Ntawm cov kev paub txog mob qog noj ntshav thaum ntxov uas neeg paub ntau, muaj qee cov ntsiab lus txog kab mob tsawg tsawg uas xav tau kev saib xyuas thiab kev kawm tshwj xeeb. Ib qho ntawm lawv yog mob qog noj ntshav HP-negative. Lub tswv yim ntawm "cov qog epithelial tsis kis kab mob" tam sim no nrov dua. Yuav muaj kev xav sib txawv txog qhov teeb meem lub npe. Lub tswv yim ntsiab lus no feem ntau yog raws li cov ntsiab lus ntsig txog phau ntawv xov xwm "Stomach and Intestine", thiab lub npe kuj siv "HP-negative gastric cancer".
Cov hom mob no muaj cov yam ntxwv ntawm qhov tshwm sim tsawg, nyuaj rau txheeb xyuas, kev paub txog kev xav nyuaj, thiab cov txheej txheem MESDA-G yooj yim tsis siv tau. Kev kawm cov kev paub no yuav tsum tau ntsib cov teeb meem.
1. Kev paub txog mob qog noj ntshav hauv plab uas tsis muaj HP
Keeb kwm
Yav dhau los, neeg ntseeg tias tus neeg ua rau mob qog noj ntshav hauv plab yog tus kab mob HP, yog li tus qauv mob qog noj ntshav qub yog HP - atrophy - plab hnyuv metaplasia - qog qis - qog siab - mob qog noj ntshav. Tus qauv qub yeej ib txwm tau lees paub dav dav, lees txais thiab ntseeg ruaj khov. Cov qog tsim ua ke raws li atrophy thiab nyob rau hauv kev ua ntawm HP, yog li cov qog noj ntshav feem ntau loj hlob hauv cov hnyuv atrophic thiab cov hnyuv tsis zoo li qub.
Tom qab ntawd, qee tus kws kho mob tau pom tias mob qog noj ntshav hauv plab tuaj yeem tshwm sim txawm tias tsis muaj tus kab mob HP. Txawm hais tias tus nqi tshwm sim tsawg heev, nws yeej ua tau. Hom mob qog noj ntshav hauv plab no hu ua mob qog noj ntshav hauv plab HP-negative.
Nrog kev nkag siab maj mam txog hom kab mob no, kev soj ntsuam tob tob thiab kev sau cov ntsiab lus tau pib, thiab cov npe hloov pauv tas li. Muaj ib tsab xov xwm hauv xyoo 2012 hu ua "Kab Mob Cancer Tom Qab Ua Kom Tsis Muaj Mob", ib tsab xov xwm hauv xyoo 2014 hu ua "Kab Mob Cancer Tsis Zoo Rau Mob Hp", thiab ib tsab xov xwm hauv xyoo 2020 hu ua "Cov Qog Mob Epithelial Tsis Muaj Kab Mob Hp". Kev hloov lub npe qhia txog kev nkag siab tob thiab dav.
Cov Hom Qog thiab Cov Qauv Kev Loj Hlob
Muaj ob hom tseem ceeb ntawm cov qog fundic thiab cov qog pyloric hauv plab:
Cov qog Fundic (cov qog oxyntic) tau muab faib rau hauv lub fundus, lub cev, ces kaum, thiab lwm yam ntawm lub plab. Lawv yog cov qog linear ib leeg tubular. Lawv yog tsim los ntawm cov hlwb mucous, cov hlwb tseem ceeb, cov hlwb parietal thiab cov hlwb endocrine, txhua tus ua lawv tus kheej lub luag haujlwm. Ntawm lawv, cov hlwb tseem ceeb Cov xim PGI thiab MUC6 uas tau tso tawm yog qhov zoo, thiab cov hlwb parietal tau tso tawm hydrochloric acid thiab intrinsic factor;
Cov qog pyloric nyob hauv thaj tsam gastric antrum thiab muaj cov hlwb mucus thiab cov hlwb endocrine. Cov hlwb mucus yog MUC6 zoo, thiab cov hlwb endocrine suav nrog G, D hlwb thiab enterochromaffin hlwb. G hlwb tso gastrin, D hlwb tso somatostatin, thiab enterochromaffin hlwb tso 5-HT.
Cov qe ntshav hauv plab thiab cov qe ntshav qog ib txwm muaj ntau hom protein ntawm cov hnoos qeev, uas muab faib ua "gastric", "intestinal" thiab "mixed". Kev qhia tawm ntawm cov hnoos qeev hauv plab thiab plab hnyuv hu ua phenotype thiab tsis yog qhov chaw tshwj xeeb ntawm lub plab thiab cov hnyuv.
Muaj plaub hom qog nqaij hlav hauv plab: mob plab tag nrho, mob plab sib xyaw, mob plab sib xyaw, thiab mob plab tag nrho. Cov qog nqaij hlav uas tshwm sim los ntawm kev hloov pauv ntawm txoj hnyuv feem ntau yog cov qog nqaij hlav sib xyaw. Cov qog nqaij hlav sib txawv feem ntau qhia txog hom hnyuv (MUC2+), thiab cov qog nqaij hlav sib kis feem ntau qhia txog hom plab (MUC5AC+, MUC6+).
Kev txiav txim siab seb puas muaj Hp negative yuav tsum muaj ntau txoj kev kuaj mob sib xyaw ua ke kom paub meej. Mob qog noj ntshav hauv plab uas tsis muaj HP thiab mob qog noj ntshav hauv plab tom qab ua kom huv yog ob lub tswv yim sib txawv. Yog xav paub ntxiv txog cov tsos mob X-ray ntawm mob qog noj ntshav hauv plab uas tsis muaj HP, thov saib ntu ntawm phau ntawv xov xwm "Stomach and Intestine".
2. Cov tsos mob ntawm tus mob qog noj ntshav hauv plab HP-negative los ntawm kev siv koob tshuaj endoscopic
Kev kuaj mob qog noj ntshav hauv plab uas tsis muaj HP-negative yog siv txoj kev endoscopic. Feem ntau nws suav nrog mob qog noj ntshav hauv plab fundic gland, mob qog noj ntshav hauv plab fundic gland mucosal, mob qog noj ntshav hauv plab adenoma, mob qog noj ntshav hauv plab raspberry foveolar epithelial, mob qog noj ntshav hauv lub nplhaib signet, thiab lwm yam. Tsab xov xwm no tsom mus rau kev qhia txog mob qog noj ntshav hauv plab HP-negative los ntawm txoj kev endoscopic.
1) Fundic gland type gastric gastric
-Cov qhov txhab dawb uas nce siab
fundic gland type gastric mob plab
◆Cov Ntaub Ntawv 1: Cov qhov txhab dawb, nce siab
Kev piav qhia:Gastric fundic fornix-qhov nkhaus loj dua ntawm lub cardia, 10 hli, dawb, hom O-lia (zoo li SMT), tsis muaj atrophy lossis intestinal metaplasia nyob tom qab. Cov hlab ntsha zoo li Arbor tuaj yeem pom ntawm qhov chaw (NBI thiab loj me ntsis)
Kev kuaj mob (ua ke nrog kev mob nkeeg):U, O-1la, 9mm, fundic gland type gastric cancer, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Cov qhov txhab dawb tiaj tiaj
fundic gland type gastric mob plab
◆Cov ntaub ntawv thib 2: Cov qhov txhab dawb, tiaj tus/nqaim
Kev piav qhia:Phab ntsa pem hauv ntej ntawm lub plab hnyuv fundic fornix-cardia loj dua, 14 hli, dawb, hom 0-1lc, tsis muaj atrophy lossis plab hnyuv metaplasia nyob rau tom qab, ciam teb tsis meej, thiab pom cov hlab ntsha dendritic ntawm qhov chaw. (NBI thiab amplification luv luv)
Kev kuaj mob (ua ke nrog kev mob nkeeg):U, 0-Ilc, 14mm, fundic gland type gastric cancer, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
- Cov qhov txhab liab uas nce siab
fundic gland type gastric mob plab
◆Cov Ntaub Ntawv 3: Cov qhov txhab liab thiab nce siab
Kev piav qhia:Phab ntsa pem hauv ntej ntawm qhov nkhaus loj ntawm lub cardia yog 12 hli, pom tseeb liab, hom 0-1, tsis muaj atrophy lossis plab hnyuv metaplasia nyob rau tom qab, ciam teb meej, thiab cov hlab ntsha dendritic ntawm qhov chaw (NBI thiab nthuav dav me ntsis)
Kev kuaj mob (ua ke nrog kev mob nkeeg):U, 0-1, 12mm, fundic gland type gastric cancer, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
- Qhov mob liab, tiaj tus, thiab mob siabs
fundic gland type gastric mob plab
◆Case 4: Cov qhov txhab liab, tiaj/nqaim
Kev piav qhia:Phab ntsa tom qab ntawm qhov nkhaus loj dua ntawm sab saud ntawm lub cev plab, 18 hli, liab dawb, hom O-1Ic, tsis muaj atrophy lossis plab hnyuv metaplasia nyob rau tom qab, ciam teb tsis meej, tsis muaj cov hlab ntsha dendritic ntawm qhov chaw, (NBI thiab kev loj hlob tsis suav nrog)
Kev kuaj mob (ua ke nrog kev mob nkeeg):U, O-1lc, 19mm, fundic gland type gastric cancer, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
sib tham
Cov txiv neej uas muaj tus kab mob no laus dua cov poj niam, nrog rau hnub nyoog nruab nrab yog 67.7 xyoo. Vim yog cov yam ntxwv ntawm kev sib koom ua ke thiab heterochrony, cov neeg mob uas kuaj pom tias muaj mob qog nqaij hlav hauv plab yuav tsum tau kuaj xyuas ib xyoos ib zaug. Qhov chaw feem ntau yog thaj chaw qog nqaij hlav hauv nruab nrab thiab sab saud ntawm lub plab (fundus thiab nruab nrab thiab sab saud ntawm lub cev plab). Cov qhov txhab dawb zoo li SMT feem ntau pom ntau dua hauv lub teeb dawb. Kev kho mob tseem ceeb yog kev kuaj mob EMR/ESD.
Tsis tau pom muaj qog lymphatic metastasis lossis cov hlab ntsha nkag mus rau hauv. Tom qab kho mob lawm, yuav tsum txiav txim siab seb puas yuav phais ntxiv thiab soj ntsuam kev sib raug zoo ntawm cov mob qog thiab HP. Tsis yog txhua tus mob qog hauv plab fundic gland-type yog HP negative.
1) Mob qog nqaij hlav ntawm lub plab zom mov
Mob qog nqaij hlav ntawm lub qog Fundic gland
◆Cov Ntaub Ntawv 1
Kev piav qhia:Qhov mob no nce me ntsis, thiab RAC non-atrophic gastric mucosa tuaj yeem pom nyob ib puag ncig nws. Cov qauv me me thiab cov hlab ntsha me me uas hloov pauv sai tuaj yeem pom hauv qhov nce ntawm ME-NBI, thiab DL tuaj yeem pom.
Kev kuaj mob (ua ke nrog kev mob nkeeg):Fundic gland mucosal gastric gastric, U zone, 0-1la, 47 * 32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Mob qog nqaij hlav ntawm lub qog Fundic gland
◆Cov Ntaub Ntawv 2
Kev piav qhia: Ib qho mob tiaj tiaj ntawm phab ntsa pem hauv ntej ntawm qhov nkhaus me dua ntawm lub cardia, nrog rau kev hloov pauv xim thiab liab sib xyaw, cov hlab ntsha dendritic tuaj yeem pom ntawm qhov chaw, thiab qhov mob tau tsa me ntsis.
Kev kuaj mob (ua ke nrog pathology): Fundic gland mucosal gastric gastric, 0-lla, pT1a/M, ULO, LyOV0, HM0, VMO
sib tham
Lub npe ntawm "gastric gland mucosal adenocarcinoma" nyuaj me ntsis rau hais, thiab tus nqi ntawm kev kis tus kab mob tsawg heev. Nws yuav tsum tau siv zog ntau dua los paub thiab nkag siab txog nws. Fundic gland mucosal adenocarcinoma muaj cov yam ntxwv ntawm kev mob qog nqaij hlav siab.
Muaj plaub yam ntxwv tseem ceeb ntawm kev siv lub teeb dawb endoscopy: ① cov qhov txhab uas ploj mus tas li; ② qog nqaij hlav subepithelial SMT; ③ cov hlab ntsha dendritic nthuav dav; ④ cov microparticles hauv cheeb tsam. Kev ua tau zoo ntawm ME: DL(+)IMVP(+)IMSP(+)MCE ua rau IP dav dua thiab nce ntxiv. Siv cov txheej txheem pom zoo ntawm MESDA-G, 90% ntawm cov qog nqaij hlav fundic gland mucosal gastric ua tau raws li cov qauv kuaj mob.
3) Mob qog hauv plab (pyloric gland adenoma PGA)
adenoma ntawm lub plab
◆Cov Ntaub Ntawv 1
Kev piav qhia:Pom muaj ib qho mob dawb tiaj tiaj ntawm phab ntsa tom qab ntawm lub plab hnyuv nrog cov ciam teb tsis meej. Cov xim indigo carmine tsis qhia cov ciam teb meej, thiab pom zoo li LST-G ntawm txoj hnyuv loj (loj me ntsis).
Kev kuaj mob (ua ke nrog kev mob nkeeg):carcinoma atypia qis, O-1la, 47*32mm, well-differentiated tubular adenocarcinoma, pT1a/M, ULO, Ly0, VO, HMO, VMO
adenoma ntawm lub plab
◆Cov Ntaub Ntawv 2
Kev piav qhia: Ib qho mob uas nce siab nrog cov pob ntawm phab ntsa pem hauv ntej ntawm nruab nrab ntawm lub plab. Koj tuaj yeem pom mob plab hnyuv uas tseem ua haujlwm nyob tom qab. Koj tuaj yeem pom xim av daj ua ciam teb. (NBI thiab magnification me ntsis)
Kev kuaj mob: Pom muaj MUC5AC qhia nyob rau hauv cov epithelium sab saud, thiab pom MUC6 qhia nyob rau hauv cov epithelium sab saud. Qhov kev kuaj mob zaum kawg yog PGA.
sib tham
Cov adenomas hauv plab yog cov qog mucinous uas nkag mus rau hauv stroma thiab npog los ntawm foveolar epithelium. Vim muaj kev loj hlob ntawm cov qog protrusions, uas yog hemispherical lossis nodular, cov adenomas hauv plab pom nrog lub teeb dawb endoscopic yog txhua yam nodular thiab protruding. Nws yog ib qho tsim nyog yuav tsum tau them sai sai rau 4 pawg ntawm Jiu Ming nyob rau hauv kev kuaj endoscopic. ME-NBI tuaj yeem pom cov yam ntxwv papillary / villous ntawm PGA. PGA tsis yog HP tsis zoo kiag li thiab tsis yog atrophic, thiab muaj qee qhov kev pheej hmoo ntawm kev mob qog noj ntshav. Kev kuaj mob thaum ntxov thiab kev kho mob thaum ntxov yog qhov pom zoo, thiab tom qab nrhiav pom, kev ua haujlwm en bloc resection thiab kev tshawb fawb ntxiv yog qhov pom zoo.
4) (zoo li txiv pos nphuab) mob qog nqaij hlav foveolar epithelial gastric
mob qog nqaij hlav raspberry foveolar epithelial
◆Cov Ntaub Ntawv 2
Kev piav qhia:(tsis suav nrog)
Kev kuaj mob (ua ke nrog pathology)mob qog nqaij hlav foveolar epithelial
mob qog nqaij hlav raspberry foveolar epithelial
◆Teeb meem 3
Kev piav qhia:(tsis suav nrog)
Kev kuaj mob (ua ke nrog kev mob nkeeg):mob qog nqaij hlav foveolar epithelial
sib tham
Txiv pos nphuab, hu ua "Tuobai'er" hauv peb lub nroog, yog ib hom txiv hmab txiv ntoo qus ntawm ntug kev thaum peb tseem yog menyuam yaus. Cov qog epithelium thiab cov qog sib txuas, tab sis lawv tsis yog tib yam. Nws yog ib qho tsim nyog kom nkag siab txog kev loj hlob thiab kev txhim kho ntawm cov hlwb epithelial. Mob qog noj ntshav hauv plab hnyuv ntawm txiv pos nphuab zoo ib yam li cov polyps hauv plab hnyuv thiab tuaj yeem yuam kev rau cov polyps hauv plab hnyuv. Lub ntsiab lus tseem ceeb ntawm foveolar epithelium yog qhov tseem ceeb ntawm MUC5AC. Yog li foveolar epithelial carcinoma yog lo lus dav dav rau hom no. Nws tuaj yeem muaj nyob rau hauv HP tsis zoo, zoo, lossis tom qab sterilization. Endoscopic tsos: puag ncig liab ci zoo li strawberry, feem ntau nrog cov ciam teb meej.
5) Cov qog nqaij hlav cell carcinoma uas muaj lub nplhaib cim
Signet ring cell carcinoma: pom lub teeb dawb
Signet ring cell carcinoma: pom lub teeb dawb
mob qog nqaij hlav cell carcinoma
◆Cov Ntaub Ntawv 1
Kev piav qhia:Qhov txhab tiaj tiaj ntawm phab ntsa tom qab ntawm lub plab zom mov, 10 hli, ploj mus, hom O-1Ib, tsis muaj atrophy hauv keeb kwm yav dhau, pom ciam teb thaum xub thawj, tsis pom ciam teb thaum rov kuaj dua, ME-NBI: tsuas yog qhov interfoveal xwb thiaj li dawb, IMVP(-)IMSP (-)
Kev kuaj mob (ua ke nrog kev mob nkeeg):Cov qauv ESD yog siv los kuaj mob qog nqaij hlav signet ring cell carcinoma.
Cov tsos mob ntawm tus kab mob
Signet ring cell carcinoma yog hom mob phem tshaj plaws. Raws li Lauren classification, gastric signet ring cell carcinoma yog hom mob qog nqaij hlav uas kis tau thiab yog ib hom mob qog nqaij hlav uas tsis paub meej. Nws feem ntau tshwm sim hauv lub cev ntawm lub plab, thiab feem ntau tshwm sim hauv cov qhov txhab uas tiaj thiab poob nrog cov xim tsis zoo. Cov qhov txhab uas nce siab tsis tshua muaj thiab kuj tuaj yeem tshwm sim ua qhov lwj lossis mob qog. Nws nyuaj rau pom thaum lub sijhawm kuaj mob endoscopic thaum ntxov. Kev kho mob tuaj yeem yog kev phais mob xws li endoscopic ESD, nrog rau kev soj ntsuam tom qab phais thiab kev soj ntsuam seb puas yuav phais ntxiv. Kev phais mob uas tsis kho tau yuav tsum tau phais ntxiv, thiab txoj kev phais yog tus kws phais txiav txim siab.
Cov ntawv nyeem thiab cov duab saum toj no los ntawm "Plab thiab Txoj Hnyuv"
Tsis tas li ntawd xwb, yuav tsum tau saib xyuas rau mob qog noj ntshav esophagogastric junction, mob qog noj ntshav cardia, thiab mob qog noj ntshav adenocarcinoma uas pom muaj nyob rau hauv keeb kwm yav dhau los HP-negative.
3. Kev Txheeb Xyuas
Niaj hnub no kuv tau kawm txog kev paub thiab cov tsos mob ntawm tus mob qog noj ntshav hauv plab uas tsis pom los ntawm HP. Feem ntau nws muaj xws li: mob qog noj ntshav hauv plab fundic gland, mob qog noj ntshav hauv plab fundic gland mucosal, mob qog noj ntshav hauv plab gastric adenoma, mob qog noj ntshav zoo li txiv pos nphuab (raspberry-like) foveolar epithelial thiab mob qog noj ntshav hauv lub nplhaib signet.
Qhov tshwm sim ntawm tus mob qog noj ntshav hauv plab uas tsis muaj HP yog qhov tsawg, nws nyuaj rau txiav txim siab, thiab nws yooj yim rau kev kuaj mob tsis raug. Qhov nyuaj dua yog qhov tshwm sim ntawm cov kab mob nyuaj thiab tsis tshua muaj los ntawm kev siv txoj kev endoscopic. Nws kuj tseem yuav tsum nkag siab los ntawm kev xav ntawm endoscopic, tshwj xeeb tshaj yog kev paub txog kev xav tom qab nws.
Yog koj saib cov polyps hauv plab, cov qhov tawg, thiab cov cheeb tsam liab thiab dawb, koj yuav tsum xav txog qhov ua tau ntawm mob qog noj ntshav hauv plab Hp-negative. Kev txiav txim siab ntawm HP negative yuav tsum ua raws li cov qauv, thiab yuav tsum tau them sai sai rau cov cuav negatives uas tshwm sim los ntawm kev cia siab rau cov txiaj ntsig ntawm kev kuaj pa ntau dhau. Cov kws kho mob endoscopist uas muaj kev paub dhau los ntseeg lawv lub qhov muag ntau dua. Ntsib lub tswv yim ntxaws ntxaws tom qab mob qog noj ntshav hauv plab HP-negative, peb yuav tsum txuas ntxiv kawm, nkag siab thiab xyaum kom paub txog nws.
Peb, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., yog lub chaw tsim khoom hauv Suav teb tshwj xeeb hauv cov khoom siv endoscopic, xws licov forceps biopsy, hemoclip, polyp snare, koob txhaj tshuaj sclerotherapy, tshuaj tsuag catheter, cov txhuam cytology,txoj hlua qhia,pob zeb rov qab tau pob zeb, lub qhov ntswg biliary kua catheter thiab lwm yam. uas siv dav hauvEMR,ESD,ERCP.Peb cov khoom muaj daim ntawv pov thawj CE, thiab peb cov nroj tsuag muaj daim ntawv pov thawj ISO. Peb cov khoom tau raug xa tawm mus rau Tebchaws Europe, North America, Middle East thiab ib feem ntawm Asia, thiab tau txais kev lees paub thiab qhuas los ntawm cov neeg siv khoom!
Lub sijhawm tshaj tawm: Lub Xya Hli-12-2024