I-Endoscopic Mucosal Resection (EMR): Kuyini, Inqubo kanye Nenqubo Yokubuyisela

I-EMR, noma i-Endoscopic Mucosal Resection, iyindlela yokwelapha esetshenziselwa ukuxilonga nokwelashwa kwezilonda eziyingozi noma ezinomdlavuza. izimila (ezigabeni zokuqala) kusuka epheshaneni lesisu (lokugaya). Kuyinqubo yokuhlinza engenele kancane eyenziwa yi-Gastroenterologist engenele ngosizo lwe-endoscope. 

I-endoscope ifakwe ikhamera ebekwe phezulu, ehlinzeka ngezithombe zesikhathi sangempela zokwakheka kwangaphakathi kwezicubu nezitho zepheshana lesisu. I-endoscope ingase ifakwe emphinjeni ukuze ifinyelele emthonjeni, isisu, kanye ne-duodenum (ingxenye engenhla yamathumbu amancane) ukulandelela nokukhipha izimila zepheshana eliphezulu lamathumbu. Ukufakwa kwe-procto-endoscope kungenziwa ukuze kufinyelele izimila noma izilonda ezakhiwe engxenyeni engezansi yomzila wamathumbu (amathumbu amakhulu).

Inqubo ye-EMR isusa izimila nezilonda ezikhula ngaphakathi kongqimba lwe-mucosa yepheshana lesisu. Le nqubo ayisizi nje kuphela ukuveza ukubonwa kokungajwayelekile ngaphakathi kwepheshana lamathumbu kodwa futhi ivumela ukususwa kwezilonda ezingaphezulu nezimila ezikhona kulwelwesi lwamafinyila kanye nongqimba lwe-submucosa lomgudu wamathumbu. 

Ngaphezu kwalokho, inqubo ye-endoscopic mucosal resection isiza ukuqoqwa kwezicubu ezivela emgudwini wamathumbu ukuze kuhlolwe ilabhorethri kanye nokuxilongwa. Uma ubukhona bomdlavuza buqinisekiswa, inqubo ye-EMR ingasiza ekuboneni ukungena noma ukuhlasela komdlavuza ekujuleni kolwelwesi lomgudu wokugaya ukudla. 

Yiziphi Izinkomba kanye Nezingqinamba Zokususwa Kwe-Endoscopic Mucosal Resection?

Kukhona izinkomba ezimbalwa kanye nokuphikisana okufanele kucatshangelwe ngaphambi kwenqubo ye-EMR. Ekuqaleni, le nqubo yenzelwe i-sigmoidoscopy eqinile futhi kamuva yasetshenziselwa i-colonoscopy eguquguqukayo. Ngakho-ke, izinkomba zekholoni zokukhishwa kwe-endoscopic mucosal zifana ncamashi nezangaphambili futhi zihlanganisa okulandelayo.

• Umdlavuza we-esophagal wesigaba sokuqala noma umdlavuza colorectal
• Ukususwa kabusha kwezimila ezinomdlavuza kutholakale ngephutha
• Ukususwa kwezimila ezingaphezulu ezindongeni zamathumbu ezinobubanzi obungaphansi kuka-2 cm 
• I-Barrett's esophagus 

Ukuphikisana nenqubo ye-EMR nakho kudingeka kucatshangelwe kuye ngokuthi izici ezithile zesilonda ngaphambi kwenqubo, ezihlanganisa okulandelayo.

• Izici: Uma isilonda noma isimila sikhona ekujuleni kwe-submucosa, inqubo ye-EMR ingase ingavezi imiphumela ephumelelayo futhi ingase yandise ngisho nengozi yokukhishwa kabusha okungaphelele kanye nokuphindaphinda kwesimila okungenzeka.
• Usayizi: Izilonda ezinkulu kuno-2 cm angeke zisuswe ngempumelelo ngenqubo ye-EMR futhi zidinga ukusebenzisa ezinye izindlela ezifana ne-endoscopic submucosal dissection (ESD).
• Indawo: Izilonda noma izimila ezikhona ezindaweni okungenzeka kube nzima ukufinyelela kuzo kusetshenziswa izindlela ezijwayelekile zokuhlinza zingadinga ukwelashwa ngezinye izindlela.

Ngaphandle kwalezi zici, iziguli ezinokugula okukhulu zingase zibe nomthelela emiphumeleni yenqubo, zizenze zingafaneleki inqubo ye-EMR. Ukwengeza, iziguli ezingakwazi ukubekezelela noma ukungezwani ne-anesthesia zingase zelulekwe ukuba ziyigweme le nqubo.

Ubani Ongaba Umuntu Ozokhethwa Endoscopic Mucosal Resection?

Inqubo ye-EMR isetshenziswa kakhulu ekutholeni izimila ezikhona ku-mucosa. Iziguli ezinezilonda ezinomdlavuza noma izimila ezincane zingase zidinge ukuba kwenziwe inqubo ye-EMR. 

Izilonda ezinkulu noma izimila ku amathumbu ulwelwesi kungenzeka lungasuswa yinqubo ye-EMR futhi ludinga izinqubo ezihlaselayo ezifana nokwelashwa ngamakhemikhali, ukwelapha ngemisebe, noma ukuhlukaniswa kwe-endoscopic submucosal dissection.

Kwenzekani Ngaphambi Kwe-Endoscopic Mucosal Resection?

Iziguli ezikhishwa i-endoscopic mucosal resection kungenzeka zinikezwe imiyalelo enemininingwane ngodokotela bazo ukuze zilungiselele inqubo. Kubalulekile ukwazisa udokotela nganoma yimiphi imithi noma izithasiselo ezithathiwe noma uma kungenzeka ukuthi unenkinga iguliswa ukusabela ku-anesthesia. Lokhu kungasiza futhi ukuvimbela izinkinga zangemva kokuhlinzwa.

Nansi eminye yemiyalo ejwayelekile engase iphakanyiswe ngaphambi kwenqubo ye-EMR.

• Inqubo ye-EMR ku-Lower Gastrointestinal Tract: Ukulandela ukudla okuwuketshezi isikhathi esiholela osukwini lwenqubo, kanye nokwenza i-enema yokuhlanza amathumbu. Ama-laxatives angase anconywe ukuhlanza ikholoni futhi avumele isithombe esicacile sezakhiwo zangaphakathi zekholoni kanye ne-rectum. 
• Inqubo ye-EMR ku-Upper Gastrointestinal Tract: Gwema ukudla ukudla noma iziphuzo okungenani amahora angu-12 ngaphambi kwenqubo ukuze uqinisekise ukungabi khona kokudla ku-esophagus.

Kwenzekani Ngesikhathi se-Endoscopic Mucosal Resection Procedure?

Phakathi nenqubo ye-endoscopic mucosal resection, isiguli singathola i-anesthesia ejwayelekile, lapho singase silale khona ngenqubo noma mhlawumbe sihlaliswe ngomugqa we-IV ukuze sigweme ukungahambi kahle noma ubuhlungu ngesikhathi senqubo. Le nqubo ye-endoscopic ihilela ukusebenzisa i-endoscope enencazelo ephezulu (ishubhu eliguquguqukayo, elikhanyayo elinekhamera ebekwe ekhanda layo) elishuthekwa ngomlomo we-anus kuye ngemfuneko yenqubo kanye nendawo yesimila noma isilonda.

Izithombe ezikhiqizwe i-endoscope zingase ziveze isithombe esicacile sezakhiwo zangaphakathi ukuze kutholwe isimila noma isilonda ngaphandle kokulimaza izicubu ezizungezile. Intambo kagesi ezacile, iboshelwe ngaphakathi nge-endoscope futhi iqondiswe ukuzungeza lonke noma ingxenye yesimila. Intambo kagesi ihlukanisa isimila noma isilonda ngaphandle kokulimaza izicubu ezixhumene futhi imboze ukusikwa kanyekanye.

Isimila sitholwa ngokumuncwa noma ngethuluzi elikhethekile lokubuyisa, ngokuvamile ingxenye ngayinye uma isimila sikhulu. Njengoba inqubo ye-EMR ingase isetshenziselwe izinjongo zokuxilonga, isampula yezicubu zesimila esitholiwe ingase ithunyelwe elabhorethri ukuze ihlolwe okwengeziwe. 

Kwenzekani Ngemva kokususwa kwe-endoscopic mucosal?

Ngemva kokuba inqubo isiqediwe, isiguli singase sidinge ukugadwa nokunakekelwa kwezempilo ngemva kokuhlinzwa isikhathi esithile noma kuze kuphele i-sedative noma imithi yokubulala izinzwa. Udokotela angase axoxe ngomphumela noma abike ngenqubo ngaphambi kokuba isiguli sikhishwe esibhedlela. 

Udokotela wezifo angase aqashwe ukuze abone izimpawu zesifo kusampula yethishu noma aqinisekise ukuthi zonke izingxenye zesimila zisusiwe. 

Ukulandela inqubo, isiguli kungenzeka sibe nemiphumela emibi evamile ngenxa yenqubo, engase ihlanganise okulandelayo.

• Ubuhlungu bomphimbo, uma i-endoscope ifakwe emlonyeni
• Isisu esicasulayo noma ukuhlanza uma inqubo ye-endoscopic ihloselwe ukwelapha izinkinga esiswini noma emathunjini.
• Ukuqunjelwa/ukuminyanisa/igesi eyeqile uma inqubo ye-endoscopic ehilelekile ukukhukhumala kwesisu

Ukubuyisela kanye Ne-Outlook Ngemva Kwenqubo Ye-Endoscopic Mucosal Resection

Ngemva kokuba isiguli sesiphumile esibhedlela, kudingeka silandele imiyalelo kadokotela mayelana nokudla nokudla, kanye nokuthatha noma yimiphi imithi engase ituswe esigulini ngasinye. Bangase badinge ukuvakashela i-gastroenterologist ukuze baphinde bahlolwe, cishe phakathi namaviki angu-12 kulandela inqubo. Ukuhlolwa kungase futhi kwenziwe nge-endoscopically ukuze kuqinisekiswe ukululama okuphelele kwezicubu zangaphakathi zohlelo lokugaya ukudla. Bangase futhi batuse ukuhlolwa okwengeziwe noma izindlela zokwelapha ngesikhathi sokuvakasha kokulandelela, kuye ngokutholakele. 

Iziguli eziningi ziyakwazi ukuphinde ziqale ukusebenza ngosuku olungemva kokwenziwa kwenqubo ye-EMR. Uketshezi Ukudla ingase inqunywe isikhathi esithile kuze kube yilapho umgudu wokugaya ululama. 

Imibuzo Evame Ukubuzwa

1. Ithatha isikhathi esingakanani inqubo ye-endoscopic mucosal resection?

Yonke inqubo yokukhishwa kwe-endoscopic mucosal ingathatha imizuzu engama-30-60 ukuqedwa. 

2. Yiziphi izinzuzo zenqubo ye-endoscopic mucosal resection?

Inqubo ye-endoscopic mucosal resection ivumela i-gastroenterologists ukuthi isuse izilonda eziyingozi noma izimila ezinomdlavuza ngokusikwa okuncane. Lokhu kusiza ukuhlonza nokuvimbela ukukhula nokusabalala kwezicubu ezinomdlavuza kwezinye izingxenye zomzimba. Ukusetshenziswa kwe-endoscopic kuqinisekisa ukuvinjelwa kokulimala kwezicubu ezizungezile kanye nokwenza imicu emikhulu noma ukususa izingxenye zesistimu yokugaya ukudla. Ngakho-ke, uma kuqhathaniswa nokuhlinzwa okuvulekile, le nqubo ihlanganisa izinzuzo ezilandelayo:

• Ukufa okuphansi noma ukugula
• Ubuhlungu obuncane
• Ukululama ngokushesha
• Ingozi ephansi yezinkinga
• Ukuncipha kwezibazi 

3. Ingabe zikhona izinkinga ezihlobene nenqubo ye-endoscopic mucosal resection?

Nakuba kungavamile, kunezinye izinkinga ezihlobene nenqubo ye-endoscopic mucosal resection, engabandakanya:

• ukopha
• Ukutheleleka
• Ukubhoboza emgudwini wamathumbu
• Ukuvuvukala emthonjeni