Aqoonta caanka ah ee ku saabsan kansarka caloosha ee hore, waxaa jira qodobo aqoon cudur oo naadir ah oo u baahan fiiro gaar ah iyo barasho. Mid ka mid ah waa kansarka caloosha ee HP-negative. Fikradda "burooyinka epithelial-ka aan qabin cudurka" hadda waa mid aad loo jecel yahay. Waxaa jiri doona fikrado kala duwan oo ku saabsan arrinta magaca. Aragtidan nuxurka ah waxay inta badan ku salaysan tahay macluumaadka la xiriira joornaalka "Caloosha iyo Xiidmaha", magacuna wuxuu kaloo isticmaalaa "kansarka caloosha ee HP-negative".
Noocan nabarrada ah waxay leeyihiin astaamo muujinaya hoos u dhac ku yimaada dhacdooyinka, adkaanta aqoonsiga, aqoonta aragtiyeed ee adag, habka fudud ee MESDA-G-na laguma dabaqi karo. Barashada aqoontan waxay u baahan tahay in la wajaho dhibaatooyinka.
1. Aqoon aasaasi ah oo ku saabsan kansarka caloosha ee HP-negative
Taariikh
Waagii hore, waxaa la aaminsanaa in sababta kaliya ee keenta iyo horumarinta kansarka caloosha ay tahay caabuqa HP, sidaa darteed qaabka kansarka caadiga ah waa HP - atrophy - metaplasia mindhicirka - buro yar - buro sare - kansar. Qaabka caadiga ah had iyo jeer si weyn ayaa loo aqoonsaday, loo aqbalay oo si adag loo aaminsanaa. Burooyinku waxay isku soo ururaan iyagoo ku saleysan atrophy iyo ficilka HP, sidaa darteed kansarradu waxay inta badan ku koraan marinnada mindhicirka ee atrophic iyo xuubka caloosha ee aan caadiga ahayn ee aan atrophic ahayn.
Dabadeed, dhakhaatiir qaar ayaa ogaaday in kansarka caloosha uu dhici karo xitaa haddii uusan jirin caabuqa HP. Inkasta oo heerka dhacdooyinka uu aad u hooseeyo, haddana waa suurtagal. Noocan kansarka caloosha waxaa loo yaqaan kansarka caloosha ee HP-negative.
Iyadoo si tartiib tartiib ah loo fahmayo nooca cudurkan, waxaa bilaabmay in si qoto dheer loo eego lana soo koobo, magacyaduna si joogto ah ayay isu beddelaan. Waxaa jiray maqaal sannadkii 2012 lagu qoray "Kansarka Caloosha ka dib jeermis dile", maqaal sannadkii 2014 lagu qoray "Kansarka Caloosha ee HP-negative", iyo maqaal sannadkii 2020 lagu qoray "Burooyinka Epithelial-ka ee aan ku dhicin Hp". Isbeddelka magaca ayaa ka tarjumaya fahamka qoto dheer iyo kan dhammaystiran.
Noocyada Qanjirka iyo Qaababka Koritaanka
Waxaa caloosha ku jira laba nooc oo waaweyn oo ah qanjidhada fundic iyo qanjidhada pyloric:
Qanjidhada fundic (qanjidhada oksijiinta) waxay ku kala firirsan yihiin fundus-ka, jirka, geesaha, iwm. ee caloosha. Waa qanjidhada hal-tube ee toosan. Waxay ka kooban yihiin unugyada xuubka, unugyada madaxa, unugyada parietal iyo unugyada endocrine, kuwaas oo mid walba uu qabto shaqooyinkiisa. Kuwaas waxaa ka mid ah unugyada madaxa. Midabaynta PGI iyo MUC6 ee la soo saaray waxay ahaayeen kuwo togan, unugyada parietal-na waxay soo saareen aashitada hydrochloric iyo qodobka gudaha;
Qanjidhada pyloric waxay ku yaalaan aagga caloosha iyo mindhicirka waxayna ka kooban yihiin unugyada xabka iyo unugyada endocrine. Unugyada xabka waa MUC6 positive, unugyada endocrine-na waxaa ka mid ah unugyada G, D iyo unugyada enterochromaffin. Unugyada G waxay soo saaraan gastrin, unugyada D waxay soo saaraan somatostatin, unugyada enterochromaffin-na waxay soo saaraan 5-HT.
Unugyada caadiga ah ee xuubka caloosha iyo unugyada burooyinka waxay soo saaraan noocyo kala duwan oo borotiinno xab ah, kuwaas oo loo qaybiyay borotiinno xab ah oo "gastric", "mindhicir" iyo "isku dhafan". Muujinta mucins-ka caloosha iyo xiidmaha waxaa loo yaqaan phenotype ee maaha goobta gaarka ah ee jirka ee caloosha iyo xiidmaha.
Waxaa jira afar nooc oo unugyo ah oo burooyinka caloosha ah: caloosha oo gebi ahaanba isku dhafan, caloosha oo isku dhafan, mindhicirka oo isku dhafan, iyo mindhicirka oo dhan. Burooyinka ku dhaca metaplasia-ga mindhicirka ayaa inta badan ah burooyinka isku dhafan ee caloosha iyo mindhicirka. Kansarrada kala duwan waxay inta badan muujiyaan nooca mindhicirka (MUC2+), kansarrada kala duwanna waxay inta badan muujiyaan nooca caloosha (MUC5AC+, MUC6+).
Go'aaminta Hp-negative waxay u baahan tahay isku-darka gaarka ah ee habab badan oo lagu ogaan karo si loo helo go'aan dhammaystiran. Kansarka caloosha ee HP-negative iyo kansarka caloosha ee ka dambeeya jeermiska waa laba fikradood oo kala duwan. Wixii macluumaad ah ee ku saabsan muujinta raajada ee kansarka caloosha ee HP-negative, fadlan tixraac qaybta khuseeya ee joornaalka "Caloosha iyo Mindhicirka".
2. Calaamadaha Endoscopic ee kansarka caloosha ee HP-negative
Baaritaanka Endoscopic-ga waa diiradda kansarka caloosha ee HP-negative. Waxaa inta badan ka mid ah kansarka caloosha ee nooca fundic gland, kansarka caloosha ee nooca fundic gland, adenoma caloosha, burooyinka epithelial ee raspberry foveolar, kansarka unugyada giraanta signet, iwm. Maqaalkani wuxuu diiradda saarayaa muujinta endoscopic ee kansarka caloosha ee HP-negative.
1) qanjidhka fundic nooca kansarka gastric
- Nabaro cad oo soo baxay
qanjirka fundic nooca kansarka caloosha
◆Kiiska 1aad: Nabaro cad oo kor u kacay
Sharaxaad:Gastric fundic fornix - qalooc weyn oo wadnaha ah, 10 mm, caddaan ah, nooca O-lia (sida SMT), oo aan lahayn atrophy ama metaplasia mindhicirka ah oo gadaasha ah. Xididdada dhiigga ee u eg arbor-ka ayaa laga arki karaa dusha sare (NBI iyo si yar oo weynaan ah)
Baadhista cudurka (oo ay weheliso cudur-sidaha):U, O-1la, 9mm, qanjirka fundic nooca kansarka gastric, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
- Nabaro cad oo fidsan
qanjirka fundic nooca kansarka caloosha
◆Kiiska 2aad: Nabaro cad, siman/niyad jabsan
Sharaxaad:Darbiga hore ee qalooca weyn ee caloosha ee fornix-cardia, 14 mm, caddaan ah, nooca 0-1lc, oo aan lahayn atrophy ama metaplasia xiidmaha oo ku yaal gadaasha, xuduudaha aan caddayn, iyo xididdada dhiigga ee dendritic oo lagu arko dusha sare. (NBI iyo kor u qaadis la soo gaabiyay)
Baadhista cudurka (oo ay weheliso cudur-sidaha):U, 0-Ilc, 14mm, qanjirka fundic nooca kansarka gastric, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
- Nabaro cas oo soo baxay
qanjirka fundic nooca kansarka caloosha
◆Kiiska 3aad: Nabaro casaan iyo kuwa kor u kacay
Sharaxaad:Darbiga hore ee qalooca weyn ee wadnaha waa 12 mm, oo si cad u casaan ah, nooca 0-1, oo aan lahayn atrophy ama metaplasia xiidmaha oo ku yaal gadaasha, xuduudo cad, iyo xididdada dhiigga ee dendritic oo dusha sare ah (NBI iyo ballaarin yar)
Baadhista cudurka (oo ay weheliso cudur-sidaha):U, 0-1, 12mm, qanjirka fundic nooca kansarka gastric, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
-Nabar cas, siman, oo niyad jabsans
qanjirka fundic nooca kansarka caloosha
◆Kiiska 4: Nabaro casaan ah, siman/niyad jabsan
Sharaxaad:Darbiga dambe ee qalooca weyn ee qaybta sare ee jirka caloosha, 18mm, casaan khafiif ah, nooca O-1Ic, ma jiro atrophy ama metaplasia xiidmaha oo gadaasha ah, xuduud aan caddayn, xididdada dhiigga ee dendritic-ga ah oo dusha sare ku yaal, (NBI iyo ballaarinta waa laga saaray)
Baadhista cudurka (oo ay weheliso cudur-sidaha):U, O-1lc, 19mm, qanjirka fundic nooca kansarka gastric, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
ka wada hadal
Ragga qaba cudurkan way ka da' weyn yihiin dumarka, iyadoo da'doodu celcelis ahaan tahay 67.7 sano jir. Iyada oo ay ugu wacan tahay astaamaha isku mar iyo kala duwanaanshaha, bukaanada lagu ogaado kansarka caloosha ee nooca qanjirka 'fundic gland' waa in dib loo eegaa hal mar sannadkii. Goobta ugu badan waa aagga qanjirka 'fundic gland' ee qaybta dhexe iyo sare ee caloosha (fundus iyo qaybta dhexe iyo sare ee jirka caloosha). Nabarrada cadcad ee kor u kacay ee u eg SMT ayaa aad ugu badan iftiinka cad. Daaweynta ugu weyn waa ogaanshaha EMR/ESD.
Ilaa hadda lama arag wax metastasis lymphatic ah ama duullaan xididdada dhiigga ah. Daaweynta ka dib, waxaa lagama maarmaan ah in la go'aamiyo in la sameeyo qalliin dheeraad ah iyo in la qiimeeyo xiriirka ka dhexeeya xaaladda kansarka iyo HP. Ma aha dhammaan kansarka caloosha ee nooca qanjirka 'fundic' oo aan ahayn kuwa HP taban.
1) Kansarka caloosha ee xuubka caloosha ee qanjidhada fundic
Kansarka caloosha ee xuubka maskaxda ee fungic gland
◆Kiiska 1aad
Sharaxaad:Nabarku si yar ayuu u kor u kacay, xuubka caloosha ee aan lahayn atrophic RAC ayaa lagu arki karaa hareeraha. Qaab-dhismeedka yar yar iyo xididdada yaryar ee si degdeg ah isu beddelaya ayaa lagu arki karaa qaybta kor u kacday ee ME-NBI, DL-na waa la arki karaa.
Baadhista cudurka (oo ay weheliso cudur-sidaha):Qanjirka 'fundic mucosal mucosal cancer', U zone, 0-1la, 47*32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Kansarka caloosha ee xuubka maskaxda ee fungic gland
◆Kiiska 2aad
Sharaxaad: Nabar fidsan oo ku yaal derbiga hore ee qalooca yar ee wadnaha, oo leh midab isku dhafan iyo casaan, xididdada dhiigga ee dendritic ayaa laga arki karaa dusha sare, nabarkuna si yar ayuu u kor u kacay.
Baadhista cudurka (oo ay weheliso cudur-sidaha)Qanjirka 'fundic mucosal mucosal cancer', 0-lla, pT1a/M, ULO, LyOV0, HM0, VMO
ka wada hadal
Magaca "adenocarcinoma-ka xuubka caloosha" way adag tahay in lagu dhawaaqo, heerka dhacdooyinkana aad ayuu u hooseeyaa. Waxay u baahan tahay dadaal badan si loo aqoonsado loona fahmo. Adenocarcinoma-ka xuubka caloosha ee xuubka caloosha wuxuu leeyahay astaamo kansar sare.
Waxaa jira afar astaamood oo waaweyn oo ah baaritaanka endoscopy-ga iftiinka cad: ① nabarrada homochromatic-deping; ② burooyinka subepithelial SMT; ③ xididdada dhiigga ee dendritic-ga oo ballaaran; ④ microparticles-ka gobolka. Waxqabadka ME: DL(+)IMVP(+)IMSP(+)MCE waxay ballaarisaa IP-ga waxayna kordhisaa. Iyadoo la adeegsanayo habka lagu taliyay ee MESDA-G, 90% kansarka caloosha ee xuubka qanjirka 'fundic' ayaa buuxiya shuruudaha ogaanshaha.
3) Adenoma-ka caloosha (adenoma-ka qanjirka 'pyloric gland')
adenoma caloosha
◆Kiiska 1aad
Sharaxaad:Nabar cad oo fidsan ayaa lagu arkay derbiga dambe ee caloosha fornix oo leh xuduudo aan caddayn. Midabka Indigo carmine ma muujin xuduudo cad, muuqaalka LST-G ee xiidmaha waaweynna waxaa la arkay (oo si yar u weynaaday).
Baadhista cudurka (oo ay weheliso cudur-sidaha):Kansarka atypia-ga oo hooseeya, O-1la, 47*32mm, adenocarcinoma tuubo oo si fiican loo kala saaray, pT1a/M, ULO, Ly0, VO, HMO, VMO
adenoma caloosha
◆Kiiska 2aad
Sharaxaad: Nabar kor u kacay oo leh buro ku taal derbiga hore ee qaybta dhexe ee jirka caloosha. Gastritis-ka firfircoon waxaa laga arki karaa gadaasha. Indigo carmine waxaa loo arki karaa xuduud. (NBI iyo weyneyn yar)
Cudurrada: Muujinta MUC5AC waxaa lagu arkay epithelium-ka dusha sare, muujinta MUC6na waxaa lagu arkay epithelium-ka dusha sare. Baaritaankii ugu dambeeyay wuxuu ahaa PGA.
ka wada hadal
Adenomas-ka caloosha ayaa asal ahaan ah qanjidhada mucinous ee galaya stroma-ka waxaana daboolaya epithelium-ka foveolar. Sababtoo ah faafitaanka qanjidhada, kuwaas oo ah hemispherical ama nodular, adenomas-ka caloosha ee lagu arko iftiinka cad ee endoscopic dhammaantood waa nodular oo soo baxaya. Waa lagama maarmaan in fiiro gaar ah loo yeesho 4ta kala-soocid ee Jiu Ming marka la eego baaritaanka endoscopic. ME-NBI waxay arki kartaa muuqaalka astaamaha papillary/villous ee PGA. PGA gebi ahaanba ma aha HP taban oo aan atrophic ahayn, waxayna leedahay khatar gaar ah oo kansar ah. Baaritaanka hore iyo daaweynta hore ayaa la dhiirrigeliyaa, ka dib marka la ogaado, waxaa lagula talinayaa in la gooyo firfircoon oo en bloc ah iyo daraasad faahfaahsan oo dheeraad ah.
4) kansarka caloosha ee loo yaqaan 'foveolar epithelial' (sida raspberry oo kale)
kansarka caloosha ee foveolar ee raspberry
◆Kiiska 2aad
Sharaxaad:(la dayacay)
Baadhista cudurka (oo ay weheliso cudur-sidaha): kansarka caloosha ee xuubka caloosha ee foveolar epithelial
kansarka caloosha ee foveolar ee raspberry
◆Kiiska 3aad
Sharaxaad:(la dayacay)
Baadhista cudurka (oo ay weheliso cudur-sidaha):kansarka caloosha ee epithelial-ka ee foveolar
ka wada hadal
Raspberry, oo loogu yeero "Tuobai'er" magaalada aan ku noolnahay, waa miro duurjoog ah oo ku yaal waddada markii aan carruur ahayn. Epithelium-ka qanjidhada iyo qanjidhada ayaa isku xiran, laakiin isku mid ma aha. Waa lagama maarmaan in la fahmo astaamaha koritaanka iyo horumarka unugyada epithelial. Kansarka caloosha ee Raspberry epithelial aad buu ugu eg yahay polyps-ka caloosha waxaana si fudud loogu qaldi karaa polyps-ka caloosha. Astaamaha lagu garto ee epithelium-ka foveolar waa muujinta ugu badan ee MUC5AC. Markaa kansarka epithelial-ka foveolar waa ereyga guud ee noocan ah. Waxay ku jiri kartaa HP taban, togan, ama ka dib jeermis dile. Muuqaalka Endoscopic: barar wareegsan oo casaan ah oo u eg strawberry, guud ahaan leh xuduudo cad.
5) Kansarka unugyada giraanta ee Signet
Kansarka unugyada giraanta signet: muuqaalka iftiinka cad
Kansarka unugyada giraanta signet: muuqaalka iftiinka cad
kansarka unugyada giraanta signetka
◆Kiiska 1aad
Sharaxaad:Nabar fidsan oo ku yaal derbiga dambe ee caloosha, 10 mm, oo libdhay, nooca O-1Ib, ma jiro wax barar ah oo gadaasha ah, xuduud muuqata marka hore, xuduud aan caddayn marka dib loo eego, ME-NBI: kaliya qaybta interfoveal-ka ayaa caddaanaysa, IMVP(-)IMSP (-)
Baadhista cudurka (oo ay weheliso cudur-sidaha):Shaybaarada ESD waxaa loo isticmaalaa in lagu ogaado kansarka unugyada giraanta ee signet.
Calaamadaha cudur-sidaha
Kansarka unugyada giraanta ee Signet waa nooca ugu xun. Sida laga soo xigtay kala soocidda Lauren, kansarka unugyada giraanta ee signet waxaa loo kala saaraa nooc kansar ah oo kala firirsan waana nooc ka mid ah kansarka aan kala sooc lahayn. Waxay caadi ahaan ka dhacdaa jirka caloosha, waxayna ku badan tahay nabarrada fidsan iyo kuwa godan ee leh midabyo midab leh. Nabarrada kor u kacay waa kuwo naadir ah 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 qalliin daaweyn ah sida ESD endoscopic, iyadoo la raacayo dabagal adag oo qalliinka kadib ah iyo qiimeyn ah in la sameeyo qalliin dheeraad ah iyo in kale. Qalliinka aan daaweynta lahayn waa inuu u baahan yahay qalliin dheeraad ah, habka qalliinkana waxaa go'aamiya dhakhtarka qalliinka.
Aragtida iyo sawirrada qoraalka ee kor ku xusan waxay ka yimaadeen "Caloosha iyo Mindhicirka"
Intaa waxaa dheer, fiiro gaar ah waa in sidoo kale la siiyaa kansarka isgoyska hunguriga, kansarka wadnaha, iyo adenocarcinoma si fiican loo kala soocay oo laga helo asalka HP-negative.
3. Soo Koobid
Maanta waxaan bartay aqoonta ku habboon iyo muujinta endoscopic ee kansarka caloosha ee HP-negative. Waxaa inta badan ka mid ah: kansarka caloosha ee nooca fundic gland, kansarka caloosha ee xuubka xuubka, adenoma caloosha, burooyinka epithelial-ka ee foveolar (sida raspberry-ka) iyo kansarka unugyada giraanta signet.
Tirada kansarka caloosha ee HP-negative-ka ah waa mid yar, way adag tahay in la qiimeeyo, waana ay fududahay in la waayo ogaanshaha. Waxa ka sii adag waa muujinta endoscopic-ga ee cudurrada adag iyo kuwa naadirka ah. Sidoo kale waa in laga fahmaa aragtida endoscopic-ga, gaar ahaan aqoonta aragtida ee ka dambeysa.
Haddii aad eegto burooyin caloosha ah, nabaad-guurka, iyo meelaha casaanka iyo caddaanka ah, waa inaad tixgelisaa suurtagalnimada kansarka caloosha ee Hp-negative. Xukunka HP-negative waa inuu waafaqsanaadaa heerarka, waana in fiiro gaar ah loo yeesho taban been ah oo ay keento ku tiirsanaanta xad-dhaafka ah ee natiijooyinka baaritaanka neefta. Dhakhaatiirta khibradda leh ee endoscopy-ga ayaa si aad ah u aaminsan indhahooda. Iyadoo la wajahayo aragtida faahfaahsan ee ka dambeysa kansarka caloosha ee HP-negative, waa inaan sii wadnaa barashada, fahamka iyo ku dhaqanka si aan u baranno.
Annaga, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., waa soo-saare ku takhasusay isticmaalka endoscopic-ga, sidaqalabka lagu baadho unugyada, hemoclip, Dabin polyp ah, irbad daaweynta sclerotherapy, kateetarka buufinta, Burushyada unugyada,hagaha,dambiisha soo celinta dhagaxa, kateetarka dheecaanka sanka ee biliary iwm.kuwaas oo si weyn loogu isticmaaloEMR,ESD,ERCP.Badeecadahayagu waa kuwa haysta shahaadada CE, warshadeenuna waa kuwo haysta shahaadada ISO. Badeecadahayagu 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: Luulyo-12-2024