N'ime ihe ọmụma a ma ama gbasara ọrịa kansa afọ mbụ, e nwere ụfọdụ ihe ọmụma ọrịa na-adịghị ahụkebe nke chọrọ nlebara anya na mmụta pụrụ iche. Otu n'ime ha bụ ọrịa kansa afọ na-adịghị mma nke HP. Echiche nke "ọrịa akpụ epithelial na-enweghị ọrịa" na-ewu ewu ugbu a. A ga-enwe echiche dị iche iche gbasara aha aha. Ozizi ọdịnaya a dabere na ọdịnaya metụtara akwụkwọ akụkọ "Stomach and Intestine", na aha ahụ na-ejikwa "HP-negative gastric cancer".
Ụdị ọnya a nwere njirimara nke ọnọdụ dị ala, ihe isi ike na njirimara, ihe ọmụma usoro ihe ọmụma dị mgbagwoju anya, na usoro MESDA-G dị mfe adịghị adaba. Ịmụta ihe ọmụma a chọrọ iche ihe isi ike ihu.
1. Ihe omuma ihe omuma nke HP-negative gastric cancer
Akụkọ ihe mere eme
N'oge gara aga, a kwenyere na otu onye na-eme ihe na-eme na mmepe nke ọrịa cancer gastric bụ ọrịa HP, ya mere ụdị ọrịa cancer nke kpochapụwo bụ HP - atrophy - intestinal metaplasia - obere tumor - nnukwu tumor - canceration. A na-amatakarị ihe nlereanya kpochapụwo mgbe niile, nabata ma kwenyesie ike. Tumors na-etolite ọnụ na ndabere nke atrophy na n'okpuru omume nke HP, ya mere ọrịa cancer na-akasị eto na atrophic eriri afọ tract na obere nkịtị na-abụghị atrophic gastric mucosa.
Mgbe e mesịrị, ụfọdụ ndị dọkịta chọpụtara na ọrịa kansa afọ nwere ike ime ọbụna na enweghị ọrịa HP. Ọ bụ ezie na ọnụ ọgụgụ ihe omume dị ntakịrị, ọ ga-ekwe omume n'ezie. Ụdị ọrịa kansa afọ a ka a na-akpọ HP-negative cancer gastric.
Site na nghota nke nta nke nta nke ụdị ọrịa a, nleba anya n'usoro ihe omimi na nchịkọta amalitela, aha na-agbanwekwa mgbe niile. Enwere akụkọ n'afọ 2012 akpọrọ "Cancer Gastric after Sterilization", edemede dị na 2014 akpọrọ "HP-negative Gastric Cancer", na edemede na 2020 akpọrọ "Epithelial Tumors Not Infected with Hp". Mgbanwe aha ahụ na-egosipụta nghọta miri emi na nke sara mbara.
Ụdị gland na ụkpụrụ uto
Enwere ụdị isi abụọ nke fundic glands na pyloric glands na afọ:
Fundic glands (oxyntic glands) na-ekesa na fundus, ahụ, nkuku, wdg nke afo. Ha bụ linear otu tubular glands. Ha mejupụtara sel mucous, sel ndị isi, sel parietal na sel endocrine, nke ọ bụla na-arụ ọrụ nke ya. N'ime ha, sel ndị isi Ihe PGI zoro ezo na MUC6 dị mma, na sel parietal zoro ezo hydrochloric acid na ihe dị n'ime ya;
Ọkpụkpụ pyloric dị na mpaghara antrum gastric ma mejupụtara sel mucus na sel endocrine. Mkpụrụ ndụ mucus bụ MUC6 ziri ezi, sel endocrine gụnyere sel G, D na sel enterochromaffin. Mkpụrụ ndụ G na-ezobe gastrin, mkpụrụ ndụ D na-ezobe somatostatin, mkpụrụ ndụ enterochromaffin na-ezobe 5-HT.
Mkpụrụ ndụ mucosal gastric nkịtị na mkpụrụ ndụ tumor na-ezobe ụdị protein protein dị iche iche dị iche iche, nke na-ekewa n'ime "gastric", "intestinal" na "agwakọta" protein protein imi. Okwu nke eriri afọ na eriri afọ mucins ka a na-akpọ phenotype ọ bụghị kpọmkwem ọnọdụ anatomical nke afọ na eriri afọ.
Enwere phenotypes cell phenotypes nke etuto afọ: kpamkpam gastric, gastric na-achị agwakọta, eriri afọ na-achị agwakọta, na eriri afọ kpamkpam. Tumor na-eme na ndabere nke eriri afọ metaplasia na-abụkarị etuto phenotype agwakọtara eriri afọ. Ọrịa cancer dị iche iche na-egosikarị ụdị eriri afọ (MUC2+), na ọrịa cancer na-agbasasị na-egosikarị ụdị gastric (MUC5AC+, MUC6+).
Ịchọpụta ihe ọjọọ Hp chọrọ ngwakọta a kapịrị ọnụ nke ọtụtụ ụzọ nchọpụta maka mkpebi zuru oke. HP-negative cancer gastric cancer na post-sterilization gastric cancer bụ echiche abụọ dị iche iche. Maka ozi gbasara ngosipụta X-ray nke ọrịa kansa afọ na-adịghị mma nke HP, biko rụtụ aka n'akụkụ dị mkpa nke akwụkwọ akụkọ "Stomach and Intestine".
2. Endoscopic ngosipụta nke HP-adịghị mma gastric cancer
Nchọpụta endoscopic bụ ihe a na-elekwasị anya na ọrịa kansa afọ na-adịghị mma nke HP. Ọ tumadi na-agụnye fundic gland ụdị gastric cancer, fundic gland mucosal ụdị gastric cancer, gastric adenoma, raspberry foveolar epithelial tumor, signet mgbanaka cell carcinoma, wdg Isiokwu a na-elekwasị anya na endoscopic ngosipụta nke HP-adịghị mma gastric cancer.
1) Fundic gland ụdị ọrịa kansa afọ
-Ọcha welitere ọnya
fundic gland ụdị ọrịa kansa afọ
◆Ikpe 1: Ọcha, ọnya ewelitere
Nkọwa:Gastric fundic fornix-karịrị curvature nke cardia, 10 mm, ọcha, O-lia ụdị (SMT-dị ka), na-enweghị atrophy ma ọ bụ eriri afọ metaplasia n'azụ. Enwere ike ịhụ arịa ọbara dị ka Arbor n'elu (NBI na mmụba ntakịrị)
Nchọpụta nchọpụta (ejikọta ya na pathology):U, O-1la, 9mm, fundic gland ụdị ọrịa kansa afọ, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Ọnya dị larịị na-acha ọcha
fundic gland ụdị ọrịa kansa afọ
◆ Ikpe 2: Ọcha ọcha, larịị/ dara mbà n'obi
Nkọwa:Mgbidi ihu nke gastric fundic fornix-cardia ka ukwuu curvature, 14 mm, ọcha, ụdị 0-1lc, na-enweghị atrophy ma ọ bụ eriri afọ metaplasia na ndabere, edoghị oke ókè, na dendritic arịa ọbara hụrụ n'elu. (NBI na mkpirisi mkpirisi)
Nchọpụta nchọpụta (ejikọta ya na pathology):U, 0-Ilc, 14mm, fundic gland ụdị ọrịa kansa afọ, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
- Red welitere ọnya
fundic gland ụdị ọrịa kansa afọ
◆Ikpe nke 3: Ọnya na-acha uhie uhie na elu
Nkọwa:Mgbidi dị n'ihu nke nnukwu curvature nke cardia bụ 12 mm, doro anya na-acha uhie uhie, ụdị 0-1, na-enweghị atrophy ma ọ bụ metaplasia intestinal n'azụ, ókèala doro anya, na arịa ọbara dendritic n'elu (NBI na mmụba ntakịrị)
Nchọpụta nchọpụta (ejikọta ya na pathology):U, 0-1, 12mm, fundic gland ụdị ọrịa kansa afọ, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
- Red, larịị, ọnya dara mbà n'obis
fundic gland ụdị ọrịa kansa afọ
◆Ikpe nke 4: Ọnya na-acha uhie uhie, larịị/ dara mbà n'obi
Nkọwa:N'azụ mgbidi nke ukwuu curvature nke elu akụkụ nke gastric ahụ, 18mm, ìhè ọbara ọbara, O-1Ic ụdị, ọ dịghị atrophy ma ọ bụ nsia metaplasia na ndabere, edoghị ókè, ọ dịghị dendritic ọbara arịa n'elu, (NBI na mmụba ewepụrụ. )
Nchọpụta nchọpụta (ejikọta ya na pathology):U, O-1lc, 19mm, fundic gland ụdị ọrịa kansa afọ, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
kwurịta
Ụmụ nwoke nwere ọrịa a tọrọ ụmụ nwanyị, na nkezi afọ bụ 67.7 afọ. N'ihi njirimara nke simultaneity na heterochrony, a ga-enyocha ndị ọrịa na-arịa ọrịa fundic gland ụdị ọrịa kansa afọ otu ugboro n'afọ. Ebe a na-ahụkarị bụ mpaghara fundic gland dị n'etiti na akụkụ elu nke afọ (fundus na etiti na akụkụ elu nke gastric ahụ). Ọnya ebiligoro dị ka SMT na-acha ọcha na-adịkarị na ọkụ ọcha. Isi ọgwụgwọ bụ diagnostic EMR/ESD.
Ọ dịghị metastasis lymphatic ma ọ bụ mbuso agha vaskụla ahụbeghị ugbu a. Mgbe ọgwụgwọ gasịrị, ọ dị mkpa iji chọpụta ma ọ ga-emekwu ịwa ahụ ma nyochaa mmekọrịta dị n'etiti ọnọdụ ọjọọ na HP. Ọ bụghị ụdị ọrịa cancer afọ nke gland niile bụ HP adịghị mma.
1) Fundic gland mucosal ọrịa kansa afọ
Fundic gland mucosal ọrịa kansa afọ
◆Ikpe nke 1
Nkọwa:A na-ebuli ọnyá ahụ ntakịrị, na RAC na-abụghị atrophic mucosa gastric nwere ike ịhụ gburugburu ya. Enwere ike ịhụ microstructure na microvessels na-agbanwe ngwa ngwa na akụkụ ME-NBI ewelitere, na DL nwere ike ịhụ.
Nchọpụta nchọpụta (ejikọta ya na pathology):Fundic gland mucosal gastric cancer, U mpaghara, 0-1la, 47*32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Fundic gland mucosal ọrịa kansa afọ
◆Ikpe nke 2
Nkọwa: Ọkpụkpụ dị larịị na mgbidi ihu nke obere curvature nke cardia, nke nwere mgbagwoju anya na-acha uhie uhie, a na-ahụ arịa ọbara dendritic n'elu, na ọnyá ahụ dị ntakịrị.
Nchọpụta nchọpụta (ejikọta ya na pathology): Fundic gland mucosal ọrịa kansa afọ, 0-lla, pT1a/M, ULO, LyOV0, HM0, VMO
kwurịta
Aha "gastric gland mucosal adenocarcinoma" dị ntakịrị ihe siri ike ịkpọ, ọnụ ọgụgụ ya dị ntakịrị. Ọ na-achọ mgbalị ka ukwuu iji mata na ịghọta ya. Fundic gland mucosal adenocarcinoma nwere njirimara nke nnukwu malignancy.
Enwere isi njirimara anọ nke endoscopy ìhè ọcha: ① ọnya homochromatic-fading; ② ụbụrụ subepithelial SMT; ③ arịa ọbara dendritic gbasaa; ④ microparticles mpaghara. Ọrụ ME: DL (+) IMVP (+) IMSP (+) MCE na-agbasawanye IP wee na-abawanye. N'iji usoro akwadoro MESDA-G, 90% nke fundic gland mucosal cancer cancer na-ezute usoro nyocha.
3) Adenoma afọ (pyloric gland adenoma PGA)
adenoma gastric
◆Ikpe nke 1
Nkọwa:A hụrụ ọnya dị larịị dị larịị na-acha ọcha na mgbidi azụ nke fornix gastric nwere oke edoghị anya. Indigo carmine staining egosighi oke doro anya, a na-ahụkwa ọdịdị LST-G nke nnukwu eriri afọ (na-amụba ntakịrị).
Nchọpụta nchọpụta (ejikọta ya na pathology):obere atypia carcinoma, O-1la, 47 * 32mm, tubular adenocarcinoma dị iche iche, pT1a/M, ULO, Ly0, VO, HMO, VMO
adenoma gastric
◆Ikpe nke 2
Nkọwa: Ọnya na-ebuli elu na nodules na mgbidi ihu nke akụkụ etiti nke ahụ gastric. Enwere ike ịhụ gastritis na-arụ ọrụ n'azụ. Enwere ike ịhụ indigo carmine dị ka oke. (NBI na mmụba ntakịrị)
Pathology: A hụrụ okwu MUC5AC na epithelium dị elu, a na-ahụkwa okwu MUC6 na epithelium dị elu. Nchọpụta ikpeazụ bụ PGA.
kwurịta
Adenoma afọ bụ n'ezie mucinous glands na-abanye na stroma ma kpuchie ya foveolar epithelium. N'ihi mmụba nke protrusions glandular, bụ nke na-ahụ anya ma ọ bụ nodular, adenoma gastric a na-ahụ na ìhè endoscopic na-acha ọcha bụ ihe niile nodular na-apụta. Ọ dị mkpa ịṅa ntị na nhazi 4 nke Jiu Ming n'okpuru nyocha endoscopic. ME-NBI nwere ike ịhụ ọdịdị papillary/villous nke PGA. PGA abụghị kpamkpam HP adịghị mma na nke na-abụghị atrophic, ma nwee ụfọdụ ihe ize ndụ nke ọrịa kansa. A na-akwado nyocha nke mbụ na ọgwụgwọ mmalite, na mgbe achọpụtara ya, a na-atụ aro ka a na-arụ ọrụ en block resection na nyocha ndị ọzọ.
4) (dị ka raspberry) ọrịa kansa afọ epithelial foveolar
raspberry foveolar epithelial ọrịa kansa afọ
◆Ikpe nke 2
Nkọwa:(ahapụrụ)
Nchọpụta nchọpụta (ejikọta ya na pathology): ọrịa kansa afọ epithelial foveolar
raspberry foveolar epithelial ọrịa kansa afọ
◆Ikpe nke 3
Nkọwa:(ahapụrụ)
Nchọpụta nchọpụta (ejikọta ya na pathology):foveolar epithelial ọrịa kansa
kwurịta
Raspberry, nke a na-akpọ "Tuobai'er" n'obodo anyị, bụ mkpụrụ ọhịa n'akụkụ okporo ụzọ mgbe anyị bụ ụmụaka. Ejikọtara epithelium glandular na glands, mana ha abụghị otu ọdịnaya. Ọ dị mkpa ịghọta uto na njirimara mmepe nke mkpụrụ ndụ epithelial. Raspberry epithelial ọrịa kansa gastric dị nnọọ ka gastric polyps ma nwee ike imehie n'ụzọ dị mfe maka polyps gastric. Ihe ama ama nke epithelium foveolar bụ ngosipụta kachasị nke MUC5AC. Ya mere foveolar epithelial carcinoma bụ okwu izugbe maka ụdị a. Ọ nwere ike ịdị na HP adịghị mma, nke dị mma, ma ọ bụ ka emechara ọgwụ mgbochi nwa. Ọdịdị Endoscopic: strawberry na-acha uhie uhie na-egbuke egbuke dị ka mpụta, n'ozuzu ya nwere oke doro anya.
5) carcinoma cell mgbanaka
Carcinoma cell mgbanaka mgbanaka: ọdịdị ìhè ọcha
Carcinoma cell mgbanaka mgbanaka: ọdịdị ìhè ọcha
mgbanaka cell carcinoma
◆Ikpe nke 1
Nkọwa:Flat ọnya na posterior mgbidi nke gastric vestibule, 10 mm, adịkwaghị agbapụta, ụdị O-1Ib, ọ dịghị atrophy na ndabere, anya ókè na mbụ, ọ bụghị doro anya ókè na nyochagharị, ME-NBI: naanị interfoveal akụkụ na-aghọ ọcha, IMVP (-)IMSP (-)
Nchọpụta nchọpụta (ejikọta ya na pathology):A na-eji ụdị ESD achọpụta ọrịa carcinoma cell mgbanaka.
Ihe ngosi pathological
Carcinoma cell mgbanaka mgbanaka bụ ụdị kachasị njọ. Dịka nhazi nke Lauren si kwuo, a na-ekewa carcinoma nke eriri afọ eriri afọ dị ka ụdị carcinoma na-agbasasị ma bụrụ ụdị carcinoma na-enweghị atụ. Ọ na-emekarị n'ime ahụ afọ, ọ na-adịkarịkwa na ọnya dị larịị na nke dara ada nwere ụda na-agbanwe agbanwe. Ọnya ewelitere dị ụkọ ma nwee ike igosipụta dị ka mbuze ma ọ bụ ọnya. O siri ike ịchọpụta n'oge nyocha endoscopic n'oge mmalite. Ọgwụgwọ nwere ike ịbụ resection curative dị ka endoscopic ESD, yana nleba anya nke ọma mgbe arụchara ọrụ ahụ yana nleba anya ma ọ ga-emekwu ịwa ahụ. Ntughari na-abụghị ọgwụgwọ ga-achọ ịwa ahụ ọzọ, dọkịta na-awa ahụ kpebiri usoro ịwa ahụ.
Ozizi ederede na foto dị n'elu sitere na "afọ na eriri afọ"
Tụkwasị na nke a, ekwesịrị ịṅa ntị na ọrịa cancer nkwụsị nke esophagogastric, ọrịa cancer obi, na adenocarcinoma dị iche iche dị iche iche dị na HP-negative ndabere.
3. Nchịkọta
Taa, m mụtara ihe ọmụma dị mkpa na ngosipụta endoscopic nke HP-adịghị mma ọrịa cancer gastric. Ọ na-agụnyekarị: fundic gland ụdị ọrịa kansa afọ, fundic gland mucosal ụdị ọrịa kansa afọ, adenoma gastric, (raspberry-dị ka) foveolar epithelial tumor na signet cell carcinoma.
Ihe omume ụlọ ọgwụ nke HP-negative cancer gastric dị ala, ọ na-esiri ike ikpe ikpe, ọ dịkwa mfe ịchọta nyocha. Ihe siri ike karị bụ ngosipụta endoscopic nke ọrịa ndị dị mgbagwoju anya na nke na-adịghị ahụkebe. E kwesịkwara ịghọta ya site n'echiche endoscopic, karịsịa ihe ọmụma usoro ihe ọmụma dị n'azụ ya.
Ọ bụrụ na ị na-eleba anya na polyps gastric, erosions, na ebe na-acha uhie uhie na nke ọcha, ị kwesịrị ịtụle ohere nke ọrịa cancer gastric Hp-negative. Mkpebi nke HP adịghị mma ga-agbasorịrị ụkpụrụ, yana nlebara anya na ihe ọjọọ na-adịghị mma kpatara site na ịdabere na nsonaazụ ule ume. Ndị endoscopy nwere ahụmahụ tụkwasịrị anya nke ha obi karịa. Na-eche echiche zuru ezu n'azụ HP-na-adịghị mma ọrịa kansa gastric, anyị ga-aga n'ihu na-amụta, ghọta na omume iji mara ya.
Anyị, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., bụ emeputa na China ọkachamara na endoscopic consumables, dị kabiopsy forceps, hemoclip, polyp ọnyà, sclerotherapy agịga, ịgbasa catheter, cytology brushes,ndu,nkata eweghachite okwute, imi biliary drainage catheter wdg. nke a na-ejikarị eme ihe naEMR,ESD,ERCP.Ngwaahịa anyị bụ CE asambodo, na osisi anyị bụ ISO asambodo. Ebupụla ngwongwo anyị na Europe, North America, Middle East na akụkụ nke Eshia, na-enwetakwa ndị ahịa nke nnabata na otuto!
Oge nzipu: Jul-12-2024