Ntawm cov kev paub nrov txog kev paub mob hnyuv qog nqaij hlav cancer thaum ntxov, muaj qee cov ntsiab lus ntawm cov kab mob tsis tshua muaj neeg xav tau kev saib xyuas thiab kev kawm tshwj xeeb. Ib tug ntawm lawv yog HP-tsis zoo rau mob cancer. Lub tswv yim ntawm "kev txiav txim siab epithelial kab mob" yog tam sim no nrov dua. Yuav muaj kev xav txawv ntawm lub npe qhov teeb meem. Cov ntsiab lus no feem ntau yog raws cov ntsiab lus ntsig txog cov ntawv xov xwm "lub plab thiab txoj hnyuv" kuj siv "HP-cov pa tsw phem".
Hom kab mob no muaj cov yam ntxwv ntawm qhov tsis tshua muaj, nyuaj rau kev paub, thiab cov kev paub ntawm Mesda-G tsis siv tau. Kawm cov kev paub no yuav tsum tau ntsib txoj kev nyuaj.
1. Kev paub yooj yim ntawm HP-cov qog nqaij hlav cancer tsis zoo
Zaj liv xwm
Yav dhau los, nws tau ntseeg tias ib leeg ua ke ntawm qhov tshwm sim thiab tus qauv mob plab yog HP - Kev mob plab zom mov - plab hnyuv laus - cov qog mis - muaj mob qog noj ntshav. Tus qauv classic yeej ib txwm tau pom dav, lees paub thiab ntseeg khov kho. Cov hlav tuaj yeem tsim ua ke raws ntawm Atrophy thiab hauv kev ua haujlwm ntawm HP, yog li cov qog nqaij hlav feem ntau tsis yog-atrophic pais plab mucosa.
Tom qab ntawd, qee tus kws kho mob tau pom tias mob qog nqaij hlav cancour tuaj yeem tshwm sim txawm tias tsis muaj kab mob HP. Txawm hais tias qhov xwm txheej tsis muaj qhov tsawg, nws yog qhov tseeb tiag. Hom mob plab hnyuv qog nqaij hlav yog hu ua HP-cov qog nqaij hlav cancer hp-tsis zoo.
Nrog kev nkag siab dav ntawm hom mob no, qhov tob tob tob thiab cov ntsiab lus tau pib, thiab cov npe yog hloov tas li. Muaj ib tsab xov xwm hauv 2012 hu ua "Pahaus Cancer tom qab tsis muaj menyuam", thiab ib tsab xov xwm nyob rau xyoo 2014 hu ua "epithelial cov qog tsis kis tus HP". Lub npe hloov qhia txog qhov tob thiab nkag siab.
Hom Gland Hom
Muaj ob hom qog fidlic thiab cov qog pyloric hauv plab:
Fundic glands (oxyntic caj pas) tau faib rau hauv lub chaw pab nyiaj, lub cev, cov ces kaum, thiab lwm yam ntawm lub plab. Lawv yog cov kab ib leeg tubular caj pas. Lawv muaj cov tshuaj molous, thawj cov hlwb, cov xov tooj cua parietal thiab cov hlwb endocrine, txhua yam uas ua lawv tus kheej lub zog. Ntawm lawv, tus thawj ntawm cov hlwb uas zais cia yog qhov zoo, thiab cov parochloric zais cia hydrochloric acid thiab intrinsic yam;
Cov qog pyloric nyob hauv thaj chaw plab hnyuv thiab muaj cov hnoos qeev thiab cov hlwb endocrine. Cov hnoos qeev yog MUC6 zoo, thiab endocrine hlwb suav nrog g, d hlwb thiab enlochromaffin hlwb. G cell zais pa taws Gastrin, D cov hlwb zais cia Somatostatin, thiab enterochromaffin hlwb zais cia 5-ht.
Cov plab hnyuv plab hnyuv mucosal hlwb thiab cov qog nqaij hlav tso tawm ntau hom hnoos qeev, uas tau muab faib ua "plab zom mov" thiab "mucus" hnoos qeev ". Qhov kev qhia ntawm pais plab thiab plab hnyuv mucins yog hu ua phenotype thiab tsis yog qhov tshwj xeeb qhov chaw ntawm lub plab thiab cov hnyuv.
Muaj plaub lub phenotypes ntawm cov qog pastric: plab zom mov, cov plab zom mov, sib xyaw ua ke, thiab cov hnyuv. Cov qog uas tshwm sim ntawm lub hauv paus ntawm plab hnyuv metapalies yog feem ntau cov plab zom mov phenotype hlav phenotype. Cov qog nqaij hlav sib txawv tsuas yog qhia cov hom hnyuv (MUC2 +), thiab diffuse cancers tsuas yog qhia cov hom phiaj ua plab (Muc5ac +, Muc5ac +).
Txiav txim siab HP qhov tsis zoo yuav tsum muaj kev sib txuam ntawm ntau txoj kev kuaj pom rau kev txiav txim siab. HP-tsis zoo rau mob cancer thiab kev tshaj tawm-kom tsis taus cov qog nqaij hlav cancer yog ob lub tswv yim sib txawv. Yog xav paub txog cov duab xoo hluav taws xob kev tshwm sim ntawm HP-cov mob ntshav qab zib tsis zoo, thov saib ntu ntawm "plab thiab txoj hnyuv".
2. Endoscopic tshwm sim ntawm HP-cov mob qog tsis zoo
Kev kuaj mob endoscopic yog qhov tseem ceeb ntawm HP-tsis zoo ntshav qog nqaij hlav. Nws tsuas yog suav nrog fluic ploctric hom mob qog noj ntshav, roj plab ua rau cov menyuam mob plab zom mov,
1) Fundic Gland Hom Pais plab cancer
-White tsa txhab
Funda Gland Hom Pais plab cancer
Fiture 1: Dawb, tsa qhov txhab
Nqe lus piav qhia:Pais pa hluav taws xob fillix-ntau dua curvature ntawm daim cardia, 10 hli, dawb, tsis muaj atrophy los yog mob plab hnyuv nyob rau tom qab. Arbor-zoo li cov hlab ntsha tuaj yeem pom nyob rau saum npoo (NBI thiab ERIDGENGARARY)
Kev kuaj mob (ua ke nrog pathology):U, O-1la, 9mm, fundic glic hom mob plab hnyuv, PT1B / SMO, LO, HMO, VMO
-White ca lub qhov txhab
Funda Gland Hom Pais plab cancer
◆ Case 2: Cov Khaub Ncaws Dawb, Kev Nyuaj Siab
Nqe lus piav qhia:Phab ntsa anterior ntawm lub plab zom mov ntawm cov pa roj carvic fornix-cardia me ntsis nkhaus lossis hom 0-1nc, tsis paub txog cov hlab ntshav pom ntawm cov hlab ntshav. (NBI thiab Ambationification)
Kev kuaj mob (ua ke nrog pathology):U, 0-ilc, 14mm, fundic gland hom mob plab hnyuv, PT1B / SMO, LO, HMO, VMO
-Ru tsa txhab
Funda Gland Hom Pais plab cancer
Cov Ntaub Ntawv 3: Liab thiab tsa txhab
Nqe lus piav qhia:Phab ntsa anterior ntawm tus nkhaus loj ntawm daim cardia yog 12 hli, pom tseeb liab, thiab cov hlab ntshav ntshiab, thiab cov hlab ntshav kom meej rau saum npoo (NBI thiab offgement me ntsis)
Kev kuaj mob (ua ke nrog pathology):U, 0-1, muaj 12 hli, fundic gland hom mob plab hnyuv, PT1B / SM1 (200μm), UPO, HMO, HMO, VMO
-Ru, tiaj tus, nyuaj siabs
Funda Gland Hom Pais plab cancer
Mathe 4: Liab, tiaj / nyuaj siab
Nqe lus piav qhia:Posterior phab ntsa ntawm tus nkhaus ntau dua ntawm sab qaum kev ntawm lub plab zom mov, 18 hli, thaj tsam ntawm lub teeb liab, tsis paub txog cov hlab ntshav ntawm sab, (NBI thiab EBGENGENT rho tawm )
Kev kuaj mob (ua ke nrog pathology):U, O-1LC, 19mm, fundic gland hom mob plab hnyuv, PT1B / SMO, LO, HMO, VMO
sib tham
Cov txiv neej nrog tus kab mob no yog cov laus dua li poj niam, muaj hnub nyoog nruab nrab yog 67.7 xyoo. Vim yog cov yam ntxwv ntawm kev sib dhos thiab cov neeg mob, cov neeg mob kuaj mob nrog cov qog nqaij hlav cancer hom yuav tsum raug tshuaj xyuas ib xyoos ib zaug. Lub vev xaib tshaj plaws yog thaj chaw thaj av hauv av hauv nruab nrab thiab sab qaum kev ntawm lub plab (cov nyiaj txiag thiab nruab nrab thiab sab saud ntawm lub plab zom mov). Dawb Smt-nyiam tsa cov qhov txhab muaj ntau dua nyob rau hauv lub teeb dawb. Kev kho mob tseem ceeb yog kuaj mob ERR / ESD.
Tsis muaj Lymphatic Metastasis lossis vascular ntxeem tau tau pom kom deb li deb. Tom qab kev kho, nws yog ib qho tsim nyog los txiav txim siab kev phais mob puas tau ua ntxiv thiab ntsuas qhov kev sib raug zoo ntawm kev sib raug zoo thiab HP. Tsis yog txhua yam peev txheej Glotric cancer yog HP tsis zoo.
1) Fundic Gland molbosal pais plab hnyuv
Fund Pog Gland Mucosal Parotric
Hais plaub 1
Nqe lus piav qhia:Lub qhov txhab yog me ntsis tsa, thiab runhic pattric mucosa tuaj yeem pom ib puag ncig nws. Sai sai hloov microstructure thiab microvisseny tuaj yeem pom nyob rau hauv tau tsa ib feem ntawm Me-NBI, thiab DL tuaj yeem pom.
Kev kuaj mob (ua ke nrog pathology):Fund Pog Gland Mucosal Pais plab hnyuv, koj cheeb tsam, 47 * 32100μm), ULO, LO, HMO, VMO
Fund Pog Gland Mucosal Parotric
◆ Case 2
Kev piav txog: Ib lub tiaj tiaj tus nyob rau ntawm phab ntsa anterior ntawm tus curvature tsawg dua ntawm daim cardia, nrog cov hlab ntshav qis dua tuaj yeem pom nyob rau saum npoo, thiab qhov chaw nyob me ntsis.
Kev kuaj mob (ua ke nrog pathology): Fundic Gland Mirosal Pahaus Mob Cancer, 0-Lla, PT1A / M, Upo, Lyov0, HM0, VMO
sib tham
Lub npe ntawm "pais plab gland mucosal adenocarcinoma" yog ib qho nyuaj nyuaj tshaj tawm, thiab qhov tshwm sim tsis tshua muaj tsawg. Nws yuav tsum muaj kev siv zog ntau ntxiv thiab nkag siab nws. Fundic Gland mucosal adenocarcinoma muaj cov yam ntxwv ntawm malignancy.
Muaj plaub qhov tseem ceeb ntawm lub teeb dawb lub teeb endoscopy: ① Homochtromatic-fading qhov txhab; ② Subepithelial qog pob qog; ③ Dilated dendritic cov hlab ntsha; ④ cheeb tsam ntawm lub micropartict. Kuv Kev Ua Tau Zoo: DL (+) IMVP (+) IMSP (+) MCE Hidens IP thiab ntau dua. Siv cov txheej txheem Mesda-G
3) pais plab adenoma (pyloric gland adenoma pga)
Pais plab adenoma
Hais plaub 1
Nqe lus piav qhia:Ib lub tiaj dawb tsa cov kab mob xiav tau pom nyob rau ntawm phab ntsa tom qab ntawm lub plab zom mov nrog cov ciaj ciam tsis meej. Indigo carmine staining qhia tsis muaj thaj tsam meej, thiab cov plaub hau ci ntsa iab ntawm cov hnyuv loj tau pom (loj me ntsis).
Kev kuaj mob (ua ke nrog pathology):Tsawg Atylia Carcinoma, O-1La, 47 * 47 * 46, zoo nkauj tubular adenocarcinoma, PTO, LO, HMO, VMO
Pais plab adenoma
◆ Case 2
Kev piav txog: Ib tug tsa tawm nrog nodules ntawm phab ntsa anterior ntawm nruab nrab ntawm nruab nrab ntawm lub plab zom mov. Nquag gastritis tuaj yeem pom nyob rau tom qab. Indigo carmine tuaj yeem pom raws li tus ciam teb. (NBI thiab MAPERATIONATION)
Kev kho pa: Muc5A cov lus tau pom nyob rau hauv cov ecithelium, thiab txo tus mob hnoos qeev tau pom hauv cov ecithelium. Kev kuaj mob zaum kawg yog PGA.
sib tham
Lub plab mog adenomas yog qhov tseem ceeb mucinous glands censetrating cov stromat thiab duav los ntawm foveolar epithelium. Vim yog cov muaj peev xwm ntawm glandular protrusions, uas yog hemispherical lossis nodular, pais plab, pais plab adenomas pom nrog endoscopic dawb lub teeb yog txhua yam nodular thiab tawm tsam. Nws yog ib qho tsim nyog los them sai sai rau 4 cov kev faib tawm ntawm Jiu ming nyob rau hauv endoscopic kev kuaj. Me-NBI tuaj yeem saib cov yam ntxwv zoo li qub / cov zos pom ntawm PGA. PGA tsis yog HP qhov tsis zoo thiab tsis yog-atrophic, thiab muaj qee yam kev pheej hmoo ntawm kev mob qog noj ntshav. Kev paub thaum ntxov thiab kho ntxov ntxov, thiab tom qab tshawb nrhiav, thiab kev kawm ua haujlwm zoo thiab cov ncauj lus kom ntxaws ntxiv.
4) (raspberry zoo li) failerarar epithelial mob cancer
Raspberry fover epithelial mob qog noj ntshav
◆ Case 2
Nqe lus piav qhia:(rho tawm)
Kev kuaj mob (ua ke nrog pathology): fovarar epithelial mob qog noj ntshav
Raspberry fover epithelial mob qog noj ntshav
Hais plaub 3
Nqe lus piav qhia:(rho tawm)
Kev kuaj mob (ua ke nrog pathology):Foverar augithelial mob cancer epithelial
sib tham
Raspberry, hu ua "Tuobai'er" hauv peb lub tsev, yog cov txiv ntoo qus ntawm ntug kev thaum peb yog menyuam yaus. Glandular epithelium thiab cov qog ua ke txuas, tab sis lawv tsis yog cov ntsiab lus qub. Nws yog qhov tsim nyog kom nkag siab txog kev loj hlob thiab kev nthuav dav ntawm epithelial hlwb. Raspberry epithelial mob qog yog ib qho zoo heev rau cov pastric polyps thiab tuaj yeem yooj yim ua yuam kev rau lub plab zom mov. Lub Wallmark feature ntawm FoverArar epithelium yog qhov tseem ceeb tshaj plaws ntawm Muc5ac. Yog li finarar epithelial carcinoms yog cov lus dav dav rau hom no. Nws tuaj yeem muaj nyob hauv HP qhov tsis zoo, zoo, lossis tom qab kom tsis muaj menyuam. Lub ntsej muag Endoscopic: Round ci ntsa liab strawberry zoo li kev lom zem, feem ntau nrog cov ciam teb meej.
5) SUPETET RING CELL CARCINOMA
Cov paib ntiv nplhaib Cell Carcinoma: Lub teeb pom kev zoo lub teeb
Cov paib ntiv nplhaib Cell Carcinoma: Lub teeb pom kev zoo lub teeb
Cov paib nplhaib Phaj Carcinoma
Hais plaub 1
Nqe lus piav qhia:Tiaj Tus Poj Niam Nyob Sab Nraud ntawm lub pas teb ntawm lub plab zom mov, 10 hli, tsis pom zoo rau ntawm kev pib ua ntej, kuv-NBI: Tsuas yog cov interfovere part ua dawb, IMVP (-) IMSP (-)
Kev kuaj mob (ua ke nrog pathology):ESD cov hnoos qeev yog siv los kuaj xyuas cov paib ntiv nplhaib cell Carcinoma.
PATICALICING QHIA
Cov paib nplhaib ntawm lub cev carcinoma yog hom siab tshaj plaws. Raws li kev faib tawm Lauren, cov plab zom mov nrov nrov nrov ntawm lub cev carcinoma tau cais los ua tus qauv ntawm carcinomely. Nws feem ntau tshwm sim nyob rau hauv lub cev ntawm lub plab, thiab muaj ntau dua nyob rau hauv tiaj thiab sunken txhab nrog cov suab nrov muaj teeb meem. Cov qhov txhab qis yog qhov tsawg thiab tseem tuaj yeem ua kom pom zoo li kev yaig lossis mob rwj. Nws yog qhov nyuaj rau kuaj thaum lub sijhawm kuaj endoscopic nyob rau hauv thaum ntxov. Kev kho mob tuaj yeem yuav curative resection xws li endoscopic ESD, nrog kev ua raws li ncej rov qab ua raws thiab tshuaj xyuas seb puas yuav phais ntxiv. Tsis yog-curative resection yuav tsum tau kom phais ntxiv, thiab kev phais mob tau txiav txim siab los ntawm tus kws phais neeg.
Cov ntsiab lus saum toj no thiab cov duab los ntawm "plab thiab txoj hnyuv"
Ib qho ntxiv, kev saib xyuas yuav tsum tau them rau Esophagogastrtic kev sib tw mob clut, thiab cov lus qhia zoo adenocarcinoma pom hauv keeb kwm hp-tsis zoo.
3. Ntsiab lus
Niaj hnub no kuv kawm paub cov kev paub txog thiab cov kev ua kom pom tseeb ntawm HP-cov qog nqaij hlav cancer tsis zoo. Nws tsuas yog suav nrog: mob qog qog ua mob qog noj ntshav, roj plab ua pa roj carrum,
Cov tshuaj tua kab mob HP-tsis zoo yog tsawg, nws yog qhov nyuaj rau kev txiav txim, thiab nws yooj yim kom nco kev kuaj mob. Dab tsi yog qhov nyuaj dua yog qhov ua tiav endoscopic ntawm cov kab mob uas tsis tshua muaj. Nws kuj yuav tsum tau to taub los ntawm kev pom endoscopic, tshwj xeeb tshaj yog cov kev paub theoretical tom qab nws.
Yog tias koj saib ntawm polyric polyps, kev yaig, thiab thaj chaw xim liab thiab dawb, koj yuav tsum xav txog qhov ua rau muaj mob qog tsis zoo ntawm HP-tsis zoo. Kev txiav txim siab ntawm HP qhov tsis zoo yuav tsum ua raws cov qauv, thiab saib xyuas yuav tsum tau them rau kev tsis ncaj ncees los ntawm kev cia siab ntawm kev ua pa. Kev paub txog Endoscopists ntseeg lawv tus kheej lub qhov muag ntau dua. Ntsib cov ncauj lus kom ntxaws tom qab hp-tsis muaj mob qog nqaij hlav cancer, peb yuav tsum kawm txuas ntxiv, nkag siab thiab xyaum rau nws.
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Lub Sijhawm Post: Jul-12-2024