Waxaa ka mid ah aqoonta caanka ah ee ku saabsan kansarka caloosha hore, waxaa jira qaar ka mid ah dhibcaha aqoonta cudurrada naadir ah oo u baahan feejignaan iyo waxbarasho gaar ah.Mid ka mid ah waa kansarka caloosha ee HP-negative.Fikradda "buro epithelial aan la qabin" hadda waa caan.Waxaa jiri doona fikrado kala duwan oo ku saabsan arrinta magaca.Aragtida nuxurku waxay inta badan ku salaysan tahay nuxurka la xidhiidha majaladda "Calool iyo Mindhicirka", iyo magaca sidoo kale isticmaalaa "HP-negative kansarka caloosha".
Nabarrada noocan ah waxay leeyihiin sifooyinka dhacdooyinka hooseeya, dhibka aqoonsiga, aqoonta aragtiyaha adag, iyo habka fudud ee MESDA-G maaha mid lagu dabaqi karo.Barashada aqoontan waxay u baahan tahay in la wajaho dhibaatooyinka.
1. Aqoonta aasaasiga ah ee kansarka caloosha ee HP-negative
Taariikhda
Waagii hore, waxaa la rumaysan yahay in dembiilaha kaliya ee dhacdada iyo horumarinta kansarka caloosha uu ahaa caabuqa HP, sidaas awgeed qaabka kansarka caadiga ah waa HP - atrophy - metaplasia xiidmaha - burada hoose - buro sare - kansar.Habka caadiga ah ayaa had iyo jeer si weyn loo aqoonsaday, la aqbalay oo si adag loo rumaystay.Burooyinku waxay si wadajir ah u koraan iyada oo ku saleysan atrophy iyo hoos yimaada ficilka HP, sidaas darteed kansarrada inta badan waxay ku koraan mareenka mindhicirka atrophic iyo xuubka caloosha ee aan caadiga ahayn ee aan caadi ahayn.
Kadib, dhakhaatiirta qaarkood waxay ogaadeen in kansarka caloosha uu ku dhici karo xitaa maqnaanshaha caabuqa HP.Inkastoo heerka dhacdooyinka uu aad u hooseeyo, runtii waa suurtagal.Noocaan kansarka caloosha waxaa loo yaqaan HP-negative kansarka caloosha.
Iyada oo si tartiib tartiib ah loo fahmayo nooca cudurkan, indho-indheyn qoto dheer oo nidaamsan iyo soo koobid ayaa bilaabmay, magacyaduna si joogto ah ayey isu beddelayaan.Waxaa jiray 2012-kii maqaal loogu magac daray "Kansarka gastric ka dib dhalmada", maqaal 2014 ah oo lagu magacaabo "HP-negative Gastric Kansarka", iyo maqaal 2020 ah oo loo yaqaan "Epithelial Tumors Not Infected with Hp".Magaca beddelku wuxuu ka tarjumayaa qoto-dheeraanta iyo fahamka dhammaystiran.
Noocyada qanjidhada iyo qaababka koritaanka
Waxaa jira laba nooc oo waaweyn oo qanjidhada fundic ah iyo qanjidhada pyloric ee caloosha:
Qanjirrada fundic (qanjirrada oxyntic) waxay u qaybsan yihiin fundus, jidhka, geesaha, iwm. ee caloosha.Waa qanjidhada tuubada ee tooska ah.Waxay ka kooban yihiin unugyo xabag ah, unugyo madax, unugyo parietal iyo unugyo endocrine, kuwaas oo mid kastaa uu qabto hawlihiisa gaarka ah.Kuwaas waxaa ka mid ah, unugyada madaxa The qarsoodi ah PGI iyo MUC6 midabaynta ahaayeen togan, iyo parietal unugyada qarsoodi ah hydrochloric acid iyo factor gudaha;
Qanjirrada pyloric waxay ku yaalaan aagga antrum gastric waxayna ka kooban yihiin unugyo xab ah iyo unugyo endocrine.Unugyada xabxabku waa MUC6 togan, iyo unugyada endocrine waxaa ka mid ah unugyada G, D iyo unugyada enterochromaffin.Unugyada G waxay soo saaraan gastrin, Unugyada D waxay soo saaraan somatostatin, iyo unugyada enterochromaffin waxay soo saaraan 5-HT.
Unugyada xuubka caloosha ee caadiga ah iyo unugyada burooyinka ayaa siinaya noocyo kala duwan oo borotiinno xab ah, kuwaas oo u qaybsan "caastric", "mindhicirrada" iyo borotiinnada xab-xabeedka "isku dhafan".Muujinta xuubka caloosha iyo mindhicirka waxaa loo yaqaan 'phenotype' ee maaha meesha gaarka ah ee anatomical ee caloosha iyo mindhicirrada.
Waxaa jira afar nooc oo unugyo ah oo ah burooyinka caloosha: gabi ahaanba gastric, gastric-ominin isku qasan, xiidmaha-xun isku dhafan, iyo gabi ahaanba xiidmaha.Burooyinka ku dhaca saldhigga metaplasia ee mindhicirka ayaa u badan burooyinka phenotype ee isku dhafan ee mindhicirka.Kansarrada kala duwan ayaa inta badan muujiya nooca mindhicirka (MUC2+), iyo kansarrada fidsan inta badan waxay muujiyaan nooca caloosha (MUC5AC+, MUC6+).
Go'aaminta Hp taban waxay u baahan tahay isku darka gaarka ah ee hababka ogaanshaha badan si loo helo go'aan dhammaystiran.Kansarka caloosha ee HP-negative iyo kansarka gastric-ka kadib waa laba fikradood oo kala duwan.Macluumaad ku saabsan muujinta raajada ee kansarka caloosha ee HP-negative, fadlan tixraac qaybta ku habboon ee majaladda "Calool iyo xiidmaha".
2. Calaamadaha Endoscopic ee kansarka caloosha ee HP-negative
Baaritaanka Endoscopic waa diiradda HP-negative kansarka caloosha.Waxaa inta badan ka mid ah qanjidhada fundic nooca kansarka caloosha, fundic qanjidhada xuubka nooca kansarka gastric, gastric adenoma, raspberry foveolar epithelial buro, kansarka gacanta giraanta, iwm. Maqaalkani waxa uu diiradda saarayaa muujinta endoscopic ee HP-negative kansarka caloosha.
1) qanjidhka fundic nooca kansarka gastric
-Nabarada kor u kaca cad
qanjirka fundic nooca kansarka caloosha
Kiiska 1: Caddaan, nabarro kor u kacay
Sharaxaad:Qallooca caloosha ee fornix-weyn ee wadnaha, 10 mm, caddaan, nooca O-lia (SMT-like), oo aan lahayn atrophy ama metaplasia mindhicirka ee gadaasha.Xididdada dhiiga sida Arbor-ka ayaa lagu arki karaa dusha sare (NBI iyo koror yar)
ogaanshaha (oo lagu daray pathology):U, O-1la, 9mm, qanjirka fundic nooca kansarka gastric, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Nabaro fidsan oo cad
qanjirka fundic nooca kansarka caloosha
Kiiska 2: Nabaro cad, fidsan/ niyad jabsan
Sharaxaad:Darbiga hore ee fundic fundic gastric fornix-cardia curvature weyn, 14 mm, caddaan, nooca 0-1lc, oo aan lahayn atrophy ama metaplasia mindhicirka ee gadaasha, xuduudaha aan caddayn, iyo xididdada dhiigga dendritic ee lagu arkay dusha sare.(NBI iyo amplification oo la soo gaabiyo)
ogaanshaha (oo lagu daray pathology):U, 0-Ilc, 14mm, qanjirka fundic nooca kansarka gastric, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Nabarada kor u kacday
qanjirka fundic nooca kansarka caloosha
Kiiska 3: Nabaro casaan iyo kor u kaca
Sharaxaad:Darbiga hore ee qalooca weyn ee wadnaha waa 12 mm, cad cas, nooca 0-1, oo aan lahayn atrophy ama metaplasia mindhicirka ee gadaasha, xudduudaha cad, iyo xididdada dhiigga dendritic ee dusha sare (NBI iyo ballaarinta wax yar)
ogaanshaha (oo lagu daray pathology):U, 0-1, 12mm, qanjirka fundic nooca kansarka gastric, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
-Casaan, fidsan, dhaawac niyad jabsans
qanjirka fundic nooca kansarka caloosha
Kiiska 4: Nabaro cas, fidsan/ niyad jabsan
Sharaxaad:Darbiga dambe ee qalooca weyn ee qaybta sare ee jidhka gastric, 18mm, casaan khafiif ah, nooca O-1Ic, ma atrophy ama metaplasia mindhicirka ee gadaasha, xuduud aan caddayn, ma xididdada dhiigga dendritic ee dusha, (NBI iyo ballaarinta laga saaray. )
ogaanshaha (oo lagu daray pathology):U, O-1lc, 19mm, qanjirka fundic nooca kansarka gastric, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
wada hadal
Ragga qaba cudurkaan ayaa ka weyn dumarka, iyadoo celceliska da'da ay tahay 67.7 sano.Sababo la xiriira sifooyinka isku midka ah iyo heterochrony, bukaanada laga helay qanjirka fundic nooca kansarka caloosha waa in dib loo eego hal mar sanadkii.Meesha ugu badan waa qanjidhada fundic ee ku yaala bartamaha iyo qaybta sare ee caloosha (fundus iyo qaybta dhexe iyo qaybta sare ee caloosha).Nabarada kor u kaca ee SMT u eg ayaa ku badan iftiinka cad.Daawaynta ugu weyn waa ogaanshaha EMR/ESD.
Ilaa hadda lama arag metastasis-ka qanjidhada ama xuubka xididdada dhiigga.Daaweynta ka dib, waa lagama maarmaan in la go'aamiyo in la sameeyo qalliin dheeraad ah iyo in la qiimeeyo xiriirka ka dhexeeya heerka malignantiga ah iyo HP.Dhammaan noocyada qanjidhada fundic-ka ee kansarka gastric ma aha kuwa HP negative ah.
1) Qanjirka 'fundic mucosal mucosal cancer'
Qanjirka 'fundic mucosal mucosal cancer'
◆Kiiska 1
Sharaxaad:Dhaawaca ayaa xoogaa kor u kacay, RAC-ga aan lahayn atrophic xuubka caloosha ayaa lagu arki karaa hareeraheeda.Dhismayaasha yaryar ee degdega u beddelaya iyo microvessels ayaa lagu arki karaa qaybta sare ee ME-NBI, iyo DL waa la arki karaa.
ogaanshaha (oo lagu daray pathology):Qanjirka 'fundic mucosal mucosal cancer', U zone, 0-1la, 47*32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Qanjirka 'fundic mucosal mucosal cancer'
◆Kiiska 2
Sharaxaada: Nabaro fidsan oo ku yaal darbiga hore ee qalooca yar ee wadnaha, oo leh midab isku dhafan iyo casaan, xididdada dhiigga dendritic ayaa lagu arki karaa dusha sare, nabarkuna xoogaa kor ayuu u kacay.
Cilad-sheegid (oo lagu daray pathology)Qanjirka 'fundic mucosal mucosal cancer', 0-lla, pT1a/M, ULO, LyOV0, HM0, VMO
wada hadal
Magaca "adenocarcinoma qanjirka gastric xuubka" way adag tahay in lagu dhawaaqo, heerka dhacdooyinkana aad ayuu u hooseeyaa.Waxay u baahan tahay dadaal dheeraad ah si loo aqoonsado oo loo fahmo.adenocarcinoma xuubka qanjidhada fundic wuxuu leeyahay sifooyinka malignantiga sare.
Waxaa jira afar sifo oo waaweyn oo loo yaqaan endoscopy-ga iftiinka cad: ① nabarada homochromatic-fading;② burada subepithelial SMT;③ xididdada dhiigga ee dendritic oo fidsan;④ microparticles gobolka.Waxqabadka ME: DL (+) IMVP (+) IMSP (+) MCE waxay ballaarisaa IP oo kordhisaa.Isticmaalka habka lagu taliyay MESDA-G, 90% qanjidhada fundic xuubka xabka ee kansarka caloosha ayaa buuxiya shuruudaha ogaanshaha.
3) adenoma caloosha (pyloric adenoma PGA)
adenoma gastric
◆Kiiska 1
Sharaxaad:Nabaro kor u kacay oo fidsan ayaa lagu arkay gidaarka dambe ee qanjidhka caloosha (fornix) ee caloosha oo leh xuduudo aan caddayn.Midabaynta indigo carmine ma muujin xuduudo cad, iyo muuqaalka LST-G-u eg ee mindhicirka weyn ayaa la arkay (wax yar baa weynaaday).
ogaanshaha (oo lagu daray pathology):Kansarka atypia hooseeya, O-1la, 47*32mm, adenocarcinoma tubular si fiican u kala duwan, pT1a/M, ULO, Ly0, VO, HMO, VMO
adenoma gastric
◆Kiiska 2
Sharaxaada: Nabaro kor u kacay oo qanjidhada ku leh gidaarka hore ee qaybta dhexe ee jidhka gastric.Gastritis firfircoon ayaa lagu arki karaa gadaasha.Indigo carmine waxaa loo arki karaa xuduud.(NBI iyo weynaynta wax yar)
Pathology: MUC5AC waxa lagu arkay epithelium-ka sare, iyo MUC6 waxa lagu arkay epithelium-ka sare.Cilad-baadhistii ugu dambaysay waxay ahayd PGA.
wada hadal
Adenomas gastric waa qanjirro mucinous ah oo gala stroma oo ay daboolaan epithelium foveolar.Sababtoo ah bararka qanjidhada qanjidhada, kuwaas oo ah hemispherical ama nodular, adenomas gastric adenomas oo lagu arko iftiinka cad ee endoscopic ayaa dhamaantood nodular ah oo soo baxaya.Waa lagama maarmaan in fiiro gaar ah loo yeesho 4-da qaybood ee Jiu Ming ee baaritaanka endoscopic.ME-NBI waxay ilaalin kartaa muuqaalka papillary / villous sifada ee PGA.PGA gabi ahaanba maaha HP taban iyo mid aan atrophic ahayn, waxayna leedahay khatar gaar ah oo kansar ah.Baaritaanka hore iyo daawaynta hore ayaa lagu talinayaa, ka dib markii la helo, dib-u-eegis firfircoon oo firfircoon iyo daraasad faahfaahsan ayaa lagula talinayaa.
4) ( raspberry u eg) kansarka caloosha ee epithelial foveolar
raspberry foveolar epithelial kansarka caloosha
◆Kiiska 2
Sharaxaad:(laga saaray)
Cilad-sheegid (oo lagu daray pathology)Kansarka caloosha ee epithelial foveolar
raspberry foveolar epithelial kansarka caloosha
◆Kiiska 3
Sharaxaad:(laga saaray)
ogaanshaha (oo lagu daray pathology):foveolar epithelial kansarka caloosha
wada hadal
Raspberry, oo loo yaqaan "Tuobai'er" ee magaaladeena, waa miro duurjoog ah oo waddada dhinaceeda yaal markii aan carruurta ahayn.Epithelium qanjidhada iyo qanjidhada ayaa isku xidhan, laakiin isku mid maaha.Waa lagama maarmaan in la fahmo koritaanka iyo sifooyinka horumarinta unugyada epithelial.Kansarka caloosha ee raspberry epithelial wuxuu aad ugu eg yahay polyps gastric waxaana si fudud loogu khaldi karaa burooyinka caloosha.Tilmaamaha astaanta u ah epithelium foveolar waa muujinta ugu weyn ee MUC5AC.Markaa foveolar epithelial carcinoma waa ereyga guud ee noocaan ah.Waxay ku jiri kartaa HP taban, togan, ama jeermis-dilid kadib.Muuqashada Endoscopic: wareegsan oo dhalaalaysa strawberry-cas oo kale, guud ahaan leh xuduudo cad.
5) Kansarka unugga giraanta calaamadda
Kansarka unugga giraanta calaamadda: muuqaalka iftiinka cad
Kansarka unugga giraanta calaamadda: muuqaalka iftiinka cad
kansarka gacanta giraanta
◆Kiiska 1
Sharaxaad:Nabaro fidsan oo ku yaal darbiga dambe ee gabbaadka caloosha, 10 mm, baaba'ay, nooca O-1Ib, aan lahayn atrophy gadaasha, xuduud la arki karo marka hore, ma aha xuduud cad oo dib-u-eegis ah, ME-NBI: kaliya qaybta interfoveal waxay noqotaa caddaan, IMVP (-)IMSP (-)
ogaanshaha (oo lagu daray pathology):Muunadaha ESD waxaa loo isticmaalaa in lagu baaro kansarka unugyada giraanta.
Tilmaamaha pathological
Kansarka unugga giraanta calaamaduhu waa nooca ugu xun.Marka loo eego kala-soocidda Lauren-ka, kansarka unugyada giraanta ee caloosha waxa loo kala saaraa sida nooc kansar ah oo fidsan waana nooc ka mid ah kansarka aan la kala saarin.Waxay caadi ahaan ku dhacdaa jidhka caloosha, waxayna ku badan tahay nabarrada fidsan iyo kuwa go'ay ee leh midabyo midab leh.Nabaro kor u kaca waa naadir waxayna sidoo kale u muuqan karaan nabaad guur ama boogo.Way adag tahay in la ogaado inta lagu jiro baaritaanka endoscopic marxaladaha hore.Daaweyntu waxay noqon kartaa dib-u-soo-celin daweyn ah sida endoscopic ESD, oo leh dabagal adag oo qalliinka ka dambeeya iyo in la sameeyo qalliin dheeraad ah iyo in kale.Dib-u-soo-celinta aan daawaynta ahayn waa inay u baahan tahay qalliin dheeraad ah, habka qalliinka waxaa go'aaminaya dhakhtarka qalliinka.
Aragtida qoraalka sare iyo sawiradu waxay ka yimaadeen "Calool iyo xiidmaha"
Intaa waxaa dheer, fiiro gaar ah waa in sidoo kale la bixiyaa kansarka isgoysyada hunguriga, kansarka wadnaha, iyo adenocarcinoma si fiican u kala duwan oo laga helo asalka HP-negative.
3. Kooban
Maanta waxaan bartay aqoonta ku habboon iyo muujinta endoscopic ee kansarka caloosha ee HP-negative.Inta badan waxaa ka mid ah: qanjidhka fundic nooca kansarka caloosha, fundic qanjidhada xuubka nooca kansarka gastric, adenoma gastric, (raspberry-u eg) burada epithelial foveolar iyo kansarka unugyada giraanta.
Dhacdooyinka caafimaad ee kansarka caloosha ee HP-negative waa hooseeyaa, way adagtahay in la xukumo, wayna fududahay in la seego ogaanshaha.Maxaa xitaa ka sii adag waa muujinta endoscopic ee cudurrada adag iyo kuwa dhifka ah.Waa in sidoo kale laga fahmo dhinaca endoscopic, gaar ahaan aqoonta aragtida ka dambeysa.
Haddii aad eegto burooyinka caloosha, nabaad-guurka, iyo meelaha casaanka iyo caddaanka ah, waa inaad tixgelisaa suurtogalnimada kansarka caloosha ee Hp-negative.Xukunka diidmada HP-ga waa inuu u hoggaansamaa heerarka, waana in fiiro gaar ah loo yeesho diidmada beenta ah ee ay sababtay ku tiirsanaanta natiijada baaritaanka neefta.Dhakhaatiirta khibradda leh ee indha-indheynta ayaa aad ugu kalsoon indhahooda.Annaga oo wajahayna aragtida tafatiran ee ka dambaysa kansarka caloosha ee HP-negative, waa in aan sii wadnaa barashada, fahamka iyo ku celcelinta si aan u maaraynno.
Anaga, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., waa soo saaraha Shiinaha oo ku takhasusay isticmaalka endoscopic, sidaxoog ka-qaadista, hemoclip, buro dabin, irbadda sclerotherapy, tuubada buufin, burushka cytology,guidewire,dambiilaha soo celinta dhagaxa, Kateetarka biliary drainage sanka iwm.kuwaas oo si weyn loogu isticmaaloEMR,ESD,ERCPBadeecadahayagu waa shahaado CE, dhirtayaduna waa ISO shahaado.Alaabadayada waxaa loo dhoofiyay Yurub, Waqooyiga Ameerika, Bariga Dhexe iyo qayb ka mid ah Aasiya, waxayna si ballaaran u helaan macaamiisha aqoonsiga iyo ammaanta!
Waqtiga boostada: Jul-12-2024