Yini i-Endoscopic Mucosal Resection? Injongo, Amazinga/Inqubo & Imiphumela

I-Endoscopic mucosal resection (EMR) iyinqubo encane yokuhlasela esusa izicubu ezingavamile emgqeni wamathumbu akho. Cabanga ngayo njengendlela eqondile yodokotela yokuphakamisa ngokucophelela nokususa izindawo ezinzima ngaphandle kokuhlinzwa okukhulu. Le ndlela isiza ukwelapha iminyango yomdlavuza yasekuqaleni kanye nokukhula okungaphambi komdlavuza e-esophagus yakho, esiswini, noma emathunjini amakhulu ngenkathi kugcinwa izicubu ezinempilo ezizungezile.

Yini i-Endoscopic Mucosal Resection?

I-Endoscopic mucosal resection iyindlela ekhethekile lapho odokotela basebenzisa khona ipayipi eliguquguqukayo elinekhamera (i-endoscope) ukususa izicubu ezingavamile ngaphakathi kwamathumbu akho. Le nqubo iqondiswe kuphela ku-mucosa, okuyisendlalelo sangaphakathi sezicubu ezihlanganisa amathumbu akho.

Ngesikhathi se-EMR, udokotela wakho ufaka isixazululo esikhethekile ngaphansi kwezicubu ezingavamile ukuze asiphakamise kude nezendlalelo ezijulile. Lokhu kudala umcamelo ophephile ovikela udonga lwemisipha olungaphansi. Bese, basebenzisa iluphu yocingo noma elinye ithuluzi lokusika ukuze basuse ngokucophelela izicubu eziphakanyisiwe.

Ubuhle bale ndlela bulele ekunembeni kwayo. Ngokungafani nokuhlinzwa kwendabuko okudinga ukusikeka okukhulu, i-EMR isebenza ngaphakathi ngemigodi yemvelo yomzimba. Lokhu kusho ukulimala okuncane emzimbeni wakho nezikhathi zokululama ngokushesha.

Kungani Kwenziwa I-Endoscopic Mucosal Resection?

I-EMR isebenza njengamathuluzi okuxilonga nawokuphulukisa ezimweni ezihlukahlukene emathunjini akho. Udokotela wakho angase ancome le nqubo lapho ethola izicubu ezingavamile ezidinga ukususwa kodwa ezingadingi ukuhlinzwa okukhulu.

Isizathu esivame kakhulu se-EMR ukwelapha iminyango yomdlavuza yasekuqaleni engakaze isabalale ngale kwe-mucosa. Le midlavuza isagcinwe esendlalelweni esingaphezulu, okuyenza ibe ngabakhethiwe abaphelele kule ndlela engahlaseli kangako. Umdlavuza wesisu wasekuqaleni, umdlavuza we-esophageal, kanye neminye imidlava yomdlavuza wamathumbu amakhulu bavame ukusabela kahle ku-EMR.

Izimo ezingaphambi komdlavuza nazo ziyazuza kulolu hlobo lokwelashwa. I-Barrett's esophagus ene-dysplasia ephezulu, ama-polyps amakhulu e-colon, kanye ne-gastric adenomas konke kungalawulwa ngempumelelo nge-EMR. Udokotela wakho angasusa lezi zinto ezingase zibe yingozi ngaphambi kokuba zibe nomdlavuza.

Ngezinye izikhathi, i-EMR iyasiza ekuxilongweni futhi. Uma izivivinyo zokuthwebula izithombe zingakwazi ukuthola ukuthi izicubu zinomdlavuza yini, ukuzisusa ngokuphelele nge-EMR kuvumela ukuhlolwa okuphelele ngaphansi kwe-microscope. Lokhu kunikeza ithimba lakho lezokwelapha umfanekiso ocacile walokho ababhekene nakho.

Yini Inqubo Yokuhlinzwa Kwe-Endoscopic Mucosal Resection?

Inqubo ye-EMR ngokuvamile yenzeka esikhungweni se-endoscopy esingaphandle noma esibhedlela. Uzothola imithi yokukhuza ukuze ikugcine ukhululekile futhi uphumule kuyo yonke inqubo, evame ukuthatha imizuzu engama-30 kuya emahoreni amabili kuye ngobunzima.

Udokotela wakho uqala ngokufaka i-endoscope ngomlomo wakho (ngomgudu wokugaya ukudla ongaphezulu) noma ngesinqe (ngezinqubo ze-colon). Le tube eguquguqukayo iqukethe ikhamera enikeza ukubonakala okucacile kwendawo okuyiwa kuyo. Uma sebethole izicubu ezingavamile, bazihlola ngokucophelela ukuze baqinisekise ukuthi zifaneleka ku-EMR.

Isigaba sokujova silandelayo. Udokotela wakho ujova isixazululo esikhethekile esiqukethe i-saline, ngezinye izikhathi nge-epinephrine noma i-methylene blue, ngqo ngaphansi kwezicubu ezingavamile. Lo mjovo udala umcamelo oluketshezi oluphakamisa izicubu kude nezendlalelo zemisipha ejulile, okwenza ukususwa kuphephe.

Amaqhinga amaningana angayiqeda ngempela le ndlela yokususwa. Indlela evame kakhulu isebenzisa i-snare, okuyintambo encane yocingo ezungeza izicubu eziphakanyisiwe. Udokotela wakho uqinisa iluphu futhi asebenzise ugesi ukuze anqamule izicubu ngendlela ehlanzekile. Ezilondeni ezincane, bangase basebenzise ama-forceps akhethekile noma imimese.

Ngemva kokususwa, udokotela wakho uhlola ngokucophelela indawo ukuze abone noma yikuphi ukopha futhi uyayelapha uma kunesidingo. Bangase basebenzise iziqeshana noma basebenzise ugesi ukuvala imithambo yegazi. Izicubu ezisusiwe ziya elabhorethri ye-pathology ukuze zihlolwe ngokuningiliziwe.

Ungalungiselela Kanjani Ukususwa Kwakho Kwe-Endoscopic Mucosal?

Ukulungiselela i-EMR kuyahlukahluka kuye ngokuthi iyiphi ingxenye yesistimu yakho yokugaya ukudla edinga ukwelashwa. Udokotela wakho uzohlinzeka ngemiyalelo ethile eyenzelwe isimo sakho, kodwa ezinye iziqondiso ezijwayelekile ziyasebenza ezinqubweni eziningi.

Ukuzila ukudla kuvame ukudingeka ngaphambi kwe-EMR. Ngezindlela zokupheka eziphezulu zokugaya ukudla, kuzodingeka uyeke ukudla nokuphuza okungenani amahora angu-8 ngaphambi kwesikhathi. Lokhu kuqinisekisa ukuthi isisu sakho sikhona, sinikeza ukubonakala okucacile futhi kunciphisa ingozi yezinkinga.

Uma wenza i-colon EMR, ukulungiswa kwamathumbu kubalulekile. Kuzodingeka ukulandela ukudla okukhethekile futhi uthathe imithi ukuze uhlanze ikholoni yakho ngokuphelele. Le nqubo ivamise ukuqala izinsuku eziyi-1-2 ngaphambi kwenqubo futhi ihlanganisa ukuphuza izixazululo ezithile ezisiza ukuqeda yonke imfucuza.

Ukulungiswa kwemithi kungase kudingeke. Izinciphisi zegazi ezinjenge-warfarin noma i-aspirin kungase kudingeke ukuthi ziyekwe izinsuku eziningana ngaphambi kwenqubo ukunciphisa ingozi yokopha. Kodwa-ke, ungalokothi uyeke imithi ngaphandle kwemiyalelo ecacile evela kudokotela wakho, njengoba ezinye izimo zidinga ukwelashwa okuqhubekayo.

Ukuhlelwa kwezokuthutha kubalulekile njengoba uzothola ukuthuliswa. Hlela ukuthi othile akuqhubele ekhaya ngemva kwenqubo, njengoba imithi ingathinta ukwahlulela kwakho kanye nokucabanga amahora amaningana.

Ungawafunda Kanjani Imiphumela Yakho Yokususwa Kwe-Endoscopic Mucosal?

Ukuqonda imiphumela yakho ye-EMR kuhilela izingxenye ezimbili eziyinhloko: okutholakele okusheshayo kwenqubo kanye nombiko we-pathology olandelayo. Udokotela wakho uzochaza zombili izici ukukusiza ukuthi uqonde ukuthi kwenziwani nokuthi yini elandelayo.

Imiphumela esheshayo igxila empumelelweni yezobuchwepheshe. Udokotela wakho uzokutshela ukuthi ngabe bakufezile yini ukususwa okuphelele kwesicubu esingajwayelekile ngemiphetho ecacile. Ukususwa okuphelele kusho ukuthi zonke izicubu ezingajwayelekile ezibonakalayo zisusiwe, kanti imiphetho ecacile ikhomba izicubu ezinempilo ezizungeze indawo yokususwa.

Umbiko we-pathology unikeza imininingwane enemininingwane mayelana nesicubu esisusiwe. Lokhu kuhlaziywa kuvame ukuthatha izinsuku ezi-3-7 futhi kwembula uhlobo oluqondile lwamaseli akhona, ukuthi ngabe umdlavuza ukhona yini, nokuthi izinguquko ezingajwayelekile zifinyelela kangakanani. I-pathologist iphinda iqinisekise ukuthi imiphetho ngempela ayinayo yini isifo.

Ulwazi lwesigaba lubaluleka kakhulu uma umdlavuza ukhona. Umbiko we-pathology uzochaza ukujula komdlavuza wokuhlasela nokuthi ngabe usabalale emithanjeni ye-lymph noma imithambo yegazi. Lolu lwazi lusiza ukunquma ukuthi ngabe ukwelashwa okwengeziwe kuyadingeka.

Udokotela wakho uzohlela i-aphoyintimenti yokulandela ukuze axoxe ngemiphumela ephelele futhi enze uhlelo lokuqapha. Noma ngabe i-EMR iphumelele, ama-endoscopy okuqapha avamile avame ukunconywa ukuze kuqashelwe noma yikuphi ukuphindeka noma izindawo ezintsha ezingajwayelekile.

Ziyini Izici Zengozi Zokudinga Ukususwa Kwe-Endoscopic Mucosal?

Izici eziningana zingakhuphula amathuba akho okuthuthukisa izimo ezingadinga i-EMR. Ukuqonda lezi zici zengozi kukusiza ukuthi wenze izinqumo ezinolwazi mayelana nokuhlolwa nokuvimbela.

Iminyaka idlala indima ebalulekile emdlavuzeni wamathumbu nokugula okungaphambi komdlavuza. Iningi lezinqubo ze-EMR zenziwa ezigulini ezingaphezu kweminyaka engama-50, njengoba ukukhula kwezicubu ezingajwayelekile kuvame kakhulu ngeminyaka eqhubekayo. Kodwa-ke, iziguli ezincane ezinokuthambekela okuthile zingadinga futhi lokhu kwelashwa.

Izici zokuphila zifaka isandla esikhulu ezinkingeni zamathumbu. Ukubhema nokusetshenziswa ngokweqile kotshwala kukhulisa kakhulu ingozi yakho yomdlavuza we-esophageal ne-gastric. Lezi zinto zingadala ukuvuvukala okungapheli nokulimala kwamaselula okungadinga ukungenelela kwe-EMR ekugcineni.

Izimo ezingapheli zokugaya ngokuvamile zandulela isidingo se-EMR. I-Barrett's esophagus, evela ekugayeni ukudla okunesikhathi eside, ingaholela ku-dysplasia nomdlavuza wakuqala. Izifo zokuvuvukala kwamathumbu njenge-ulcerative colitis nazo zikhuphula ingozi yomdlavuza ezindaweni ezithintekile.

Umlando womndeni nezici zofuzo zithonya iphrofayili yakho yengozi. Ukuba nezihlobo ezinomdlavuza wamathumbu kungase kwandise amathuba akho okuthuthukisa izimo ezifanayo. Izifo ezithile zofuzo, njenge-familial adenomatous polyposis, zikhuphula kakhulu ukwakheka kwama-polyp nengozi yomdlavuza.

Amaphethini okudla athinta impilo yokugaya isikhathi eside. Ukudla okunokudla okuningi okucutshungulwe, inyama ebomvu, nokuncane kwezithelo nemifino kungase kube nomthelela ezimweni ezidinga i-EMR. Ngokuphambene nalokho, ukudla okunothile nge-fiber nama-antioxidants kungase kunikeze ukuvikelwa okuthile.

Ziyini Izinkinga Ezingase Zenzeke Zokuhlinzwa Kwe-Endoscopic Mucosal?

Ngenkathi i-EMR ivikelekile ngokuvamile, ukuqonda izinkinga ezingaba khona kukusiza ukuthi wenze izinqumo ezinolwazi futhi uqaphele izimpawu zokuxwayisa. Izinkinga eziningi zivamile futhi ziyalawuleka uma zenzeka.

Ukuphuma kwegazi kumelela inkinga evame kakhulu, eyenzeka cishe ku-1-5% wezinqubo. Ukuphuma kwegazi okuncane kuvame ukuzimela noma ngemithi elula ngesikhathi senqubo. Kodwa-ke, ukuphuma kwegazi okukhulu kungase kudingeke ukungenelela okwengeziwe njengama-clip, ukwelashwa ngomjovo, noma ngokungavamile, ukuhlinzwa.

Ukugwazwa, nakuba kungavamile, kubeka enye ingozi enkulu. Lokhu kwenzeka lapho inqubo yokususa idala imbobo odongeni lwethumbu lokugaya. Ingozi iyahlukahluka ngendawo, ngokuphuma kwegazi emathunjini amakhulu kuvamile kakhulu kunokuphuma kwegazi kwesitho sokugaya esiphezulu. Ukuphuma kwegazi okuncane okuningi kungelashwa ngama-clip ngesikhathi senqubo.

Ukutheleleka akuvamile ukwenzeka ngemva kwe-EMR, kodwa kungenzeka lapho amagciwane engena emgudwini wegazi noma ezicutshini eziqashile. Udokotela wakho angase akwelaphe ngama-antibiotics uma unezimo ezithile zenhliziyo noma izinkinga zesimiso somzimba esivikela izifo ezikhuphula ingozi yokutheleleka.

Ukwakheka kwe-stricture kungase kuvele emasontweni kuya ezinyangeni ngemuva kwe-EMR, ikakhulukazi uma izindawo ezinkulu zezicubu zisusiwe. Lokhu kuncipha kwendlela yokugaya ukudla kungabangela ubunzima bokugwinya noma ukuvinjelwa kwamathumbu. Ama-stricture amaningi aphendula kahle ezinqubweni zokwelula ngobumnene.

Ukususwa okungaphelele kwenzeka ngezinye izikhathi ngamanxeba amakhulu noma ayinselele ngokobuchwepheshe. Uma lokhu kwenzeka, udokotela wakho angase ancome izikhathi ezengeziwe ze-EMR, ezinye izindlela zokwelapha, noma ukuqapha okuseduze kuye ngemiphumela ye-pathology.

Kufanele ngibone nini udokotela ngemuva kokususwa kwe-Endoscopic Mucosal Resection?

Ukwazi ukuthi ungaxhumana nini nethimba lakho lezempilo ngemuva kwe-EMR kusiza ukuqinisekisa ukuphola okufanele nokutholwa kwangaphambi kwesikhathi kwanoma yiziphi izinkinga. Iziguli eziningi zithola kahle, kodwa izimpawu ezithile zidinga ukunakwa ngokushesha.

Ubuhlungu obukhulu besisu obuqhubekayo noma obungathuthuki ngemithi enqunyiwe budinga ukuhlolwa ngokushesha. Ngenkathi ukungakhululeki okuthile kujwayelekile ngemuva kwe-EMR, ubuhlungu obukhulu noma obanda ngokuqhubekayo kungase kubonise izinkinga ezinjengokugqobhoza noma ukopha okukhulu.

Izimpawu zokopha okukhulu zidinga ukunakekelwa kwezempilo ngokushesha. Lokhu kufaka phakathi ukuhlanza igazi, ukudlula izitulo ezimnyama noma ezinegazi, ukuzwa isiyezi noma ukuquleka, noma ukuba nenhliziyo esheshayo. Ukopha okuncane kungase kubangele ukushintsha kombala okuncane esitulweni sakho, kodwa ukopha okukhulu kuvame ukubonakala.

Umkhuhlane ongaphezu kuka-101°F (38.3°C) noma ama-chills aqhubekayo angase abonise ukutheleleka. Nakuba kungavamile, izifo ezingemuva kwenqubo zidinga ukwelashwa ngama-antibiotics ukuze kuvinjelwe izinkinga ezingathi sína.

Ubunzima bokugwinya noma isicanucanu esikhulu nokuhlanza kungase kusikisela ukuvuvukala noma ukwakheka kwe-stricture. Lezi zimpawu zikhathaza kakhulu uma zivela ezinsukwini ezimbalwa ngemuva kwenqubo noma ziba zimbi kancane kancane ngokuhamba kwesikhathi.

Landela ama-aphoyintimenti akho ahleliwe ngisho noma uzizwa kahle. Udokotela wakho udinga ukuqapha inqubekela phambili yakho yokuphola futhi axoxe ngemiphumela ye-pathology. Lokhu kuvakasha futhi kusiza ukuhlela amasu afanele okuqapha esikhathini esizayo.

Imibuzo Evame Ukubuzwa Mayelana Nokuqedwa Kwe-Endoscopic Mucosal

Umbuzo 1. Ingabe Ukuqedwa Kwe-Endoscopic Mucosal kuyasebenza emdlalweni wokuqala?

Yebo, i-EMR isebenza kakhulu emdlalweni wokuqala ongakaze usabalale ngaphandle kwe-mucosa. Ucwaningo lubonisa amazinga okuphulukiswa angaphezu kwama-95% emdlalweni wokuqala wesisu nomphimbo okhethwe kahle. Okubalulekile ukubamba le midlalo ngesikhathi isagcinwe kungqimba olungaphezulu lwezicubu.

Impumelelo incike ekukhetheni isiguli ngokucophelela kanye nekhono elinobuchwepheshe. Udokotela wakho uzosebenzisa izithombe futhi ngezinye izikhathi ama-biopsies okuqala ukuqinisekisa ukuthi umdlavuza usesezingeni lokuqala ngaphambi kokuncoma i-EMR. Uma yenziwe ngendlela efanele kubantu abafanelekayo, i-EMR ingasebenza njengokuhlinzwa ngaphandle kokulimala okukhulu emzimbeni wakho.

Umbuzo 2. Ingabe i-EMR ibangela izinkinga zokugaya isikhathi eside?

Iziguli eziningi azihlangani nezinkinga zokugaya isikhathi eside ngemuva kwe-EMR. Le nqubo yenzelwe ukususa kuphela izicubu ezigulayo ngenkathi kugcinwa ukusebenza okujwayelekile kokugaya. Umzila wakho wokugaya ngokuvamile uyaphola emasontweni ambalwa, ubuyele ekusebenzeni okujwayelekile.

Ngokuvamile, ama-strictures angase akhule uma kususwa izindawo ezinkulu zezicubu. Kodwa-ke, lezi zindawo ezincishisiwe zivame ukusabela kahle ezinqubweni zokwelula ezimnene. Udokotela wakho uzoqapha leli thuba ngesikhathi sokuvakasha okulandelayo futhi aliphathe ngokushesha uma kwenzeka.

Umbuzo 3. Ngivame kangakanani ukudinga ama-endoscopies okulandelayo ngemuva kwe-EMR?

Amashejuli okulandelayo ancike kulokho okususwe kanye nemiphumela ye-pathology. Ezimweni ezingaphambi komdlavuza, ungase udinge ukuqapha njalo emavikini ama-3-6 ekuqaleni, bese kuthi ngonyaka uma kungekho zinkinga ezivelayo. Izimo zomdlavuza wokuqala zivame ukudinga ukuqapha okuningi, ngezinye izikhathi njalo ezinyangeni ezi-3 ngonyaka wokuqala.

Udkt. wakho uzokwenza uhlelo lokubhekisisa olwenzelwe wena ngokusekelwe esimweni sakho esithile. Lokhu kubhekisisa okuqhubekayo kusiza ukuthola noma yikuphi ukuphindeka kwangaphambi kwesikhathi futhi kuthola izindawo ezintsha ezingavamile ezingase zivele. Iziguli eziningi zithola ukuthula kwengqondo okufanele ukuphazamiseka kokuhlolwa okuvamile.

Q.4 Ingabe i-EMR ingaphindwa uma umdlavuza ubuyela emuva?

Yebo, i-EMR ivame ukuphindwa uma umdlavuza uphindeka endaweni efanayo noma uvela ezindaweni ezintsha. Kodwa-ke, ukwenzeka kuncike ezingeni lokuphindeka kanye nesimo sezicubu ezizungezile. Izicubu ezinamathambo ezivela ezinqubweni zangaphambilini ngezinye izikhathi zingenza i-EMR ephindwayo ibe yinselele enkulu.

Udkt. wakho uzohlola ngokucophelela isimo ngasinye ngasinye. Ngezinye izikhathi i-EMR ephindwayo iyindlela engcono kakhulu, kuyilapho ezinye izimo zingazuza ekwelashweni okuhlukile njengokushisa ngomsakazo noma ukuhlinzwa. Izindaba ezinhle ukuthi ukuphindeka ngemuva kwe-EMR ephumelelayo akuvamile.

Q.5 Ingabe i-EMR ibuhlungu ngesikhathi noma ngemuva kwenqubo?

Ngeke uzwe ubuhlungu ngesikhathi se-EMR ngoba uzothola imithi yokuthulisa ekugcina ukhululekile futhi uphumule. Iziguli eziningi azikhumbuli inqubo nhlobo. Imithi yokuthulisa ibhekisiswa ngokucophelela ukuqinisekisa ukuthi uhlala ungenabo ubuhlungu kuyo yonke inqubo.

Ngemuva kwenqubo, ungase uzwe ukungakhululeki okuncane noma ukuqunjelwa njengoba imithi yokuthulisa iphela. Lokhu ngokuvamile kuzizwa njengokungagayeki kahle ukudla okuncane futhi kulungiswa ngosuku olulodwa noma ezimbili. Udkt. wakho uzohlinzeka ngemithi yokwelapha ubuhlungu uma kudingeka, nakuba iziguli eziningi zithola izinketho ezingaphandle kwekhawunta zanele kunoma yikuphi ukungakhululeki.