻonui ʻana ke hōʻike i nā pilikia e like me ka perforation a i ʻole ke kahe nui.

Pono nā hōʻailona o ke kahe nui i ka nānā ʻana i ka lāʻau lapaʻau koke. Aia kēia mau mea i ka luaʻi ʻana i ke koko, ka hala ʻana i nā noho ʻeleʻele a i ʻole ke koko, ka manaʻo ʻana i ka ʻū a i ʻole ka nāwaliwali, a i ʻole ka puʻuwai wikiwiki. Hiki i ke kahe koko liʻiliʻi ke hana i ka hoʻololi iki ʻana i ke kala i loko o kāu noho, akā ʻike maʻamau ke kahe nui.

Hiki i ke kuni ma luna o 101°F (38.3°C) a i ʻole nā haʻalulu mau ke hōʻike i ka maʻi. ʻOiai he mea maʻamau, pono nā maʻi ma hope o ke kaʻina hana i ka lāʻau lapaʻau me nā lāʻau antibiotic e pale ai i nā pilikia koʻikoʻi.

Hiki i ka pilikia ʻana a i ʻole ka nausea nui a me ka luaʻi ke hōʻike i ka pehu a i ʻole ka hana ʻana i ka stricture. ʻOi aku ka hopohopo o kēia mau hōʻailona inā hana lākou i kekahi mau lā ma hope o ke kaʻina hana a i ʻole e hoʻonui mālie i ka manawa.

E hahai i kāu mau manawa i hoʻonohonoho ʻia inā maikaʻi ʻoe. Pono kāu kauka e nānā i kāu holomua hoʻōla a kūkākūkā i nā hopena pathology. Kōkua kēia mau kipa i ka hoʻolālā ʻana i nā hoʻolālā mākaʻikaʻi kūpono no ka wā e hiki mai ana.

Nīnau pinepine ʻia e pili ana i ka Endoscopic Mucosal Resection

Q.1 He mea pono anei ka Endoscopic Mucosal Resection no ka maʻi maʻi i ke kahua mua?

ʻAe, he mea pono loa ka EMR no nā maʻi maʻi i ke kahua mua i ʻaʻole i laha ma mua o ka mucosa. Hōʻike nā haʻawina i nā helu hoʻōla ma mua o 95% no nā maʻi maʻi ʻōpū a me ka esophagus i koho pono ʻia. ʻO ke kī, ʻo ka hopu ʻana i kēia mau maʻi maʻi i ka wā e paʻa ana lākou i ka papa luna o ka ʻiʻo.

Aia ka holomua i ke koho ʻana i ka mea maʻi a me ka mākaukau. E hoʻohana kāu kauka i nā kiʻi a i kekahi manawa nā biopsies mua e hōʻoia i ka maʻi maʻi i ke kahua mua maoli ma mua o ka ʻōlelo ʻana i ka EMR. Ke hana pololei ʻia ma nā moho kūpono, hiki i ka EMR ke like ka pono me ke ʻoki ʻana me ka liʻiliʻi o ka trauma i kou kino.

Q.2 Hoʻokumu anei ka EMR i nā pilikia digestive lōʻihi?

ʻAʻole ʻike ka hapa nui o nā mea maʻi i nā pilikia digestive lōʻihi ma hope o ka EMR. Hoʻolālā ʻia ke kaʻina hana e wehe wale i ka ʻiʻo maʻi me ka mālama ʻana i ka hana digestive maʻamau. Hoʻōla maʻamau kou ʻōpū i loko o kekahi mau pule, e hoʻi ana i ka hana maʻamau.

I kekahi manawa, hiki ke hoʻomohala ʻia nā strictures inā wehe ʻia nā wahi nui o ka ʻiʻo. Eia naʻe, pane maikaʻi kēia mau wahi i hoʻopaʻa ʻia i nā kaʻina hana e hohola mālie ana. E nānā kāu kauka i kēia hiki i ka wā o nā kipa ma hope a mālama koke inā loaʻa.

Q.3 Pehea ka pinepine e pono ai iaʻu nā endoscopies ma hope o ka EMR?

Aia nā papa hana ma hope o ka mea i wehe ʻia a me nā hopena pathology. No nā kūlana precancerous, pono paha ʻoe i ka nānā ʻana i kēlā me kēia 3-6 mahina i ka wā mua, a laila i kēlā me kēia makahiki inā ʻaʻole e kū mai nā pilikia. Pono pinepine nā hihia maʻi maʻi mua i ka nānā pinepine ʻana, i kekahi manawa i kēlā me kēia 3 mahina no ka makahiki mua.

E hana kāu kauka i kahi hoʻolālā mālama pilikino e pili ana i kāu kūlana kūikawā. Kōkua kēia mālama mau ʻana i ka ʻike ʻana i nā mea e hana hou ana i ka wā mua a ʻike i nā wahi maʻamau hou e hiki ke ulu. Manaʻo ka hapa nui o nā mea maʻi i ka maluhia o ka noʻonoʻo e pono ai ka pilikia o nā loiloi maʻamau.

Q.4 Hiki ke hana hou ʻia ka EMR inā hoʻi mai ka maʻi ʻaʻai?

ʻAe, hiki ke hana hou ʻia ka EMR inā hoʻi mai ka maʻi ʻaʻai ma kahi like a i ʻole e ulu ana ma nā wahi hou. Eia naʻe, pili ka hiki ke hana i ka nui o ka hana hou ʻana a me ke kūlana o ka ʻiʻo a puni. Hiki i ka ʻiʻo ʻeha mai nā kaʻina hana mua ke paʻakikī i ka hana hou ʻana i ka EMR.

E loiloi pono kāu kauka i kēlā me kēia kūlana. I kekahi manawa ʻo ka EMR hou ka koho maikaʻi loa, aʻo nā hihia ʻē aʻe e pōmaikaʻi mai nā lāʻau lapaʻau ʻē aʻe e like me ka radiofrequency ablation a i ʻole ke ʻoki ʻana. ʻO ka nūhou maikaʻi, ʻaʻole maʻamau ka hana hou ʻana ma hope o ka EMR kūleʻa.

Q.5 He ʻeha ka EMR i ka wā a i ʻole ma hope o ke kaʻina hana?

ʻAʻole ʻoe e ʻeha i ka wā EMR no ka mea e loaʻa iā ʻoe ka sedation e mālama iā ʻoe i ka ʻoluʻolu a me ka hoʻomaha. ʻAʻole hoʻomanaʻo ka hapa nui o nā mea maʻi i ke kaʻina hana. Mālama pono ʻia ka sedation e hōʻoia i ka noho ʻana o ʻoe me ka ʻeha ʻole i ke kaʻina hana.

Ma hope o ke kaʻina hana, hiki iā ʻoe ke ʻike i kekahi ʻoluʻolu māmā a i ʻole ka pehu ʻana i ka wā e pau ai ka sedation. Manaʻo maʻamau kēia e like me ka maʻi ʻai māmā a hoʻoponopono i loko o hoʻokahi a ʻelua paha lā. E hāʻawi kāu kauka i nā lāʻau lapaʻau inā pono, ʻoiai ka hapa nui o nā mea maʻi e ʻike i nā koho ma luna o ka pāʻani e lawa ai no kekahi ʻoluʻolu.