He aha te tango mucosal endoscopic? Te kaupapa, ngā taumata/tikanga & ngā hua

Ko te tango mucosal endoscopic (EMR) he tikanga iti-whakauru e tango ana i ngā kiko hē mai i te rarangi o tō ara kūnatu. Whakaarohia he huarahi tika mā ngā tākuta ki te hiki me te tango i ngā wāhi raruraru me te kore e pokanga nui. Mā tēnei tikanga e āwhina ana ki te rongoā i ngā mate pukupuku i te wā tuatahi me ngā tipu i mua i te mate pukupuku i roto i tō kōpū, puku, rānei, kōpū rānei, me te tiaki i ngā kiko hauora huri noa i a rātou.

He aha te tango mucosal endoscopic?

Ko te tango mucosal endoscopic he tikanga motuhake e whakamahi ana ngā tākuta i tētahi ngongo ngawari me te kāmera (endoscope) ki te tango i ngā kiko hē mai i roto i tō pūnaha kūnatu. Ko te tikanga e aro ana ki te mucosa anake, koinei te paparanga o roto rawa o ngā kiko e rarangi ana i tō ara kūnatu.

I te wā o te EMR, ka werohia e tō tākuta tētahi otinga motuhake i raro i ngā kiko hē hei hiki i a rātou mai i ngā paparanga hōhonu. Mā tēnei ka hangaia he urunga haumaru e tiaki ana i te pakitara uaua o raro. Muri iho, ka whakamahi rātou i tētahi rārangi waea, i tētahi atu taputapu tapahi rānei, ki te tango i ngā kiko kua hiki ake.

Ko te ataahua o tēnei huarahi kei roto i tōna tika. Kāore i rite ki te pokanga tuku iho e hiahia ana i ngā tapahi nui, ka mahi te EMR mai i roto ki waho mā ngā tuwhera tūturu o te tinana. Ko te tikanga he iti ake te whara ki tō tinana me te tere ake o te whakaora.

He aha te take i mahia ai te tango mucosal endoscopic?

He taputapu tātaritanga me te rongoā te EMR mō ngā momo āhuatanga i roto i tō pūnaha kūnatu. Ka tūtohu pea tō tākuta i tēnei tikanga i te wā e kitea ana e rātou ngā kiko hē e hiahia ana kia tangohia engari kāore e hiahia ana i te pokanga nui.

Ko te take tino noa mō te EMR ko te rongoā i ngā mate pukupuku i te wā tuatahi kāore anō kia horahia atu i tua atu i te mucosa. Kei te noho tonu ēnei mate pukupuku ki te paparanga o te mata, e hanga ana i a rātou hei kaitono tino pai mō tēnei huarahi iti-whakauru. Ko te mate pukupuku puku i te wā tuatahi, te mate pukupuku kōpū, me ētahi mate pukupuku kōpū ka pai te urupare ki te EMR.

He pai hoki nga tikanga i mua i te mate pukupuku mai i tenei maimoatanga. Ka taea te whakahaere pai i te esophagus o Barrett me te dysplasia nui, nga polyps nui o te koroni, me nga adenomas gastric me te EMR. Ka taea e to taakuta te tango i enei tipu morearea i mua i te noho mate pukupuku.

I etahi wa, ka awhina ano te EMR ki te tātaritanga. Ina kore e taea e nga whakamatautau whakaahua te whakatau mena he mate pukupuku te kiko, ma te tango katoa ma te EMR ka taea te tirotiro i raro i te karu. Ma tenei ka hoatu ki to roopu rongoa te pikitia marama o ta ratou e mahi ana.

He aha te tikanga mo te Endoscopic Mucosal Resection?

Ko te tikanga EMR te nuinga ka puta i roto i te pokapū endoscopy outpatient, i te hōhipera ranei. Ka whiwhi koe i te rongoa hei whakamarie me te whakangawari i a koe puta noa i te tukanga, e 30 meneti ki te 2 haora te roa i runga i te uaua.

Ka timata to taakuta ma te whakauru i te endoscope ma to waha (mo te ara kena o runga) ranei te nono (mo nga tikanga koroni). Kei roto i te ngongo ngawari he kamera e whakarato ana i te tirohanga marama o te waahi e whaaia ana. Kia kitea e ratou te kiko rereke, ka ata tirotirohia kia mohio he pai mo te EMR.

Ka whai mai te wahanga werohanga. Ka werohia e to taakuta he otinga motuhake kei roto te tote, i etahi wa me te epinephrine, te methylene blue ranei, i raro tonu i te kiko rereke. Ma tenei werohanga ka hanga he urunga wai e hiki ana i te kiko mai i nga paparanga uaua hohonu, ka pai ake te tango.

He maha nga tikanga ka taea te whakaoti i te tango. Ko te huarahi tino noa e whakamahi ana i te mahanga, he waea angiangi e karapoti ana i te kiko hiki. Ka whakakaha to taakuta i te koropiko me te whakamahi i te ia hiko hei tapahi i te kiko. Mo nga whara iti, ka whakamahi pea ratou i nga forceps motuhake, i nga maripi ranei.

Whai muri i te tango, ka ata tirohia e tō tākuta te wāhi mō ngā toto, ā, ka rongoa i te mea e tika ana. Ka whakamahi pea rātou i ngā topenga, i te au hiko rānei hei hiri i ngā oko toto. Ka haere te kiko i tangohia ki te taiwhanga pathology mō te tātaritanga taipitopito.

Me pēhea te whakarite mō tō Whakawātea Mucosal Endoscopic?

He rerekē te whakarite mō te EMR i runga i te wāhanga o tō pūnaha kūnatu e hiahia ana ki te rongoā. Ka hoatu e tō tākuta ngā tohutohu motuhake i hangaia mō tō āhuatanga, engari e pā ana ētahi aratohu whānui ki te nuinga o ngā tikanga.

Ko te nohopuku te tikanga e hiahiatia ana i mua i te EMR. Mō ngā tikanga o te ara kūnatu o runga, me mutu te kai me te inu i te iti rawa 8 hāora i mua. Mā tēnei e whakarite kia kore he kai i tō puku, e whakarato ana i te tirohanga mārama me te whakaiti i te tūponotanga o ngā raruraru.

Mēnā kei te EMR koe i te koroni, ka whai pānga te whakarite i te whekau. Me whai koe i tētahi kai motuhake me te tango rongoā hei horoi i tō koroni. Ko te tikanga nei ka tīmata i te 1-2 rā i mua i te tikanga, ā, ka uru ki te inu i ngā otinga motuhake hei āwhina i te whakakore i ngā para katoa.

Me whakatika pea ngā rongoā. Ko ngā whakaheke toto pēnei i te warfarin, i te aspirin rānei, me mutu pea te tango i ngā rā i mua i te tikanga hei whakaiti i te tūponotanga o te toto. Heoi, kaua rawa e mutu te tango rongoā me te kore tohutohu mārama mai i tō tākuta, i te mea e hiahia ana ētahi āhuatanga ki te rongoā tonu.

He mea nui ngā whakaritenga waka i te mea ka whiwhi koe i te whakama. Whakaritea kia haere mai tētahi ki te taraiwa i a koe ki te kāinga i muri i te tikanga, i te mea ka pā te rongoā ki tō whakatau me ō urupare mō ētahi hāora.

Me pēhea te pānui i ō Hua Whakawātea Mucosal Endoscopic?

Ko te māramatanga ki ō hua EMR e rua ngā wāhanga matua: ngā kitenga tikanga tonu me te pūrongo pathology e whai ana. Ka whakamāramahia e tō tākuta ngā āhuatanga e rua hei āwhina i a koe ki te mārama ki te mea i tutuki me te aha ka whai ake.

Ko ngā hua tonu e arotahi ana ki te angitu hangarau. Ka kōrero tō tākuta ki a koe mēnā i tutuki i a rātou te tango katoa i ngā kiko koretake me ngā tapa mārama. Ko te tango katoa te tikanga i tangohia katoa ngā kiko koretake e kitea ana, ā, ko ngā tapa mārama e tohu ana i ngā kiko hauora e karapoti ana i te wāhi i tangohia.

Ka whakawhiwhi te pūrongo pathology i ngā kōrero taipitopito mō ngā kiko i tangohia. Ko te tikanga ka roa te tātari nei i te 3-7 rā, ā, ka whakaatu i te momo pūtau tika e noho ana, mēnā he mate pukupuku, me te hōhonu o te horapa o ngā huringa koretake. Ka whakapūmau hoki te tohunga pathology mēnā he mārama tonu ngā tapa i te mate.

Ka whai wāhi nui ngā kōrero whakataunga mēnā he mate pukupuku. Ka whakaahua te pūrongo pathology i te hōhonu o te uru o te mate pukupuku me te mēnā kua horapa ki ngā oko lymph, ki ngā oko toto rānei. Mā ēnei kōrero e āwhina i te whakatau mēnā e hiahiatia ana he rongoā atu.

Ka whakarite tō tākuta i tētahi hui whai muri ki te kōrero mō ngā hua katoa me te waihanga i tētahi mahere aroturuki. Ahakoa te angitu o te EMR, e taunakitia ana te endoscopy aroturuki i te wā tonu ki te mātakitaki i ngā wāhi koretake hou, i te hokinga mai rānei.

He aha ngā Āhuatanga Mōrearea mō te Hiahia ki te Tango Mucosal Endoscopic?

He maha ngā āhuatanga ka whakanui i tō tūponotanga ki te whakawhanake i ngā āhuatanga e hiahia ana ki te EMR. Mā te māramatanga ki ēnei āhuatanga mōrearea e āwhina i a koe ki te whakatau i ngā whakataunga mō te arotake me te ārai.

He wāhi nui te tau ki ngā mate pukupuku o te ara kūnatu me ngā āhuatanga i mua i te mate pukupuku. Ko te nuinga o ngā tikanga EMR ka mahia ki ngā tūroro neke atu i te 50 tau, i te mea ka nui ake te tipu o ngā kiko koretake i te wā e pakeke haere ana. Heoi, ka hiahia pea ngā tūroro taitamariki me ngā āhuatanga mōrearea motuhake ki tēnei rongoā.

He nui te whai wāhi o ngā āhuatanga o te noho ki ngā raruraru o te ara kūnatu. Ko te kai paipa me te inu waipiro nui ka whakanui i tō tūponotanga ki ngā mate pukupuku o te esophagus me te puku. Ka taea e ēnei mea te pā mai i te mumura mau tonu me te kino o te pūtau, ā, ka hiahiatia pea te wawaotanga EMR.

He maha ngā wā ka mua ngā āhuatanga kūnatu roa i te hiahia mō te EMR. Ka taea e te esophagus o Barrett, e puta mai ana i te waikawa reflux mō te wā roa, te haere ki te dysplasia me te mate pukupuku wawe. Ko ngā mate puku mumura pēnei i te ulcerative colitis ka piki ake hoki te tūponotanga o te mate pukupuku i ngā wāhi e pā ana.

Ka pā te hītori whānau me ngā āhuatanga ira ki tō pūkete tūponotanga. Ko te whai i ngā whanaunga e mate ana i te mate pukupuku kūnatu ka piki ake pea tō tūponotanga ki te whakawhanake i ngā āhuatanga rite. Ko ētahi o ngā mate ira, pēnei i te familial adenomatous polyposis, ka nui ake te hanga polyp me te tūponotanga o te mate pukupuku.

Ka pā ngā tauira kai ki te hauora kūnatu mō te wā roa. Ko ngā kai e nui ana te kai tukatuka, te mīti whero, me te iti o ngā hua me ngā huawhenua ka whai wāhi pea ki ngā āhuatanga e hiahia ana ki te EMR. Engari, ko ngā kai e nui ana te muka me te antioxidants ka whai wāhi ki te tiaki.

He aha ngā raruraru ka puta mai i te Endoscopic Mucosal Resection?

Ahakoa te haumaru o te EMR, mā te māramatanga ki ngā raruraru ka āwhina i a koe ki te whakatau i ngā whakatau mōhio me te mōhio ki ngā tohu whakatūpato. He onge te nuinga o ngā raruraru, ā, ka taea te whakahaere i te wā e puta ana.

Ko te whakaheke toto te raruraru tino noa, e puta ana i te 1-5% o ngā tukanga. He maha ngā wā ka mutu noa te whakaheke toto iti, me ngā rongoā ngawari i te wā o te tukanga. Heoi, ka hiahia pea te whakaheke toto nui ake ki ngā wawaotanga anō pēnei i ngā topenga, te rongoā werohanga, ā, i ētahi wā, te pokanga.

Ko te werohanga, ahakoa he onge, he tūponotanga nui ake. Ka puta tēnei i te wā e hanga ana te tukanga tango i te rua i roto i te pakitara kūnatu. Ka rerekē te tūponotanga i te wāhi, me ngā werohanga kōiwi e noa ana i ngā werohanga kūnatu o runga. Ka taea te rongoā i te nuinga o ngā werohanga iti ki ngā topenga i te wā o te tukanga.

He onge te puta o te mate i muri i te EMR, engari ka taea i te wā e uru ana ngā huakita ki te toto, ki ngā kiko huri noa rānei. Ka tohutohu pea tō tākuta i ngā paturopi mēnā he āhuatanga o te ngākau, he raruraru rānei o te pūnaha ārai mate e piki ake ana te tūponotanga o te mate.

Ka taea te hanga i te hanganga i ngā wiki ki ngā marama i muri i te EMR, ina koa ka tangohia ngā wāhi nui o te kiko. Ko tēnei whāiti o te ara kūnatu ka pā mai i ngā uaua ki te horo, ki te aukati rānei i te kōpū. Ko te nuinga o ngā hanganga ka pai te urupare ki ngā tikanga totoro ngawari.

I ētahi wā ka tūtaki te tango kāore i oti i ngā whara nui, i ngā whara uaua rānei. Ina pēnei, ka tūtohu pea tō tākuta i ētahi atu hui EMR, i ētahi atu rongoā, i te mātakitaki tata rānei i runga i ngā hua o te pathology.

Āhea Au Me Kite i te Tākuta i Muri i te Tangohanga Mucosal Endoscopic?

Ko te mōhio ki te wā ki te whakapā atu ki tō rōpū hauora i muri i te EMR ka āwhina i te whakaora tika me te kite wawe i ngā raruraru. Ko te nuinga o ngā tūroro ka ora pai, engari ko ētahi tohumate e tika ana kia aro tonu.

Ko te mamae nui o te puku e kaha ake ana, e kore rānei e pai ake i ngā rongoā kua whakaritea, e hiahia ana kia arotake wawe. Ahakoa he āwangawanga noa i muri i te EMR, ko te mamae nui, te mamae rānei e kaha ake ana, ka tohu pea i ngā raruraru pēnei i te poka, i te toto nui rānei.

Ko ngā tohu o te toto nui e hiahia ana kia aro tonu te rongoā. Kei roto i tēnei ko te ruaki toto, te tuku kūtai mangu, toto rānei, te āhua mōmoe, te ngoikore rānei, te tere o te ngākau. Ko te toto iti ka pā mai i te huringa tae iti i roto i tō kūtai, engari ko te toto nui he mārama tonu.

Ko te kirika i runga ake i te 101°F (38.3°C) te pāmahana rānei, te wiri tonu rānei, ka tohu pea i te mate. Ahakoa he onge, ko ngā mate i muri i te tikanga e hiahia ana kia rongoā ki ngā paturopi hei aukati i ngā raruraru nui ake.

Ko te uaua ki te horo, te whakapairuaki nui, me te ruaki rānei, ka tohu pea i te pūhi, i te hanganga rānei. Ko ēnei tohumate he nui ake te āwangawanga mēnā ka puta mai i ētahi rā i muri i te tikanga, ka kaha ake rānei i te wā.

Whaia ō whakaritenga kua whakaritea ahakoa kei te pai koe. Me mātakitaki tō tākuta i tō haere whakaora, me te kōrero i ngā hua o te pathology. Ka āwhina hoki ēnei haerenga ki te whakamahere i ngā rautaki mātakitaki tika mō te wā anō.

Ngā Pātai Auau mō te Tango Mucosal Endoscopic

Q.1 He whai hua te Tango Mucosal Endoscopic mō te mate pukupuku wāhanga-mua?

Āe, he tino whai hua te EMR mō ngā mate pukupuku wāhanga-mua kāore anō kia horapa atu i tua atu i te mucosa. E whakaatu ana ngā rangahau i ngā reiti rongoa e neke atu ana i te 95% mō ngā mate pukupuku puku me te esophagus wāhanga-mua i tīpakohia tika. Ko te mea nui ko te hopu i ēnei mate pukupuku i te wā e mau tonu ana ki te paparanga o te kiko.

Ka whakawhirinaki te angitu ki te kōwhiri tūroro me te hangarau whai pūkenga. Ka whakamahi tō tākuta i te whakaahua me ētahi wa i ngā biopsy tuatahi hei whakarite kia pono te mate pukupuku i te wāhanga-mua i mua i te tūtohu i te EMR. Ki te mahia tika ana ki ngā kaitono e tika ana, ka taea e te EMR te whai hua pērā i te pokanga me te iti rawa o te whara ki tō tinana.

Q.2 Ka pā mai ngā raruraru keri kai wā-roa i te EMR?

Kāore te nuinga o ngā tūroro e pā ana ki ngā raruraru keri kai wā-roa i muri i te EMR. I hangaia te tikanga ki te tango anake i te kiko tūroro i te wā e tiaki ana i te mahi keri kai noa. Ka ora te ara keri kai i roto i ētahi wiki, ka hoki ki te mahi noa.

I ētahi wā, ka taea te whakawhanake i ngā here ki te tangohia ngā wāhi nui o te kiko. Heoi, ko ēnei wāhi whāiti te nuinga ka pai te urupare ki ngā tikanga totoro ngawari. Ka aroturuki tō tākuta i tēnei tūponotanga i ngā haerenga whai-ake me te rongoa wawe ki te puta mai.

Q.3 Kia pēhea te auau o taku hiahia ki ngā endoscopies whai-ake i muri i te EMR?

Ka whakawhirinaki ngā hōtaka whai-ake ki te aha i tangohia me ngā hua pathology. Mō ngā āhuatanga precancerous, ka hiahia pea koe ki te aroturuki i ngā marama 3-6 i te tīmatanga, katahi ia tau ki te kore he raruraru e puta. Ko ngā keehi mate pukupuku wāhanga-mua te nuinga e hiahia ana ki te aroturuki auau, i ētahi wā ia 3 marama mō te tau tuatahi.

Ka hangaia e tō tākuta tētahi mahere tirotiro whaiaro e hāngai ana ki tō āhuatanga motuhake. Mā tēnei aroturuki tonu e āwhina te kite wawe i ngā tūponotanga ka hoki mai anō, me te tautuhi i ngā wāhi hōu kāore i te pai ka puta pea. E whakaaro ana te nuinga o ngā tūroro he pai te rangimārie o te hinengaro ki te raruraru o ngā arowhai auau.

Q.4 Ka taea te whakahoki anō te EMR mēnā ka hoki mai te mate pukupuku?

Āe, ka taea te whakahoki anō te EMR mēnā ka hoki mai te mate pukupuku i te wāhi kotahi, ka puta rānei i ngā wāhi hōu. Heoi, kei runga i te whānuitanga o te hokinga mai me te āhua o te kiko e tata ana te whaihua. I ētahi wā ka uaua ake te EMR whakahoki anō i te kiko kiko mai i ngā tikanga o mua.

Ka āta arotake tō tākuta i ia āhuatanga takitahi. I ētahi wā ko te EMR whakahoki anō te kōwhiringa pai, engari i ētahi atu wā ka whai hua pea i ngā rongoā kē pēnei i te whakakorenga auau irirangi, i te pokanga rānei. Ko te rongo pai ko te hokinga mai i muri i te EMR angitu he mea kāore i te pāpā.

Q.5 He mamae te EMR i te wā, i muri rānei i te tikanga?

Kāore koe e pōturi i te mamae i te wā o te EMR nā te mea ka whiwhi koe i te rongoā whakamārie e noho ai koe i te pai me te whakangā. Kāore te nuinga o ngā tūroro e mahara ana ki te tikanga. Ka āta aroturukihia te rongoā whakamārie kia noho kore mamae koe i te wā o te tukanga.

I muri i te tikanga, ka pōturi pea koe i tētahi mamae ngawari, i te pupuhi rānei i te wa e ngaro ana te rongoā whakamārie. Ko te tikanga he rite tēnei ki te korenga kai ngawari, ka ngaro i roto i te rā, e rua rānei. Ka whakarato tō tākuta i ngā rongoā mamae mēnā e hiahiatia ana, ahakoa e whakaaro ana te nuinga o ngā tūroro he pai ngā kōwhiringa i runga i te kaute mō tētahi mamae.