Har'a tsebo e tsebahalang ka mofetše oa pele oa mala, ho na le lintlha tse ling tse sa tloaelehang tsa tsebo ea mafu tse hlokang tlhokomelo e khethehileng le thuto.E 'ngoe ea tsona ke mofetše oa HP-negative gastric.Khopolo ea "lihlahala tse sa tšoaetsanoang tsa epithelial" e se e tumme haholo.Ho tla ba le maikutlo a fapaneng mabapi le taba ea lebitso.Khopolo ena ea litaba e thehiloe haholo-holo ho litaba tse amanang le makasine "Mpa le Mala", 'me lebitso le boetse le sebelisa "HP-negative gastric cancer".
Mofuta ona oa liso o na le litšobotsi tse fokolang, bothata ba ho khetholla, tsebo e rarahaneng ea theory, le mokhoa o bonolo oa MESDA-G ha o sebetse.Ho ithuta tsebo ena ho hloka ho tobana le mathata.
1. Tsebo ea motheo ea mofetše oa HP-negative gastric
Histori
Nakong e fetileng, ho ne ho lumeloa hore molato o le mong ketsahalong le nts'etsopele ea kankere ea ka mpeng e ne e le tšoaetso ea HP, kahoo mohlala oa khale oa kankere ke HP - atrophy - metaplasia ea mala - hlahala e tlaase - hlahala e phahameng - kankere.Mohlala oa khale o 'nile oa tsejoa ka ho pharaletseng, o amoheloa le ho lumeloa ka tieo.Lihlahala li hlaha hammoho motheong oa atrophy le tlas'a ketso ea HP, kahoo kankere hangata e hōla ka har'a lipampitšana tsa mala a atrophic le tse sa tloaelehang tse sa tloaelehang tse se nang atrophic gastric mucosa.
Hamorao, lingaka tse ling li ile tsa fumana hore mofetše oa mala o ka hlaha leha ho se na tšoaetso ea HP.Le hoja sekhahla sa ts'oaetso se le tlase haholo, se ka khoneha.Mofuta ona oa mofetše oa ka mpeng o bitsoa mofetše oa HP-negative.
Ka kutloisiso ea butle-butle ea mofuta ona oa lefu lena, litebello tse tebileng tse hlophisitsoeng le kakaretso li qalile, 'me mabitso a lula a fetoha.Ho bile le sengoloa ka 2012 se bitsoang "Gastric Cancer After Sterilization", sengoloa ka 2014 se bitsoang "HP-negative Gastric Cancer", le sengoloa ka 2020 se bitsoang "Epithelial Tumors Not Infected with Hp".Phetoho ea lebitso e bonts'a kutloisiso e tebileng le e felletseng.
Mefuta ea Litšoelesa le Mekhoa ea Khōlo
Ho na le mefuta e 'meli e meholo ea litšoelesa tsa fundic le litšoelesa tsa pyloric ka mpeng:
Litšoelesa tsa Fundic (litšoelesa tsa oxyntic) li ajoa ka har'a fundus, 'mele, likhutlong, joalo-joalo tsa mpa.Ke litšoelesa tse nang le mela e le 'ngoe ea tubular.Li entsoe ka lisele tsa mucous, lisele tse ka sehloohong, lisele tsa parietal le lisele tsa endocrine, e 'ngoe le e' ngoe e etsa mesebetsi ea eona.Har'a bona, lisele tse ka sehloohong The pente PGI le MUC6 staining e ne e le ntle, 'me lisele parietal secreted hydrochloric acid le intrinsic factor;
Litšoelesa tsa pyloric li sebakeng sa gastric antrum 'me li entsoe ka lisele tsa mucus le lisele tsa endocrine.Lisele tsa mucus li na le li-MUC6 tse ntle, 'me lisele tsa endocrine li kenyelletsa lisele tsa G, D le lisele tsa enterochromaffin.Lisele tsa G li hlahisa gastrin, lisele tsa D li hlahisa somatostatin, 'me lisele tsa enterochromaffin li hlahisa 5-HT.
Lisele tse tloaelehileng tsa mucosal le lisele tsa hlahala li hlahisa mefuta e sa tšoaneng ea liprotheine tsa mucus, tse arotsoeng ka "gastric", "intestinal" le "motsoako" oa liprotheine tsa mucus.Polelo ea li-mucins tsa gastric le intestinal li bitsoa phenotype eseng sebaka se itseng sa sebōpeho sa mpa le mala.
Ho na le li-phenotypes tse 'nè tsa lisele tsa gastric: gastric ka ho feletseng, e kopantsoeng ka mpeng, e kopantsoeng le mala a mangata, le mala ka ho feletseng.Lihlahala tse hlahang motheong oa metaplasia ea mala hangata ke lihlahala tse tsoakiloeng tsa phenotype tsa mala.Lik'hemik'hale tse fapaneng li bonts'a haholo mofuta oa mala (MUC2+), 'me mefuta ea mofetše haholo-holo e bontša mofuta oa gastric (MUC5AC+, MUC6+).
Ho fumana hore Hp ha e mpe ho hloka motsoako o khethehileng oa mekhoa e mengata ea ho lemoha bakeng sa boikemisetso bo felletseng.Kankere ea mala ea HP-negative le mofets'e oa ka mor'a ho tsoakoa ke maikutlo a mabeli a fapaneng.Bakeng sa tlhahisoleseling mabapi le lipontšo tsa X-ray tsa mofetše oa HP-negative gastric, ka kopo sheba karolo e amehang ea makasine ea "Mpa le Mala".
2. Lipontšo tsa Endoscopic tsa HP-negative kankere ea mala
Tlhahlobo ea Endoscopic ke sepheo sa mofetše oa mala oa HP-negative.Haholo-holo e akarelletsa fundic tšoelesa mofuta gastric kankere, fundic tšoelesa mucosal mofuta gastric kankere, gastric adenoma, raspberry foveolar epithelial hlahala, signet ring cell carcinoma, joalo-joalo.
1) Mofuta oa lefu la tsoekere la mofuta oa lefu la tsoekere
-Mala a masoeu a phahamisitsoeng
mofuta oa lefu la tsoekere la mofuta oa lefu la tsoekere
◆ Nyeoe ea 1: Maqeba a masoeu, a phahamisitsoeng
Tlhaloso:Gastric fundic fornix-curvature e kholo ea cardia, 10 mm, e tšoeu, mofuta oa O-lia (SMT-like), ntle le atrophy kapa metaplasia ea mala ka morao.Methapo ea mali e kang Arbor e ka bonoa holimo (NBI le ho holisa hanyane)
Tlhahlobo (e kopantsoe le pathology):U, O-1la, 9mm, fundic gland mofuta oa kankere ea mala, pT1b/SM2 (600μm), ULO, Ly0, VO, HMO, VMO
-Maqeba a masoeu a bataletseng
mofuta oa lefu la tsoekere la mofuta oa lefu la tsoekere
◆ Nyeoe ea 2: Maqeba a masoeu, a bataletseng / a tepeletseng maikutlo
Tlhaloso:Lerako le ka pele la gastric fundic fornix-cardia more curvature, 14 mm, tšoeu, mofuta oa 0-1lc, le se nang atrophy kapa metaplasia ea mala ka morao, meeli e sa hlakang, le methapo ea mali ea dendritic e bonoang holimo.(NBI le amplification e khutsufatsoe)
Tlhahlobo (e kopantsoe le pathology):U, 0-Ilc, 14mm, tšoelesa ea fundic mofuta oa kankere ea mala, pT1b/SM2 (700μm), ULO, Ly0, VO, HMO, VMO
-Red tsohile diso
mofuta oa lefu la tsoekere la mofuta oa lefu la tsoekere
◆ Nyeoe ea 3: Maqeba a khubelu le a phahamisitsoeng
Tlhaloso:Lerako le ka pele la mokokotlo o moholo oa cardia ke 12 mm, ho hlakile hore o khubelu, mofuta oa 0-1, o se nang atrophy kapa metaplasia ea mala ka morao, meeli e hlakileng, le methapo ea mali ea dendritic holim'a metsi (NBI le ho atolosa hanyenyane).
Tlhahlobo (e kopantsoe le pathology):U, 0-1, 12mm, fundic gland mofuta oa kankere ea mala, pT1b/SM1 (200μm), ULO, LyO, VO, HMO, VMO
-E khubelu, e bataletseng, leqeba le tepeletseng maikutlos
mofuta oa lefu la tsoekere la mofuta oa lefu la tsoekere
◆ Nyeoe ea 4: Maqeba a khubelu, a bataletseng / a tepeletseng maikutlo
Tlhaloso:Lerako le ka morao la mokokotlo o moholo oa karolo e ka holimo ea 'mele oa gastric, 18mm, bofubelu bo khanyang, mofuta oa O-1Ic, ha ho na atrophy kapa metaplasia ea mala ka morao, moeli o sa hlakang, ha ho na methapo ea mali ea dendritic holim'a metsi, (NBI le ho atolosoa ha hoa lumelloa. )
Tlhahlobo (e kopantsoe le pathology):U, O-1lc, 19mm, fundic gland mofuta oa kankere ea mala, pT1b/SM1 (400μm), ULO, LyO, VO, HMO, VMO
buisana
Banna ba nang le lefu lena ba baholo ho feta ba batšehali, ka karolelano ea lilemo ke lilemo tse 67.7.Ka lebaka la litšoaneleho tsa nako e le 'ngoe le heterochrony, bakuli ba fumanoeng ba e-na le mofetše oa mofetše oa mofuta oa lefu la gastric ba lokela ho hlahlojoa hang ka selemo.Sebaka se tloaelehileng haholo ke sebaka sa tšoelesa ea fundic bohareng le karolo e ka holimo ea mpa ( fundus le karolo e bohareng le e ka holimo ea 'mele oa gastric).Maqeba a phahamisitsoeng a kang a SMT a tšoeu a atile haholo khanyeng e tšoeu.Kalafo e ka sehloohong ke ho hlahloba EMR/ESD.
Ha ho na metastasis ea lymphatic kapa tlhaselo ea methapo e kileng ea bonoa ho fihlela joale.Ka mor'a phekolo, hoa hlokahala ho fumana hore na ho etsoa opereishene e eketsehileng le ho hlahloba kamano pakeng tsa boemo bo bobe le HP.Ha se mefuta eohle ea mofetše oa mofuta oa tšoelesa ea ka mpeng e leng HP negative.
1) Fudic gland mucosal kankere ea mala
Kankere ea lefu la tsoekere ea mucosal gastric gland
◆ Nyeoe 1
Tlhaloso:Leqeba le phahamisitsoe hanyane, 'me RAC non-atrophic gastric mucosa e ka bonoa ho e potoloha.Li-microstructure tse fetohang ka potlako le li-microvessels li ka bonoa karolong e phahamisitsoeng ea ME-NBI, 'me DL e ka bonoa.
Tlhahlobo (e kopantsoe le pathology):Fundic gland mucosal gastric cancer, U zone, 0-1la, 47*32mm, pT1a/SM1 (400μm), ULO, Ly0, VO, HMO, VMO
Kankere ea lefu la tsoekere ea mucosal gastric gland
◆ Nyeoe ea 2
Tlhaloso: Leqeba le bataletseng leboteng le ka pele la sekhahla se senyenyane sa cardia, se nang le mebala e tsoakiloeng le bofubelu, methapo ea mali ea dendritic e ka bonoa holimo, 'me leqeba le phahama hanyenyane.
Tlhahlobo (e kopantsoe le pathology): Fundic gland mucosal kankere ea mala, 0-lla, pT1a/M, ULO, LyOV0,HM0,VMO
buisana
Lebitso la "gastric gland mucosal adenocarcinoma" le thata ho le bitsa, 'me sekhahla sa ts'oaetso se tlase haholo.Ho hloka boiteko bo eketsehileng ho e hlokomela le ho e utloisisa.Fundic gland mucosal adenocarcinoma e na le litšoaneleho tsa lefu le phahameng.
Ho na le litšobotsi tse 'ne tse kholo tsa endoscopy ea leseli le lesoeu: ① maqeba a homochromatic-fading;② subepithelial tumor SMT;③ methapo ea mali ea dendritic e atolositsoeng;④ li-microparticles tsa tikoloho.ME: DL(+)IMVP(+)IMSP(+)MCE e holisa IP le ho eketseha.Ho sebelisa ts'ebetso e khothaletsoang ea MESDA-G, 90% ea mafu a lefu la tsoekere a mucosal gastric a fihlella litekanyetso tsa tlhahlobo.
3) Gastric adenoma (pyloric gland adenoma PGA)
adenoma ea ka mpeng
◆ Nyeoe 1
Tlhaloso:Leqeba le lesoeu le phahamisitsoeng le ile la bonoa leboteng le ka morao la gastric fornix le nang le meeli e sa hlakang.Indigo carmine staining e ne e sa bontše meeli e hlakileng, 'me ponahalo e kang ea LST-G ea mala a maholo e ile ea bonoa (e atolosoa hanyenyane).
Tlhahlobo (e kopantsoe le pathology):low atypia carcinoma, O-1la, 47*32mm, tubular adenocarcinoma e fapaneng hantle, pT1a/M, ULO, Ly0, VO, HMO, VMO
adenoma ea ka mpeng
◆ Nyeoe ea 2
Tlhaloso: Leqeba le phahamisitsoeng le nang le maqhutsu leboteng le ka pele la karolo e bohareng ea 'mele oa mala.Active gastritis ka bonoa ka morao.Indigo carmine e ka bonoa e le moeli.(NBI le ho holisa hanyane)
Pathology: Polelo ea MUC5AC e ile ea bonoa ho epithelium e ka holimo, 'me polelo ea MUC6 e ne e bonoa ka holimo ho epithelium.Tlhahlobo ea ho qetela e bile PGA.
buisana
Gastric adenomas ha e le hantle ke litšoelesa tsa mucinous tse phunyeletsang stroma 'me li koahetsoe ke foveolar epithelium.Ka lebaka la ho ata ha litšoelesa tsa tšoelesa, e leng li-hemispherical kapa nodular, li-adenoma tsa ka mpeng tse bonoang ka khanya e tšoeu ea endoscopic kaofela li na le li-nodular le tse hlaheletseng.Hoa hlokahala ho ela hloko likarolo tse 4 tsa Jiu Ming tlas'a tlhahlobo ea endoscopic.ME-NBI e khona ho bona sebopeho sa papillary/villous ea PGA.PGA ha e na HP ka ho felletseng ebile ha e na atrophic, mme e na le kotsi e itseng ea ho tšoaroa ke mofetše.Ho khothaletsoa tlhahlobo ea kapele le kalafo ea kapele, 'me ka mor'a ho sibolloa, ho khothaletsoa ka en bloc resection le boithuto bo eketsehileng bo felletseng.
4) (raspberry-like) foveolar epithelial kankere ea mala
raspberry foveolar epithelial kankere ea mala
◆ Nyeoe ea 2
Tlhaloso:(e siiloe)
Tlhahlobo (e kopantsoe le pathology): kankere ea foveolar epithelial gastric
raspberry foveolar epithelial kankere ea mala
◆ Nyeoe 3
Tlhaloso:(e siiloe)
Tlhahlobo (e kopantsoe le pathology):foveolar epithelial kankere ea mala
buisana
Raspberry, e bitsoang "Tuobai'er" motseng oa habo rona, ke tholoana e hlaha ka thōko ho tsela ha re sa le bana.Li-glandular epithelium le litšoelesa li hokahane, empa ha li tšoane.Hoa hlokahala ho utloisisa litšobotsi tsa kholo le nts'etsopele ea lisele tsa epithelial.Kankere ea Raspberry epithelial gastric e ts'oana haholo le li-polyps tsa ka mpeng, 'me e ka nkoa e le ka phoso ka li-polyps tsa ka mpeng.Tšobotsi e ikhethang ea foveolar epithelium ke polelo e hlahelletseng ea MUC5AC.Kahoo foveolar epithelial carcinoma ke lentsoe le akaretsang la mofuta ona.E ka ba teng ho HP e mpe, e ntle, kapa ka mor'a ho thibela likokoana-hloko.Ponahalo ea Endoscopic: leqhubu le pota-potileng le bofubelu bo khanyang bo kang ba fragola, ka kakaretso bo nang le meeli e hlakileng.
5) Signet ring cell carcinoma
Signet ring cell carcinoma: ponahalo ya lebone le lesweu
Signet ring cell carcinoma: ponahalo ya lebone le lesweu
ring ring cell carcinoma
◆ Nyeoe 1
Tlhaloso:Sesosa se bataletseng leboteng le ka morao la vestibule ea gastric, 10 mm, e felile, mofuta oa O-1Ib, ha ho na atrophy ka morao, moeli o bonahalang qalong, moeli o sa totobalang oa ho hlahlojoa hape, ME-NBI: karolo feela ea interfoveal e fetoha e tšoeu, IMVP. (-)IMSP (-)
Tlhahlobo (e kopantsoe le pathology):Mehlala ea ESD e sebelisoa ho hlahloba signet ring cell carcinoma.
Lipontšo tsa pathological
Signet ring cell carcinoma ke mofuta o kotsi ka ho fetisisa.Ho ea ka sehlopha sa Lauren, gastric signet ring cell carcinoma e khetholloa e le mofuta o fapaneng oa carcinoma 'me ke mofuta oa kankere e sa khethoeng.Hangata e hlaha 'meleng oa mpa,' me e atisa ho hlaha ka maqeba a bataletseng le a tebileng a nang le melumo e sa tšoaneng.Maqeba a phahamisitsoeng a batla a fokola 'me a ka boela a bonahala e le khoholeho kapa liso.Ho thata ho lemoha nakong ea tlhahlobo ea endoscopic mehatong ea pele.Kalafo e ka ba pheko ea phekolo e kang endoscopic ESD, ka ho lateloa ka thata ka mor'a ts'ebetso le tlhahlobo ea hore na ho etsoa opereishene e eketsehileng.Resection e sa phekoleheng e tlameha ho hloka opereishene e eketsehileng, 'me mokhoa oa ho buoa o khethoa ke ngaka e buoang.
Theory le litšoantšo tse ka holimo li tsoa ho "Mpa le Mala"
Ho feta moo, tlhokomelo e boetse e lokela ho lefshoa ho mofets'e oa motsoako oa esophagogastric, mofets'e oa cardia, le adenocarcinoma e fapaneng hantle e fumanoang mokokotlong oa HP-negative.
3. Kakaretso
Kajeno ke ithutile tsebo e nepahetseng le lipontšo tsa endoscopic tsa mofetše oa mala oa HP-negative.Haholo-holo e kenyelletsa: mofets'e oa mofuta oa mofets'e oa mofets'e oa mofets'e, mofuta oa mofets'e oa mofets'e oa mofets'e oa mofets'e oa mofets'e, gastric adenoma, (raspberry-like) foveolar epithelial tumor le signet ring cell carcinoma.
Boemo ba kliniki ba mofetše oa HP-negative bo tlase, ho thata ho ahlola, 'me ho bonolo ho fosa tlhahlobo.Ntho e thata le ho feta ke lipontšo tsa endoscopic tsa mafu a rarahaneng le a sa tloaelehang.E boetse e lokela ho utloisisoa ho latela pono ea endoscopic, haholo-holo tsebo ea theory ka morao ho eona.
Haeba u sheba gastric polyps, khoholeho ea mobu, le libaka tse khubelu le tse tšoeu, u lokela ho nahana ka monyetla oa ho ba le kankere ea mpa ea Hp-negative.Kahlolo ea HP negative e tlameha ho lumellana le litekanyetso, 'me tlhokomelo e lokela ho lefshoa ho mefokolo ea bohata e bakoang ke ho itšetleha haholo ka liphello tsa tlhahlobo ea phefumoloho.Li-endoscopists tse nang le boiphihlelo li tšepa mahlo a tsona haholoanyane.Ha re shebane le khopolo e qaqileng ea mofetše oa HP-negative gastric, re tlameha ho tsoela pele ho ithuta, ho utloisisa le ho itloaetsa ho e tseba.
We, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ke moetsi oa China ea sebetsanang le lisebelisoa tsa endoscopic, joalo kabiopsy forceps, hemoclips, polyp leraba, sclerotherapy nale, fafatsa catheter, borashe ba cytology,guidewire,seroto sa ho khutlisa lejoe, nasal biliary drainage catheter joalo-joalo.tse sebelisoang haholo hoEMR,ESD,ERCP.Lihlahisoa tsa rona li netefalitsoe ke CE, 'me limela tsa rona li netefalitsoe ke ISO.Thepa ea rona e rometsoe Europe, Amerika Leboea, Bochabela bo Hare le karolo ea Asia, 'me e fumana ho pharaletseng moreki oa kananelo le thoriso!
Nako ea poso: Jul-12-2024