Chii chinonzi Endoscopic Mucosal Resection? Chinangwa, Mhando/Maitiro & Mhedzisiro

Endoscopic mucosal resection (EMR) inzira isingapindi zvakanyanya inobvisa tishu isina kujairika kubva mumutsara wekudya kwako. Funga nezvazvo senzira yakarurama yevakuru kuti vanyatso simudza nekubvisa nzvimbo dzine matambudziko pasina kuvhiyiwa kukuru. Iyi nzira inobatsira kurapa kenza yematanho ekutanga uye kukura kwekenza mumutsipa wako, mudumbu, kana ura hukuru uchichengetedza tishu ine hutano yakavapoteredza.

Chii chinonzi Endoscopic Mucosal Resection?

Endoscopic mucosal resection inzira yakakosha uko vanachiremba vanoshandisa chubhu inochinjika ine kamera (endoscope) kubvisa tishu isina kujairika kubva mukati memuviri wako wekudya. Iyi nzira inotarisa chete mucosa, iyo ndiyo yakadzama tishu inotsara nzira yako yekudya.

Munguva yeEMR, chiremba wako anobaya mhinduro yakakosha pasi petishu isina kujairika kuti iisimudze kubva kune dzakadzama. Izvi zvinogadzira cushion yakachengeteka inodzivirira rusvingo rwemhasuru ruri pasi. Zvadaro, vanoshandisa waya loop kana chimwe chishandiso chekucheka kuti vanyatso bvisa tishu yakasimudzwa.

Runako rweiyi nzira runovanda mukururama kwayo. Kusiyana nekuvhiyiwa kwechinyakare kunoda kucheka kukuru, EMR inoshanda kubva mukati kunze kuburikidza nemavhura emuviri echisikigo. Izvi zvinoreva kushungurudzwa kushoma kumuviri wako uye nguva yekupora nekukurumidza.

Nei Endoscopic Mucosal Resection ichiitwa?

EMR inoshanda sechirwere uye chishandiso chekurapa kune mamiriro akasiyana-siyana mumuviri wako wekudya. Chiremba wako angakurudzira iyi nzira pavanowana tishu isina kujairika inoda kubviswa asi isingade kuvhiyiwa kukuru.

Chikonzero chakajairika cheEMR kurapa kenza yematanho ekutanga asina kupararira kupfuura mucosa. Kenza idzi dzichiri dzakavharirwa kunzvimbo yepamusoro, dzichivaita vakakodzera zvakakwana kune iyi nzira isingapindi zvakanyanya. Early gastric cancer, esophageal cancer, uye mamwe marudzi ekenza yeura hukuru anowanzoita zvakanaka kuEMR.

Mamiriro ekutanga kenza anobatsirwawo nekutariswa uku. Barrett's esophagus ine high-grade dysplasia, colon polyps hombe, uye gastric adenomas zvese zvinogona kubatwa zvakanaka neEMR. Chiremba wako anogona kubvisa kukura uku kunogona kuva nenjodzi vasati vava kenza.

Dzimwe nguva, EMR inobatsirawo pakuongorora. Kana bvunzo dzekuongorora dzisingakwanise kuona kana tishu ine kenza, kuibvisa zvachose kuburikidza neEMR kunobvumira kuongororwa kwakadzama pasi pemicroscope. Izvi zvinopa timu yako yekurapa mufananidzo wakajeka wezvavanenge vachibata nazvo.

Ndeipi Maitiro eEndoscopic Mucosal Resection?

Maitiro eEMR anowanzoitika munzvimbo yekunze yeendoscopy kana muchipatara. Iwe uchagamuchira sedation kuti ikuchengetedze uchinyaradzwa uye wakasununguka mukati memaitiro, ayo anowanzoita maminitsi makumi matatu kusvika kumaawa maviri zvichienderana nekuoma.

Chiremba wako anotanga nekuisa endoscope nemuromo wako (kune yepamusoro digestive tract) kana rectum (kune colon procedures). Iyo chubhu inochinjika ine kamera inopa kuona kwakajeka kwenzvimbo inotarwa. Kana vangoona tishu isina kujairika, vanoiongorora zvakanyatsojeka kuti vasimbise kuti yakakodzera EMR.

Nhanho yekujekesa inotevera. Chiremba wako anojekesa mhinduro yakakosha ine saline, dzimwe nguva ine epinephrine kana methylene blue, zvakananga pasi petishu isina kujairika. Iyi jekiseni inogadzira cushion yemvura inosimudza tishu kure nemagumbeze akadzika emhasuru, zvichiita kuti kubviswa kuve kwakachengeteka.

Nzira dzakawanda dzinogona kupedzisa kubviswa chaiko. Nzira yakajairika inoshandisa snare, iyo iri waya diki inotenderedza tishu yakasimudzwa. Chiremba wako anosimbisa loop uye anoshandisa magetsi ekugura tishu zvakachena. Kune madiki madiki, vanogona kushandisa specialized forceps kana mapanga.

Mushure mekubviswa, chiremba wako anoongorora zvakanyatsonaka nzvimbo yacho kuti aone kubuda ropa uye anoirapa kana zvichidikanwa. Vanogona kushandisa makiripi kana kushandisa magetsi kuvhara tsinga dzeropa. Nyama yakabviswa inoenda kulabhu ye pathology kuti iongororwe zvakadzama.

Maitiro ekugadzirira Endoscopic Mucosal Resection yako?

Kugadzirira EMR kunosiyana zvichienderana nekuti ndeipi chikamu chemuviri wako wekugaya chikafu chinoda kurapwa. Chiremba wako achapa mirairo yakatarwa yakagadzirirwa mamiriro ako, asi mamwe matanho akajairika anoshanda kune maitiro mazhinji.

Kutsanya kunowanzoitwa pamberi pe EMR. Kune maitiro ekumusoro ekugaya chikafu, unozofanira kumira kudya nekunwa kwemaawa angangoita 8 usati waita izvozvo. Izvi zvinovimbisa kuti dumbu rako rakazara, richipa kuona kwakajeka uye kuderedza njodzi yematambudziko.

Kana uri kuita colon EMR, kugadzirira ura kunova kwakakosha. Unozofanira kutevedza chikafu chakakosha uye kutora mishonga yekuchenesa ura hwako zvachose. Iyi nzira inowanzo kutanga mazuva 1-2 pamberi pekuita uye inosanganisira kunwa mhinduro dzakatarwa dzinobatsira kubvisa zvese zvekushandisa.

Kugadziriswa kwemishonga kunogona kudiwa. Zvinhu zvinoderedza ropa zvakaita se warfarin kana aspirin zvinogona kuda kumiswa mazuva akati wandei pamberi pekuita kuti zvideredze njodzi yekubuda ropa. Zvisinei, usambomisa mishonga usina mirairo yakajeka kubva kuchiremba wako, sezvo mamwe mamiriro anoda kurapwa nguva dzose.

Kuronga zvekufambisa kwakakosha sezvo uchagamuchira sedation. Ronga kuti mumwe munhu akutyire kumba mushure mekuita, sezvo mishonga inogona kukanganisa kutonga kwako uye reflexes kwemaawa akati wandei.

Maitiro ekuverenga Endoscopic Mucosal Resection Results yako?

Kunzwisisa mhedzisiro yako ye EMR kunosanganisira zvikamu zviviri zvikuru: zvawanikwa zvakananga uye chirevo che pathology chinotevera. Chiremba wako achatsanangura zvese zvinhu zviviri kuti akubatsire kunzwisisa zvakaitwa uye zvinotevera.

Mhedzisiro dzemazuva ano dzinotarisa kubudirira kwehunyanzvi. Chiremba wako achakuudza kana vakakwanisa kubvisa zvachose tishu isina kujairika nemiganhu yakajeka. Kubviswa kwakakwana zvinoreva kuti tishu yese isina kujairika inooneka yakabviswa, nepo miganhu yakajeka inoratidza tishu ine hutano yakatenderedza nzvimbo yekubvisa.

Chirevo chepathology chinopa ruzivo rwakadzama nezve tishu yakabviswa. Ongororo iyi inowanzo tora mazuva 3-7 uye inoratidza rudzi chairo rwe maseru aripo, kana kenza iripo, uye kuti shanduko ipi isina kujairika inosvika sei. Chiremba wepathologist anosimbisawo kana miganhu yakajeka zvechokwadi kubva kuchirwere.

Ruzivo rwekutanga runova rwakakosha kana kenza iripo. Chirevo chepathology chichatsanangura kudzika kwekenza yekupinda uye kana yakapararira kumidziyo ye lymph kana midziyo yeropa. Ruzivo urwu runobatsira kuona kana imwe kurapwa kuchidikanwa.

Chiremba wako achaita nguva yekutevera kuti akurukure mhedzisiro yakazara uye agadzire chirongwa chekutarisa. Kunyangwe neEMR yakabudirira, maendoscopy ekutarisa nguva dzose anowanzo kurudzirwa kuti atarise chero kudzoka kana nzvimbo itsva dzisina kujairika.

Ndezvipi Zvinhu Zvinokonzera Kuda Endoscopic Mucosal Resection?

Zvimwe zvinhu zvinogona kuwedzera mukana wako wekuvandudza mamiriro angangoda EMR. Kunzwisisa izvi zvinhu zvinokonzera zvinokubatsira kuita sarudzo dzine ruzivo nezvekutarisa nekudzivirira.

Zera rinoita basa rakakosha mumakanzera e digestive tract uye mamiriro ekutanga-kenza. Mazhinji maitiro eEMR anoitwa pavarwere vane makore anopfuura 50, sezvo kukura kwetishu isina kujairika kunova kwakajairika nezera riri kufambira mberi. Zvisinei, varwere vaduku vane zvinhu zvakakosha zvinogonawo kuda kurapwa uku.

Zvimiro zvehupenyu zvinobatsira zvakanyanya kumatambudziko e digestive tract. Kusvuta uye kunwa doro zvakanyanya zvinowedzera zvakanyanya njodzi yako yekenza ye esophageal uye gastric. Zvinhu izvi zvinogona kukonzera kuzvimba kusingaperi uye kukuvadza maseru zvinogona kupedzisira zvichida kupindira kweEMR.

Zvirwere zvekugaya zvokudya zvinowanzoitika zvisati zvaitika kuti munhu aite EMR. Barrett's esophagus, inobva pakurwadziwa kwenguva refu kwemvura yemuromo, inogona kukura kuita dysplasia uye kenza yekutanga. Zvirwere zvinovava ura zvakaita se ulcerative colitis zvinowedzerawo njodzi yekenza munzvimbo dzakakanganiswa.

Nhoroondo yemhuri uye zvinhu zvemajini zvinokanganisa njodzi yako. Kuva nehama dzine kenza yezvokudya zvinogaya zvokudya zvinogona kuwedzera mukana wako wekuita zvirwere zvakafanana. Zvirwere zvakaita se familial adenomatous polyposis, zvinowedzera zvakanyanya kugadzirwa kwepolyp uye njodzi yekenza.

Maitiro ekudya anokanganisa hutano hwekugaya zvokudya kwenguva refu. Kudya zvakanyanya chikafu chakagadzirwa, nyama tsvuku, uye zvishoma michero nemiriwo zvinogona kuita kuti munhu aite zvirwere zvinoda EMR. Nekune rimwe divi, kudya kwakawanda fiber uye antioxidants zvinogona kupa dziviriro.

Ndezvipi Zvinetso Zvinogona Kuitika zveEndoscopic Mucosal Resection?

Nepo EMR ichiita seyakachengeteka, kunzwisisa matambudziko anogona kuitika kunokubatsira kuti uite zvisarudzo zvine ruzivo uye kuziva zviratidzo zvekuyambira. Matambudziko mazhinji haawanzoitiki uye anogona kugadziriswa kana akaitika.

Kubuda ropa kunomiririra dambudziko rinowanzoitika, richitika mune vanenge 1-5% yezvirongwa. Kubuda ropa kudiki kunowanzozvimisa kana nekubata nyore panguva yechirongwa. Zvisinei, kubuda ropa kwakakura kunogona kuda kupindira kwakawedzerwa sekushandisa makiripi, kurapa jekiseni, kana kazhinji, kuvhiyiwa.

Kupunzika, kunyangwe kusingawanzoitiki, kunopa njodzi yakakomba. Izvi zvinoitika kana maitiro ekubvisa achigadzira gomba kuburikidza nemadziro ezvokudya zvinogaya zvokudya. Njodzi inosiyana nenzvimbo, nekupunzika kwemukoloni kuchiwanzojairika kupfuura kupunzika kwepamusoro pezvokudya zvinogaya zvokudya. Kupunzika kudiki kunogona kurapwa nemakiripi panguva yechirongwa.

Utachiona hunowanzoitika mushure meEMR, asi zvinogoneka kana mabhakitiriya apinda muropa kana matishu akapoteredza. Chiremba wako anogona kukupa mishonga inorwisa mabhakitiriya kana uine mamwe mamiriro emoyo kana matambudziko emuviri anowedzera njodzi yekutapukirwa.

Kuvakwa kwe stricture kunogona kuitika mavhiki mashoma kusvika kumwedzi mushure me EMR, kunyanya kana nzvimbo huru dzetishu dzabviswa. Iyi kudzikira kwemugwagwa wekudya kunogona kukonzera matambudziko ekumedza kana kuvharika kwematumbo. Mazhinji ma strictures anopindura zvakanaka kumaitiro ekutambanudza zvinyoro nyoro.

Kubviswa kusingakwani dzimwe nguva kunoitika nemaronda makuru kana akaoma. Kana izvi zvikaitika, chiremba wako angakurudzira mamwe ma EMR sessions, mamwe marapirwo, kana kuongororwa pedyo zvichienderana nemigumisiro ye pathology.

Ndingafonera Chiremba Rini Mushure meEndoscopic Mucosal Ressection?

Kuziva nguva yekubata chikwata chako chehutano mushure me EMR kunobatsira kuona kupora kwakakodzera uye kuona nekukurumidza chero matambudziko. Vazhinji varwere vanopora zvakanaka, asi zviratidzo zvakasiyana zvinoda kutariswa nekukurumidza.

Kurwadziwa kwakanyanya mudumbu kunowedzera kana kusavandudzika nemishonga yakarairwa kunoda kuongororwa nekukurumidza. Kunyange kusagadzikana kumwe kuri kwakajairika mushure me EMR, kurwadziwa kwakanyanya kana kuwedzera kunogona kuratidza matambudziko senge perforation kana kubuda ropa kwakanyanya.

Zviratidzo zvekubuda ropa kwakakosha zvinoda kutariswa kwekurapa nekukurumidza. Izvi zvinosanganisira kurutsa ropa, kupfuudza zvigaro zvitema kana zvine ropa, kunzwa dzungu kana kufenda, kana kuva nekurova kwemoyo nekukurumidza. Kubuda ropa kudiki kunogona kukonzera kusachinja ruvara mudumbu rako, asi kubuda ropa kukuru kazhinji kunooneka.

Fivha iri pamusoro pe 101°F (38.3°C) kana kutonhora kunogara kuchigona kuratidza hutachiona. Kunyange zvichishoma, hutachiona mushure mekuita hunoda kurapwa nemishonga inorwisa mabhakitiriya kudzivirira matambudziko akakomba.

Kutadza kumedza kana kusvotwa kwakanyanya uye kurutsa zvinogona kuratidza kuzvimba kana kuvakwa kwe stricture. Zviratidzo izvi zvinonyanya kunetsa kana zvikaitika mazuva akati wandei mushure mekuita kana zvishoma nezvishoma zvichikura nekufamba kwenguva.

Tevedza nguva dzako dzakarongwa kunyangwe ukanzwa zvakanaka. Chiremba wako anoda kuongorora kufambira mberi kwako kwekupora uye kukurukura mhedzisiro ye pathology. Kushanya uku kunobatsirawo kuronga nzira dzakakodzera dzekutarisa ramangwana.

Mibvunzo Inowanzo Bvunzwa Pamusoro peEndoscopic Mucosal Resection

Mubvunzo 1: Ko Endoscopic Mucosal Resection inoshanda here kune gomarara rematangi ekutanga?

Hongu, EMR inoshanda zvakanyanya kumagomarara ematangi ekutanga asina kupararira kupfuura mucosa. Zvidzidzo zvinoratidza mitengo yekurapa inodarika 95% yemagomarara ekutanga emudumbu uye esophageal akasarudzwa zvakakodzera. Chinhu chakakosha ndechokubata magomarara aya apo achiri akaganhurirwa kune ganda repamusoro retishu.

Kubudirira kunoenderana nekusarudzwa kwakanyatsoitwa kwevarwere uye hunyanzvi. Chiremba wako achashandisa imaging uye dzimwe nguva biopsies yekutanga kuti ave nechokwadi chekuti gomarara riri mumatanho ekutanga asati arayira EMR. Kana ichiitwa nemazvo pane vakakodzera, EMR inogona kushanda sekushanda nekuvharirwa kushoma kwemuviri wako.

Mubvunzo 2: Ko EMR inokonzera matambudziko ekugaya kwenguva refu here?

Vazhinji varwere havawanzove nematambudziko ekugaya kwenguva refu mushure meEMR. Maitiro acho akagadzirirwa kubvisa chete tishu ine chirwere ichichengetedza basa rakajairika rekugaya. Gumbo rako rekugaya rinowanzo pora mukati memavhiki mashoma, richidzokera kubasa rakajairika.

Kazhinji, strictures inogona kukura kana nzvimbo huru dzetishu dzabviswa. Zvisinei, nzvimbo idzi dzakamanikana dzinowanzoita zvakanaka kumaitiro ekutambanudza zvinyoro. Chiremba wako achatarisa mukana uyu panguva yekutevera kushanya uye kurapa nekukurumidza kana zvaitika.

Mubvunzo 3: Ndingade kuongororwa kwakawanda sei mushure meEMR?

Zvirongwa zvekutevera zvinoenderana nezvakabviswa uye mhedzisiro ye pathology. Kune mamiriro ekutanga-gomarara, unogona kuda kuongororwa mwedzi mitatu yega yega, wobva wava gore negore kana pasina matambudziko anomuka. Nyaya dzegomarara rekutanga dzinowanzoita kuti vatariswe kakawanda, dzimwe nguva mwedzi mitatu yega yega wegore rekutanga.

Chiremba wako achagadzira chirongwa chekutarisa chakagadzirirwa zvinoenderana nemamiriro ako chaiwo. Kuongorora uku kunoenderera mberi kunobatsira kuona chero kudzoka nekukurumidza uye kunoona nzvimbo itsva dzisina kujairika dzinogona kukura. Varwere vazhinji vanowana rugare rwepfungwa runokosha nekusagadzikana kwekuongororwa nguva dzose.

Mubvunzo 4. EMR inogona kudzokororwa here kana kenza ikadzoka?

Hongu, EMR inogona kudzokororwa kazhinji kana kenza ikadzoka munzvimbo imwechete kana kukura munzvimbo itsva. Zvisinei, kugoneka kunoenderana nekukura kwekudzoka uye mamiriro etishu yakatenderedza. Tishu yemaronda kubva kumaitiro apfuura dzimwe nguva inogona kuita kuti kudzokorora EMR kuve kwakaoma.

Chiremba wako achanyatsoongorora mamiriro ega ega. Dzimwe nguva kudzokorora EMR ndiyo sarudzo yakanakisa, nepo dzimwe nguva dzinogona kubatsirwa nekumwe kurapwa senge radiofrequency ablation kana kuvhiyiwa. Mashoko akanaka ndeokuti kudzoka mushure mekubudirira EMR hakuzivikanwi.

Mubvunzo 5. EMR inorwadza panguva kana mushure mekuita?

Hauzoziva kurwadziwa panguva yeEMR nekuti uchagamuchira sedation inokuchengeta uchinyaradzwa uye wakasununguka. Varwere vazhinji havayeuki maitiro acho zvachose. Sedation inonyatsoongororwa kuti ive nechokwadi chekuti unogara usina kurwadziwa panguva yese yekuita.

Mushure mekuita, unogona kusangana nekusagadzikana kudiki kana kuzvimba sezvo sedation ichipera. Izvi zvinowanzoita semudumbu mudiki uye zvinogadzirisa mukati mezuva rimwe kana maviri. Chiremba wako achapa mishonga yekurwadziwa kana zvichidikanwa, kunyangwe varwere vazhinji vachiwana sarudzo dzisiri pamusoro-pe-counter dzakakwana kune chero kusagadzikana.