Kev Kho Mob Endoscopic ntawm Kev Tshaj Tawm Kev Xa Tawm ntawm Kev Ua Yeeb Yam ntawm Kev Ua Si Digestive: 3 Cov Ntsiab Lus Loj Ntxub Ntxaij hauv ib tsab xov xwm

Kev xa tawm cov qog (SMT) ntawm lub plab zom mov yog qhov chaw nyob ntawm cov kab mob ntawm cov nqaij ntshiv, submosa, lossis tej zaum yuav yog cov txhab nqaij mos. Nrog rau kev txhim kho kev kho mob technology, tso cai cov kev xaiv kev hloov kho ib txwm muaj maj mam nkag mus rau txoj kev kho mob tsis zoo, xws li lKev phais menyuam thiab phais mob loj. Txawm li cas los xij, hauv chaw kuaj mob, nws tuaj yeem pom tias "kev phais mob" tsis haum rau txhua tus neeg mob. Nyob rau hauv xyoo tsis ntev los no, tus nqi ntawm kev kho endoscopic tau maj mam tau txais kev saib xyuas. Qhov kev pom zoo tshiab ntawm cov kev pom zoo Suav suav ntawm cov kev kuaj mob endoscopic thiab kev kho ntawm SMT tau tso tawm. Kab lus no yuav qhia luv luv kawm cov kev paub cuam tshuam.

1.smt phaum tu ncuakev muab ntaub ntawv

(1) qhov xwm txheej ntawm smT yog tsis ncaj nyob rau ntau qhov chaw ntawm lub plab zom mov, thiab lub plab yog lub chaw tshaj plaws rau SMT.

Qhov xwm txheej ntawm variouS Qhov ntawm lub plab zom mov yog qhov tsis ncaj, nrog lub plab zom mov tau ua ntau dua. Ntawm cov no, 2/3 tshwm sim hauv plab, tom qab los ntawm txoj hlab pas, duodenum, thiab nyuv.

(2) Cov histopathivaL Hom SMT yog cov nyom, tab sis feem ntau SMT yog benign qhov chaw, thiab tsuas yog ob peb yog malignant.

A.smt suav nrog tsis muajn-neoplastic qhov txhab txhab xws li ectopic pancreatic cov ntaub so ntswg thiab neoplastic me.

B.among Tus Nooplastic DesionS, GastroTional Leiomyomas, Lipomas, brculosa cell qog, thiab tsawg dua 15% tuaj yeem tshwm sim raws li cov nqaij kawm paub kev ua phem.

C.gegastressestes stromal hlav (gist) thiab neuroendocrine qog (Net) hauv SMT yog hlav nrog qee qhov muaj peev xwm malignant, tab sis qhov no nyob ntawm nws loj, qhov chaw thiab hom.

D.The qhov chaw ntawm SMT muaj feem xyuamrau kev faib tawm cov kev faib tawm: a. Leiomyomas yog hom kev sib deev ntawm SMT hauv Essophagus, Accounting rau 60% rau ntawm Essophagal SMts, thiab ntau dua yuav tshwm sim nyob rau hauv av thiab qis dua ntawm txoj hlab pas. B.The hom pathabological ntawm cov pa roj plab smt yog cov sib txawv, nrog gist, leiomyoma thiab ectopic panccreas yog qhov feem ntau. Ntawm cov av gattricm, gist feem ntau pom nyob rau hauv cov nyiaj thiab lub cev ntawm lub plab thiab sab qaum kev ntawm lub cev, thiab ectopic cancreas thiab ectopic cancreas yog feem ntau. Lipomas muaj ntau nyob rau hauv lub plab zom mov; c. Lipomas thiab cysts muaj ntau dua nyob rau hauv qhov chaw nqis thiab bulbous ntawm lub duodenum; d. Hauv SMT ntawm cov plab zom mov qis, Lipomas tau tshwm sim hauv txoj hnyuv, thaum cov nets yog feem ntau hauv lub qhov quav.

(3) Siv CT thiab MRI rau qib, kho, thiab ntsuas cov qog. Rau smts uas xav tias yog muaj peev xwm malignant lossis muaj cov qog loj (ntevTxoj kab uas hla> 2 cm), CT thiab MRI pom zoo.

Lwm txoj kev xav, suav nrog CT thiab MRI, kuj tseem muaj qhov tseem ceeb rau kev kuaj mob ntawm SMT. Lawv tuaj yeem ncaj qha rau qhov chaw ntawm cov kev tshwm sim, qauv kev loj hlob, qhov tsis muaj txiaj ntsig, thiab lwm yam, thiab tuaj yeem nrhiav txawm tias yog thiab qib tuabKev sib koom ntawm cov roj plab phab ntsa huab cua. Lawv yog cov qauv tseem ceeb rau kev tshawb nrhiav cov qhab nia, kev kho mob thiab kev ntsuas kev sib tw ntawm cov qog.

(4) cov ntaub so ntswg tsis yog recoMMITED rau Benign SMts uas tuaj yeem kuaj pom los ntawm Endensional

Rau qhov txhab mob txhab uas xav tias yog malignant lossis thaum lub qhov txhab ua ke tsis tuaj yeem siv lub ntsej muag zoo nkauj lossis ua kom zoo nkauj (Eus-Biopsy Startonography Goded nplua nEEDLE ASPIRATION / Baunsy, Eus-FNA / FCBosal-itchis (Miab), thiab lwm yam ua piv txwv rau kev ntsuam xyuas kev ua haujlwm. Hauv kev pom ntawm cov kev txwv ntawm Eus-FAs thiab tom qab kev phais mob rau kev phais mob endoscopic, rau cov neeg uas tau txais kev kho mob rau cov qog ua tiav tuaj yeem kho tau los ntawm kev paub Cov Endoscopist ua cov kev hloov kho Endoscopic ncaj qha yam tsis tau txais kev kuaj mob ua ntej.

Txhua txoj kev ntawm tau txais cov hnoos qeev ua ntej kev phais mob yog qhov tsis zoo thiab yuav ua rau kev phais mob rau kev phais mob thiab muaj peev xwm ua kom muaj kev pheej hmoo los ntshav, perforation, thiab qog sib nrug. Yog li ntawd, kev ua haujlwm rau lub cev tsis tas yuav tsim nyog. Tsim nyog, tshwj xeeb tshaj yog rau SMTS uas tuaj yeem kuaj pom los ntawm endental

2.SMT Endoscopic Khont

(1) Cov hauv paus ntsiab lus raug kho

Qhov txhab uas tsis muaj Lymph ntawm Metastasis lossis kev pheej hmoo tsawg ntawm cov kab mob Lascph, thiab muaj kev rov qab muaj qhov tsim nyog rau Endoscopic Resection yog tias kev kho mob. Tshem tawm kom tiav ntawm cov qog nqaij daim qog thiab qhov kev pheej hmoo rov ua dua. TusCov ntsiab cai ntawm kev kho mob pub dawb yuav tsum tau ua raws li lub sijhawm Endoscopic tawm, thiab kev ncaj ncees ntawm cov qog tshuaj ntsiav yuav tsum ua kom zoo thaum lub sijhawm rov qab.

(2) qhia

i.tumors nrog txiv neej muaj peev xwm kuaj mob los ntawm kev kuaj mob preunpatination lossis lees paub los ntawm biopy pathology, tshwj xeeb tshaj yog cov neeg xav tias GISt nrog ib qho kev ntsuam xyuas Preoperative expression ntev ntawm ≤2CM thiab kev pheej hmoo tsawg ntawm kev rov qab dua thiab muaj peev xwm ua tiav kev rov qab ua tiav, tuaj yeem yog qhov nce qib endection); rau cov qog nrog txoj kab uas ntev ntev rau kev ntsuam xyuas tsis txaus siab gist> 2cm, yog qhov kev phais mob me me uas tau raug cais tawm ntawm cov qog ua tiav, cov kev phais mob tsis txaus ntseeg tau ua los ntawm cov kev paub dhau los ntawm cov endoscopists hauv Ib chav nrog cov kev kho kom paub tab Teasoscopic thev naus laus zis. rov qab.

ii. Symptomatic (piv txwv li los ntshav, txheej txheem) SMT.

iii.patients uas cov qog nqaij hlav yog tus neeg soj ntsuam los ntawm kev kuaj mob, tab sis tsis tuaj yeem ua raws li kev ua ntu zus los sis tsis tu ncua lub sijhawm thaum lub sijhawm rov qab ua haujlwm thiab cov uas muaj zoge rau kev kho mob endoscopic.

(3) tej yam ntxwv

Kuv. Txheeb xyuas qhov txhab uas muaj kuvTastasized rau cov qog ntshav lossis cov chaw nyob deb.

ii. Rau qee SMT nrog CLEKPHnodelossis nyob deb Metassasis, ntau tus me me yog yuav tsum tau txais pathology, uas tuaj yeem suav tias yog qhov txheeb ze contraindication.

III. Tom qab cov ncauj lus kom ntxawsKev ntsuam xyuas, nws tau txiav txim siab tias qhov kev mob uas yog tsis zoo thiab phais mob endoscopic tsis tau.

Benign cov kab mob xws li cov diasa thiab ectopic canccreas feem ntau tsis ua rau cov tsos mob xws li mob, los ntshav, thiab kev nyuaj. Thaum SMT manifests li yaig, mob rwj, lossis sai sai nyob rau hauv ib lub sijhawm luv luv, muaj peev xwm ntawm nws lub lesion malignant nce.

(4) Xaiv cov tshuaj tiv thaiv metho med

Endoscopic snare resection: rauSMT uas yog cov superficial, prorudes rau kab noj hniav raws li kev xeem thiab ct kev xeem, thiab tuaj yeem raug xa tawm txhua lub sijhawm nrog ib qho khoom siv snare, endoscopic snare rov qab yuav siv tau.

Kev tshawb fawb hauv tsev thiab txawv teb chaws tau lees tias nws muaj kev nyab xeeb thiab ua tau zoo nyob rau hauv skiv tib <2cm, nrog rau kev los ntshav txaus ntshai ntawm 4% mus rau 13% thiab 13% thiab ib qho zoo nkaujkev pheej hmoo ntawm 2% rau 70%.

Endoscopic Shipucosal, es: Rau SMts nrog cov kab ntev ntev ≥2 cm lossis yog tias kev kuaj mob xws li EUs thiab CT lees paub thNtawm cov qog cov kab ke rau hauv kab noj hniav, ees yog ua tau rau endoscopic lub tes tsho rov qab rov qab ntawm cov smts tseem ceeb heev.

Es ua raws cov txheej txheem kev kawm ntawmEndoscopic xa tawm ntawm cov ncauj lus (ESD) thiab cov kev siv hluav taws xob endoscopic tawm tsam tshem tawm cov qog nqaij daim qog kom tshem tawm cov qog thiab ua tiav cov qog. , kom ua tiav lub hom phiaj ntawm kev ua kom ncaj ncees ntawm cov qog, txhim kho lub radicalness ntawm kev phais mob, thiab txo cov teeb meem intraperatitatitive. Rau cov qog ≤1.5 cm, ib tus nqi them rov qab tiav ntawm 100% tuaj yeem ua tiav.

Shipthitosal qhov endoscopic resectIon, SMT Keeb kwm los ntawm cov leeg nqaij coverhria, Hilum, cov plab zom mov, uas yog qhov yooj yim ntawm cov cheeb tsam ≤, thiab CL, Ster tuaj yeem yog tus nyiam Txoj kev kho mob.

Ster yog lub thev naus laus zis tshiab tsim raws li peroral endoscopic ESOHACAGEPYOTOMYO (paj huam) thiab yog ib qho txuas ntxiv ntawm Asm Techtsis ntseeg. En Floc Resection tus nqi ntawm Ster rau kev kho SMT nce mus txog 84.9% rau 97.59%.

Endoscopic Tag Nrho-Thickness OrectIon, EFTR: Nws tuaj yeem siv rau SMT qhov twg nws yog qhov nyuaj los tsim lub qhov dej ntawm cov qog yog ≥3.5 cm thiab tsis haum rau Ster. Yog hais tias cov qog tiv thaiv nyob rau hauv lub paj yeeb lossis loj hlob sab nraud ntawm cov kab noj hniav, thiab cov qog yog pom kom nruj rau cov serosa txheej rau kev phais thiab tsis tuaj yeem sib cais, nws tuaj yeem siv. EFTR ua yeeb yam endoscopic.

Kev tsim nyog suturing ntawm perforationsite tom qab EFTR yog tus yuam sij rau txoj kev vam meej ntawm EFTR. Txhawm rau kom ntsuas qhov kev pheej hmoo ntawm cov lus qhia Yog tias nws yog qhov tsim nyog los tshem tawm cov qog hauv daim, yuav tsum tau kho cov qog ua ntej kom txo qis kev pheej hmoo ntawm cov qog nqaij hlav thiab kis tau. Ib co kev suturing muaj xws li: hlau cluture, omst hniav clip classe nrog cov hlau clip, Otsc) Overstitch suture thiab lwm yam Cov thev naus laus zis tshiab los kho cov plab zom mov thiab cuam tshuam nrog los ntshav, thiab lwm yam.

(5) Kev Txom Nyem Kev Txom Nyem

Kev los ntshav: Los ntshav uas ua rau tus neeg mob hemoglobin kom poob los ntawm ntau dua 20 g / l.
Txhawm rau tiv thaiv kom tiv thaiv kev loj hlob ntawm sab hauv,Yuav tsum tau ua kom txaus submucosal yuav tsum tau ua thaum lub sijhawm ua haujlwm kom ua rau cov hlab ntshav loj dua thiab ua kom pom kev los ntshav. Kev los ntshav intraoperately tuaj yeem kho nrog ntau qhov phais mob, hemostating lossis tiv thaiv hemostasis ntawm cov hlab ntshav uas pom thaum lub sij hawm dissection.

Cov ntshav postperative: postperative los ntshav ua kom pom ntshav li ntuav ntshav, Melena, lossis ntshav hauv cov quav. Thaum muaj mob hnyav, hemorrhagic poob siab yuav tshwm sim. Feem ntau nws tshwm sim hauv 1 lub lis piam tom qab phais, tab sis kuj tseem tshwm sim 2 txog 4 asthiv tom qab phais tas.

Kev tawm tsam postperating feem ntau cuam tshuam nrogYam khoom xws li cov neeg txom nyem ncua kev ncua cov ntshav siab tswj thiab corrosion ntawm cov hlab ntshav ntawm cov hlab ntshav los ntawm cov hnyuv roj acid. Tsis tas li ntawd, kev tawm hws postative kuj cuam tshuam nrog thaj chaw ntawm tus kab mob, thiab muaj ntau nyob rau hauv lub plab zom mov thiab lub qhov ncauj tsawg.

Kev ncua kev ncua ntawv perforation: feem ntau ua rau muaj mob plab, muaj cov cim tshuaj tsw qab, kub taub hau qhia tau cov roj ntxiv lossis ua kom muaj roj ntau ntxiv nrog ua ntej.

Nws feem ntau cuam tshuam rau yam xws li tsis zoo suturing ntawm cov qhov txhab, kev tswj hwm tau dhau los, kev txom nyem ntawm cov kiav txhab los ntawm cov nqaij tawv los ntawm cov kua txob. a. Yog hais tias lub qhov txhab loj los yog tob lossis lub qhov txhab muaj fisYuav tsum tau txais kev phais mob, cov neeg mob thim rov qab zoo dua thiab rov qab kho kom muaj kev phais mob ntxiv tom qab kev phais mob rov qab los yuav tsum muaj qhov quav dej ntws tawm); b. Cov neeg cov neeg mob ntshav qab zib yuav tsum tswj lawv cov ntshav qab zib; cov uas muaj cov tshuaj tiv thaiv me me thiab cov kab mob thoracic me thiab mob plab thiab mob plab yuav tsum tau noj cov mob xws li yoo mov, tawm tsam cov roj ntsha; c. Rau cov uas muaj effusion, kaw lub hauv siab tawm thiab plab plab tuaj yeem ua cov hlab yuav tsum muab tso rau kom muaj kev tawm kom huv; d. Yog tias tus kab mob tsis tuaj yeem ua rau muaj kev saib xyuas lossis ua ke nrog kev kho mob hauv lub ntiaj teb, kev kho lub plab thiab kev ua pa rau plab yuav tsum tau ua.

Cov pa-cuam tshuam nrog cov teeb meem: suav nrog subcutaNeous embysema, pneumomediastinum, pneumothorax thiab pneumoperitoneum.

Intraoperative subcutaneca (qhia kom brasysema ntawm lub ntsej muag, caj dab, lub hauv siab phab ntsa, thiab scrotum) thiab xov xwm network pneumophysema (sZoo ntawm Epiglottis tuaj yeem pom thaum lub plab zom) feem ntau tsis tas yuav muaj kev kho mob tshwj xeeb, thiab emphysema feem ntau yuav daws nws tus kheej.

Kev Pneumothorax tshwm sim loj heev During phais [ARAw HUV HUV ntau dua 20 mmHg thaum phais

(1mmHG = 0.133kpa), spo2 <90%, paub tseeb los ntawm cov duab tshav kub hluav taws xob hauv qab y-ray], yuav muaj peev xwm txuas ntxiv tom qab kaw hauv siab drainage.

Rau cov neeg mob uas muaj kev ua haujlwm thoob ntiaj teb thaum lub sijhawm ua haujlwm, siv ib rab koob rau pneumopoteritoneum koob rau pcfarland pointNyob rau hauv sab hauv lub plab kom deflate huab cua, thiab tawm ntawm lub taub hau mus txog thaum kawg ntawm kev ua haujlwm, thiab tom qab ntawd tshem tawm nws tom qab paub tseeb tias tsis muaj kev pom tseeb.

Cov GastroTagestion Fistula: Kev phais mob digestive tshwm sim los ntawm kev phais mob endoscopic ntws mus rau hauv siab los yog lub plab hnyuv kab noj hniav los ntawm kev xau.
Esophageal MediaStinal fistulas thiab esophagotoracic fistulas muaj ntau. Thaum ib lub fistula tshwm sim, ua lub hauv siab kaw hauv siab rau maintaNyob rau hauv cov dej ntws du thiab muab kev noj haus tsis txaus. Yog tias tsim nyog, cov clips hlau thiab ntau yam kaw kaw khoom tuaj yeem siv, lossis tag nrho cov kev npog tag nrho tuaj yeem rov ua dua tshiab. Stents thiab lwm txoj hauv kev yog siv los thaiv covfistula. Cov mob hnyav xav tau kev pabcuam sai sai.

3.posteroperative tswj (fOlocks)

(1) Benis Fresions:Pathology SUgigns uas benign cov txhab ua ke xws li cov diomoma thiab leiomyoma tsis xav tau kev taug qab mus ib txwm.

(2) SMT tsis muaj malignAnt lub peev xwm:Piv txwv li, lub voos ncej 2cm, thiab qhov nruab nrab, ua tiav yuav tsum tau ua thiab kev phais ntxiv (kev kho mob quav) yuav tsum tau txiav txim siab. Kho). Daim qauv ntawm txoj kev npaj yuav tsum ua raws ntau txoj kev sib tham thiab ntawm ib tus neeg hauv paus.

(3) Tsawg malignant muaj peev xwm smt:Piv txwv li, tus mob qis tus gist yuav tsum tau ntsuas los ntawm Eus los yog kev xav txhua 6 mus rau 12 hlis tom qab kev kho mob, thiab tom qab ntawd kho raws li cov lus qhia saib xyuas.

(4) SMT nrog nruab nrab thiab muaj peev xwm siab phem:Yog hais tias pathperative pathology tshaj tawm cov hom 3 pahaus tsawg, collectection gist, kev phais mob ntxiv (kev phais mob, yuav tsum tau txiav txim siab) yuav tsum tau pom tseeb. Kho). Daim qauv ntawm txoj kev npaj yuav tsum yog raws[Txog Peb 0118.Docx] kev sib tham thiab ntawm ib tus neeg hauv paus.