Ni iki cyitwa Endoscopic Mucosal Resection? Intego, Uburyo bwo gukora & Ibivamo

Endoscopic mucosal resection (EMR) ni uburyo butagira ingaruka nyinshi bukoreshwa mu gukuraho imitsi idasanzwe mu rukuta rw'inzira yo mu gifu. Bitekereze nk'uburyo bwiza abaganga bakoresha bwo gukuraho ahantu habi neza batagombye kubaga bikomeye. Ubu buryo bufasha kuvura kanseri zo mu ntangiriro ndetse n'imitsi itaratera kanseri mu muhogo wawe, mu gifu, cyangwa muri kolon mugihe bakomeza kubungabunga imitsi y'ubuzima ikikije.

Ni iki cyitwa Endoscopic Mucosal Resection?

Endoscopic mucosal resection ni uburyo bwihariye aho abaganga bakoresha urushinge rworoshye rufite kamera (endoscope) kugirango bakureho imitsi idasanzwe imbere mu nzira yo mu gifu cyawe. Ubu buryo bugamije gusa mucosa, ariyo gice cy'imbere cy'imitsi ikora urukuta rw'inzira yo mu gifu cyawe.

Mugihe cya EMR, muganga wawe ateranya umuti wihariye munsi y'imitsi idasanzwe kugirango uyikure mu bice byimbitse. Ibi bituma habaho umutekano urinda urukuta rw'imitsi ikora imitsi. Hanyuma, bakoresha uruziga rw'umugozi cyangwa ikindi gikoresho gikatira kugirango bakureho imitsi yazamuwe neza.

Ubushishozi bw'ubu buryo buri mu buryo bukoreshwa. Bitandukanye no kubaga bisanzwe bisaba gukata bikomeye, EMR ikora kuva imbere hanze binyuze mu myobo isanzwe y'umubiri. Ibi bivuze ko umubiri wawe utazakomereka cyane kandi ugakira vuba.

Kuki Endoscopic Mucosal Resection ikorwa?

EMR ikora nk'igikoresho cyo gusuzuma no kuvura indwara zitandukanye mu nzira yo mu gifu cyawe. Muganga wawe ashobora kugusaba ubu buryo mugihe babonye imitsi idasanzwe ikeneye gukurwaho ariko itasaba kubaga bikomeye.

Impamvu isanzwe ya EMR ni ukurwanya kanseri zo mu ntangiriro zitarenga mucosa. Izi kanseri zikiri mu gice cyo hejuru, zikaba arizo zikwiriye neza ubu buryo butagira ingaruka nyinshi. Kanseri yo mu gifu yo mu ntangiriro, kanseri yo mu muhogo, na kanseri zimwe na zimwe za kolon akenshi zikira neza na EMR.

Ibyo bitera kanseri na byo birafashwa n'ubu buvuzi. Umurwanzirizo wa Barrett ufite ibimenyetso bikomeye bya dysplasia, polyp nini zo mu mara manini, na adenoma zo mu gifu byose bishobora kuvurwa neza na EMR. Muganga wawe ashobora gukuraho ibi byiyongera bishobora guteza akaga mbere y'uko biba kanseri.

Rimwe na rimwe, EMR ifasha no mu gupima. Iyo ibizamini byerekana ishusho bitashobora kumenya niba igice cy'umubiri gifite kanseri, gukuraho burundu binyuze muri EMR bituma gipimwa neza hakoreshejwe mikorosikopi. Ibi bituma ikipe yawe y'abaganga ibona ishusho isobanutse y'icyo bari gukora.

Ni iki gikorerwa mu kuvura hakoreshejwe Endoscopic Mucosal Resection?

Uburyo bwa EMR busanzwe bukorwa mu kigo cy'ubuvuzi bw'indwara zo mu nda cyangwa mu bitaro. Uzaruhurwa kugira ngo ugume wumva neza kandi utuje mu gihe cyose cy'inzira, isanzwe imara iminota 30 kugeza ku masaha 2 bitewe n'uburyo bigoye.

Muganga wawe atangira ashyira endoscope mu kanwa kawe (ku gice cyo hejuru cy'inzira yo mu gifu) cyangwa mu rukururuku (ku buryo bwo mu mara manini). Uru rubo rworoheje rukubiyemo kamera itanga ishusho isobanutse y'ahantu hagamijwe. Iyo bamaze kubona igice cy'umubiri kidahwitse, baragisuzuma neza kugira ngo bemeze ko gikwiriye EMR.

Icyiciro cyo gutera urushinge kiza gikurikira. Muganga wawe atera urushinge rwihariye rukubiyemo umuti wa saline, rimwe na rimwe hamwe na epinephrine cyangwa methylene blue, mu buryo butaziguye munsi y'igice cy'umubiri kidahwitse. Uru rushinge rurema umusego w'amazi uzamura igice cy'umubiri kure y'ibice byimbitse by'imitsi, bigatuma gukuraho biba byoroshye.

Uburyo butandukanye bushobora kurangiza gukuraho nyakuri. Uburyo busanzwe bukoresha umugozi, ari uruziga ruto rw'umugozi ruzenguruka igice cy'umubiri cyazamutse. Muganga wawe akaza uruziga hanyuma agashyiraho umuriro w'amashanyarazi kugira ngo ateme igice cy'umubiri neza. Ku bikomere bito, bashobora gukoresha ibikoresho byihariye cyangwa imipanga.

Nyuma yo gukuraho, muganga wawe asuzuma neza ahantu hose havuye amaraso akavura niba bibaye ngombwa. Bashobora gukoresha utuntu twa clips cyangwa bakoreshe umuriro w'amashanyarazi mu gufunga imitsi y'amaraso. Igice cyakuweho kijyanwa muri laboratwari isuzuma indwara kugira ngo gisuzumwe neza.

Ni gute witegura kubagwa kwa Endoscopic Mucosal Resection?

Kwitegura EMR bitandukanye bitewe n'igice cy'inzira yawe yo mu gifu gikeneye kuvurwa. Muganga wawe azaguha amabwiriza yihariye yagenewe uko urugero rwawe rumeze, ariko hariho amabwiriza rusange akoreshwa mu buryo bwinshi.

Gusiba kurya bisanzwe bisabwa mbere ya EMR. Kubijyanye n'inzira yo hejuru yo mu gifu, ugomba guhagarika kurya no kunywa byibuze amasaha 8 mbere y'uko bikorwa. Ibi bituma igifu cyawe kiba cyuzuye, bitanga ishusho isobanutse kandi bigabanya ibyago byo kugira ibibazo.

Niba uri gukorerwa colon EMR, kwitegura amara birahinduka ibintu by'ingenzi. Uzakenera gukurikiza imirire yihariye no gufata imiti yo gukora isuku mu mara yawe rwose. Ubu buryo busanzwe butangira iminsi 1-2 mbere y'uko bikorwa kandi bugizwe no kunywa ibisubizo byihariye bifasha gukuraho imyanda yose.

Guhindura imiti birashobora kuba ngombwa. Imiti igabanya amaraso nka warfarin cyangwa aspirine birashobora kuba ngombwa guhagarikwa iminsi myinshi mbere y'uko bikorwa kugira ngo bagabanye ibyago byo kuva amaraso. Ariko, ntuzigere uhagarika imiti utabonye amabwiriza yihariye ava kwa muganga wawe, kuko indwara zimwe na zimwe zisaba kuvurwa buri gihe.

Gutegura uburyo bwo gutwara ni ngombwa kuko uzahabwa imiti igabanya ubwenge. Teganya ko hari umuntu uzagutwara nyuma y'uko bikorwa, kuko imiti ishobora kugira ingaruka ku gitekerezo cyawe n'ubushobozi bwawe mu masaha menshi.

Ni gute usoma ibisubizo byawe bya Endoscopic Mucosal Resection?

Gusobanukirwa ibisubizo byawe bya EMR bikubiyemo ibintu bibiri by'ingenzi: ibyavuye mu bikorwa byahise bikorwa n'itangazo ry'indwara rikurikira. Muganga wawe azasobanura ibintu byombi kugira ngo agufashe gusobanukirwa icyakozwe n'icyo gikurikira.

Ibyavuyeho byihuse byibanda ku gutsinda mu bya tekiniki. Muganga wawe azakubwira niba bagize icyo bageraho mu gukuraho burundu urugingo rutari rusanzwe rufite imipaka isobanutse. Gukuraho burundu bisobanura ko urugingo rutari rusanzwe rugaragara rwakuweho rwose, mugihe imipaka isobanutse yerekana urugingo ruzima ruzengurutse aho bakuyeho urugingo.

Raporo y'ubuvuzi itanga ibisobanuro birambuye ku rugingo rwakurweho. Iri sesengura mubisanzwe rifata iminsi 3-7 kandi rigahishura neza ubwoko bw'uturemangingo turimo, niba kanseri ihari, n'uburyo impinduka zidasanzwe zigera kure. Umuganga w'indwara kandi yemeza niba imipaka ifite indwara neza.

Ibyerekeye ibyiciro biba ngombwa niba kanseri ihari. Raporo y'ubuvuzi izasobanura ubujyakuzimu bwa kanseri yateye niba yarakwiriye mu miyoboro y'imitsi cyangwa imitsi y'amaraso. Iri somo rifasha kumenya niba hakenerwa izindi mvura.

Muganga wawe azategura gahunda yo gusubira mu kigo kugirango baganire ku byavuyeho byuzuye kandi bakore gahunda yo gukurikirana. Nubwo EMR yatsinze, ibizamini bisanzwe bya endoskopi mubisanzwe birasabwa kugirango barebe niba hari ikigaruka cyangwa ahantu hashya hatari hasanzwe.

Ni ibihe bintu bishobora gutuma ukeneye gukurwaho urugingo rwo muri endoskopi?

Ibintu byinshi bishobora kongera amahirwe yawe yo kurwara indwara zishobora gusaba EMR. Kumva ibi bintu bifasha gufata ibyemezo bifitiye akamaro ku bijyanye no gupima no gukumira.

Imyaka igira uruhare runini mu kanseri yo mu nzira yo mu gifu n'indwara zitaratera kanseri. Inzira nyinshi za EMR zikorwa ku barwayi barengeje imyaka 50, kuko gukura kw'urugingo rutari rusanzwe biba ibisanzwe uko imyaka igenda. Ariko, abarwayi bato bafite ibintu byihariye bishobora no gukenera iyi mvura.

Imibereho y'ubuzima igira uruhare runini mu bibazo byo mu nzira yo mu gifu. Kunywa itabi no kunywa inzoga nyinshi byongera cyane ibyago byawe byo kurwara kanseri yo mu muhogo no mu gifu. Ibi bintu bishobora gutera umuvumo udakira n'ubyangizi bw'uturemangingo bishobora gukenera ubufasha bwa EMR.

Indwara ziramba zo mu gifu akenshi zibanziriza gukenera EMR. Esophagus ya Barrett, ikomoka ku kantu kamara igihe kirekire, gashobora gutera dysplasia na kanseri yo hambere. Indwara zifata urwungano rw'igifu nk'ibicurane bya ulcerative colitis nazo zongera ibyago bya kanseri mu duce twafashwe.

Amateka y'umuryango n'ibintu bya genetike bigira uruhare mu byago byawe. Kugira abavandimwe bafite kanseri zo mu nzira y'igifu bishobora kongera amahirwe yo kurwara indwara nk'izo. Ibimenyetso bya genetike, nk'uko bigaragara muri familial adenomatous polyposis, byongera cyane imiterere ya polyp na kanseri.

Uburyo bwo kurya bugira ingaruka ku buzima bw'igifu bw'igihe kirekire. Imirire irimo ibiryo byinshi bikorwa, inyama zitukura, kandi irimo imbuto n'imboga nkeya bishobora gutuma habaho indwara zisaba EMR. Ku rundi ruhande, imirire irimo fibre nyinshi na antioxidants ishobora gutanga uburinzi.

Ni izihe ngaruka zishobora guterwa no gukuraho ibice byo mu gifu bya endoscopic?

Nubwo EMR muri rusange itagira ingaruka, gusobanukirwa ingaruka zishobora kuvuka bifasha gufata ibyemezo bifitiye akamaro no kumenya ibimenyetso byo kwitonda. Ingaruka nyinshi ni nke kandi zirashobora gucungwa iyo zibayeho.

Ukuva amaraso ni ingaruka isanzwe, bibaho mu bikorwa biri hagati ya 1-5%. Ukuva amaraso guto akenshi gusa ubwako cyangwa hamwe n'imiti yoroheje mu gihe cy'igikorwa. Ariko, ukuva amaraso gukomeye bishobora gusaba ubufasha bwiyongera nk'ibice, imiti y'urushinge, cyangwa gake, kubagwa.

Perforation, nubwo bidakunze kubaho, itera ibyago bikomeye. Ibi bibaho iyo uburyo bwo gukuraho butera icyuho mu rukuta rw'inzira y'igifu. Ibyago bitandukanye bitewe n'ahantu, hamwe na perforation ya colon ikunze kugaragara kurusha perforation yo mu nzira yo hejuru y'igifu. Perforation ntoya nyinshi zirashobora kuvurwa hamwe n'ibice mu gihe cy'igikorwa.

Infesiyo ntikunze kubaho nyuma ya EMR, ariko birashoboka iyo bagiteri zinjira mu maraso cyangwa mu bice byegereyeho. Muganga wawe ashobora kwandika imiti igabanya ubukana niba ufite indwara zimwe na zimwe z'umutima cyangwa ibibazo by'ubudahangarwa bigabanya ibyago byo kwandura.

Uko kwiyongera kw'imitsi bishobora gutera nyuma y'ibyumweru cyangwa amezi nyuma ya EMR, cyane cyane iyo hakuwe uduce tunini tw'imitsi. Uku kugabanuka kw'inzira y'igogora bishobora gutera ingorane zo kumira cyangwa kubangamira urugendo rw'amara. Ubusanzwe, ibibazo byinshi by'imitsi bikemurwa neza no gukoresha uburyo bwo kuyagura buhoro.

Gukuraho ibice bituzuye rimwe na rimwe bibaho iyo hakurwa ibice binini cyangwa bigoye gukuraho. Iyo ibi bibaye, muganga wawe ashobora kugusaba kongera gukora EMR, gukoresha ubundi buryo bwo kuvura, cyangwa kugukurikiranira hafi bitewe n'ibisubizo by'uburwayi.

Ni ryari nkwiriye kubona muganga nyuma yo gukuraho imitsi yo mu nda hakoreshejwe ikoranabuhanga?

Kumenya igihe cyo kuvugisha ikipe yawe y'ubuzima nyuma ya EMR bifasha kwemeza gukira neza no kumenya hakiri kare ibibazo byose bishobora kuvuka. Abarwayi benshi barakira neza, ariko ibimenyetso bimwe na bimwe bisaba kwitabwaho byihuse.

Urubavu rukabije rurushaho cyangwa ntirukire n'imiti yategetswe rusaba isuzuma ryihuse. Nubwo kutumva neza biba bisanzwe nyuma ya EMR, kuribwa cyane cyangwa kurushaho gushobora kwerekana ibibazo nk'ubwobo cyangwa kuva amaraso menshi.

Ibimenyetso byo kuva amaraso menshi bisaba ubufasha bw'ubuvuzi bwihuse. Ibi birimo kuruka amaraso, kunyara ibinyamara byirabura cyangwa bifite amaraso, kumva urujijo cyangwa guta umutwe, cyangwa kugira umutima utera cyane. Kuva amaraso gake gashobora gutera ibara rito mu binyamara byawe, ariko kuva amaraso menshi mubisanzwe biragaragara.

Ubukana burenze 101°F (38.3°C) cyangwa guhinda umushyitsi bikomeza bishobora kwerekana icyorezo. Nubwo bidasanzwe, indwara ziterwa nyuma y'uburyo zikeneye kuvurwa n'imiti yica mikorobe kugirango birinde ibibazo bikomeye.

Ingorane zo kumira cyangwa isesemi ikabije no kuruka bishobora kwerekana kubyimba cyangwa gukora imitsi. Ibi bimenyetso birakomeye cyane niba byigaragaza nyuma y'iminsi myinshi nyuma y'uburyo cyangwa bigenda birushaho uko igihe gishize.

Kurikiza gahunda yawe y'amasaha yagenwe n'ubwo wumva umeze neza. Muganga wawe akeneye gukurikirana uko ukira no kuganira ku bisubizo by'uburwayi. Uku gusura bifasha kandi gutegura ingamba zikwiye zo gukurikiranira hafi mu gihe kizaza.

Ibibazo Bikunze Kubazwa ku bijyanye no gukuraho urugingo rw'imbere mu nda hifashishijwe icyuma cy'ubuvuzi

I.1 Ese gukuraho urugingo rw'imbere mu nda hifashishijwe icyuma cy'ubuvuzi bifasha mu kurwanya kanseri yo mu ntangiriro?

Yego, EMR ifasha cyane mu kurwanya kanseri zo mu ntangiriro zitarenga urugingo rw'imbere mu nda. Ubushakashatsi bwerekana ko imiti ivura kanseri irenze 95% ku kanseri zo mu ntangiriro zo mu gifu no mu muhogo. Ikintu cy'ingenzi ni ukumenya izo kanseri igihe zikiri mu gice cyo hejuru cy'urugingo.

Intsinzi iterwa no guhitamo abarwayi neza no gukoresha uburyo bwiza. Muganga wawe azakoresha ishusho rimwe na rimwe no kubaga mbere yo kugusuzuma kugirango amenye neza niba kanseri iri mu ntangiriro mbere yo kugusaba EMR. Iyo bikozwe neza ku bantu babikwiriye, EMR irashobora kugira akamaro nk'uko kubaga bikorwa bitabangamiye umubiri wawe.

I.2 Ese EMR itera ibibazo byo mu gihe kirekire byo mu nzira y'igogora?

Abantu benshi ntibagira ibibazo byo mu gihe kirekire byo mu nzira y'igogora nyuma ya EMR. Iyi nzira igamije gukuraho gusa urugingo rurwaye mugihe urugingo rusanzwe rukora neza. Urugingo rwawe rw'igogora rukunda gukira mu byumweru bike, rugasubira mu buryo busanzwe.

Gake, imitsi irashobora kwangirika niba ibice binini by'urugingo byakuweho. Ariko, ibi bice byagabanutse bikunda gusubizwa neza mu buryo bwo kurambura buhoro. Muganga wawe azagenzura ibi bishoboka mugihe cyo gusuzuma nyuma y'ubuvuzi kandi abivure vuba niba bibayeho.

I.3 Ni kangahe nkeneye gukurikiranwa nyuma ya EMR?

Ingengabihe yo gukurikirana iterwa nicyo cyakuweho n'ibisubizo by'uburwayi. Kubijyanye n'indwara zitaratera kanseri, ushobora gukenera gukurikiranwa buri mezi 3-6 mbere, hanyuma buri mwaka niba nta bibazo bibayeho. Ibyago bya kanseri yo mu ntangiriro bikunze gusaba gukurikiranwa kenshi, rimwe na rimwe buri mezi 3 mumwaka wa mbere.

Muganga wawe azagutegurira gahunda yo kugenzura yihariye ishingiye ku miterere yawe. Uku kugenzura guhoraho bifasha kumenya kare niba indwara yongeye kugaruka no kumenya ahantu hashya hatari busanzwe hashobora kwaduka. Abantu benshi barabona ko amahoro yo mu mutima abikuramo akwiye imbogamizi zo kugenzurwa buri gihe.

Q.4 Ese EMR irashobora gusubirwamo niba kanseri yongeye kugaruka?

Yego, EMR akenshi irashobora gusubirwamo niba kanseri yongeye kugaruka ahantu hamwe cyangwa ikaduka ahantu hashya. Ariko, ibishoboka biterwa n'uburyo kanseri yongeye kugaruka n'imiterere y'igice cy'umubiri gikikije. Inkovu zaturutse ku bindi bikorwa byabaye mbere na mbere rimwe na rimwe bishobora gutuma gusubiramo EMR bigorana.

Muganga wawe azasuzuma neza buri kibazo ku giti cya cyo. Rimwe na rimwe gusubiramo EMR niyo nzira nziza, mu gihe ibindi bihe byashobora kungukirwa n'ubundi buryo bwo kuvura nko gukoresha radiofrequency ablation cyangwa kubaga. Inkuru nziza ni uko kanseri yongeye kugaruka nyuma ya EMR yagenze neza bidakunze kubaho.

Q.5 Ese EMR irababaza mu gihe cyangwa nyuma y'igikorwa?

Ntuzumva ububabare mu gihe cya EMR kuko uzahabwa imiti igufasha koroherwa kandi ukiruhuka. Abantu benshi ntibibuka na gato icyo gikorwa. Imiti igufasha koroherwa igenzurwa neza kugira ngo wemeze ko utababara mu gihe cyose cy'igikorwa.

Nyuma y'igikorwa, ushobora kugira ibibazo bito cyangwa kubyimba mu gihe imiti igufasha koroherwa igenda ishira. Ibi akenshi bimeze nk'uburwayi bworoshye bw'igifu kandi bikavaho mu munsi umwe cyangwa ibiri. Muganga wawe azatanga imiti igabanya ububabare niba bikenewe, nubwo abantu benshi babona ko imiti itangwa itagombye uruhushya rwa muganga ihagije ku bibazo byose.