I-Endoscopic Submucosal Dissection (ESD): Kuyini, Inqubo, Imiphumela Eseceleni kanye Nenqubo Yokubuyisela

Intuthuko kwezobuchwepheshe bezokwelapha iguqule indlela yokwelapha yezimo zesisu. Inqubo eyodwa ephumelelayo, i-Endoscopic Submucosal Dissection (ESD), izuze ukunakwa ngendlela yayo ehlasela kancane kanye nempumelelo ekwelapheni amathumba asemathunjini asekuqaleni. Udokotela angaluleka i-endoscopic submucosal dissection ukuthi isuse isimila noma isilonda uma sitholakala ngaphakathi kolwelwesi. amathumbu ipheshana.

I-ESD iyindlela ethuthukisiwe esetshenziselwa ukususa izicubu ezingajwayelekile noma izimila ezisanda kuqala emgudwini wokugaya ukudla. Ukwelapha okuhlasela kancane okususa izifunda eziyingozi nezinomdlavuza epheshaneni le-Gastrointestinal (GI) kusetshenziswa i-endoscope, idivayisi eguquguqukayo, efana neshubhu. Kungase kube inselele ukususa ngokuphelele lezi zimila usebenzisa amasu avamile njengoba zingase ziseduze kwezicubu zemisipha. Udokotela wakho angafinyelela ohlelweni lwakho lwe-GI ngezinqubo ze-endoscopic ngaphandle kokwenza noma yikuphi ukusikeka. Ngokuya ngendawo yendlela yokugaya abawelaphayo, odokotela bangase bafake i-endoscope emlonyeni wakho noma ku-anus (butthole). Ngemva kwalokho, basebenzisa i-endoscope ukuze bafake amathuluzi okuhlinza ukuze basuse izicubu ezingavamile. Uma kuqhathaniswa nokuvula ukuhlinzwa, le ndlela ivumela isiguli ukuba silulame ngokushesha futhi singakhululeki kancane.

Ubani Ongase Adinge I-Endoscopic Submucosal Dissection?

Abantu abatholakala benamathumba asemathunjini angaphambi kwesikhathi, izilonda ezingaphambi komdlavuza, noma ukungahambi kahle kwendawo ngaphakathi kwepheshana lamathumbu bangase babe amakhandidethi e-ESD. Iziguli ezingakwazi ukuhlinzwa ngenxa yezimo zempilo ezikhona noma lezo ezifuna izinketho zokwelapha ezingangeneleli ngokuvamile zikhetha i-ESD. I-submucosa, noma ungqimba phakathi kodonga lwemisipha kanye nolwelwesi lwezitho zangaphakathi, lungathinteka amathumba nezilonda ezibalwe ngezansi, ezingelashwa kusetshenziswa inqubo ye-ESD:

• I-Barrett's esophagus
• Izimila ezinomdlavuza wesigaba sokuqala noma ama-polyps, okuhlanganisa nomdlavuza wesisu, i-colorectal umdlavuza, kanye nomdlavuza womminzo.
• Izimila ze-oesophagus, isisu, noma ikholoni ezingakathuthuki ezingqimbeni ezijulile zodonga lwe-GI

Ukuze kususwe ezinye izimila, ikakhulukazi lezo ezinkulu kakhulu ukuthi zingasuswa esiqeshini esisodwa ngezindlela ezijwayelekile noma ezingenayo imingcele ehlukile, i-Endoscopic Suture Dissection (ESD) ingaba ukukhetha okuyimpumelelo kune-Endoscopic Mucosal Resection (EMR).

Ngaphambi kwe-Endoscopic Submucosal Dissection

Ngaphambi kwenqubo, iziguli zihlolwa ngokucophelela, okuhlanganisa ukubuyekezwa komlando wezokwelapha, ukuhlolwa ngokomzimba, kanye nezifundo zokucabanga. Uzothola imininingwane enemininingwane yokuthi ungayilungiselela kanjani inqubo ye-endoscopic submucosal dissection. Uzodinga ukuzila ukudla amahora ambalwa ngaphambi kokuhlinzwa uma i-gastroenterologist yakho yelapha ipheshana lakho le-GI eliphezulu (isisu, i-oesophagus, noma amathumbu amancane). Kungase kudingeke ukuthi ulungiselele amathumbu uma welapha ipheshana lakho eliphansi le-GI, okungamathumbu akho amakhulu, aqukethe ikholoni yakho nerectum. Ukulungiswa kwamathumbu, okubandakanya ukuhlanza umgudu wokugaya ukudla, kubalulekile ukuqinisekisa ukubonakala okucacile phakathi nenqubo.

Ngesikhathi se-Endoscopic Submucosal Dissection

I-gastroenterologist yakho izokwenza inqubo ye-ESD ngale ndlela elandelayo:

• Iziguli zithola i-sedation noma i-anesthesia ukuqinisekisa ukunethezeka kuyo yonke inqubo.
• I-endoscope ifakwa kahle ngomlomo noma ngendunu, kuye ngendawo yokungajwayelekile.
• Phakathi nenqubo, gcina iso ezithombeni ezisesikrinini ukuze uvimbele noma yikuphi ukulimala kwezicubu ezizungezile.
• I-endoscopist ikhomba isilonda futhi iphawula imingcele yayo isebenzisa odayi abakhethekile.
• Ukuze ususe isimila noma isilonda odongeni lwemisipha, faka isisombululo kungqimba olungaphansi kwalo. Ngokwenza lokhu, ukulimala kwenqubo kuzicubu ezizungezile kuyancishiswa.
• Kusetshenziswa amathuluzi akhethekile, isendlalelo esingaphansi kwezicubu ezihlosiwe sihlakazwa futhi sikhishwe.
• Ukopha kulawulwa phakathi nenqubo, futhi kwezinye izimo, isayithi lingadinga ukuvalwa kusetshenziswa iziqeshana noma ezinye izindlela.
• Ngemva kokukhipha izicubu emzimbeni usebenzisa i-endoscope, yithumele elebhu ukuze udokotela wezifo azihlole.
• Ngokuvamile, ukuhlukaniswa kwe-endoscopic submucosal kudinga ihora elilodwa kuya kwamathathu ukuze kuqedwe.

Ukubuyiselwa Ngemuva kwe-Endoscopic Submucosal Dissection

Iziguli zigadwa isikhathi sangemva kwe-ESD ukuze zibukele noma yiziphi izinkinga. Zizogcinwa ngaphansi kokubhekwa ekamelweni lokululama kuze kube yilapho isithombo siphela ngemva kokuhlinzwa kwe-ESD. Kungase kunqunywe ukuthi ingabe isimila siqedwe ngokuphelele yini udokotela wezifo ngokubheka amasampula ezicubu ngaphansi kwesibonakhulu. Iziguli zingase zibe nobuhlungu obuncane noma ukungaphatheki kahle endaweni lapho i-ESD yenziwe khona kuso sonke isigaba sokuphulukisa. Amaphilisi ezinhlungu atholwe ngaphandle kwekhawunta noma ngencwadi kadokotela, uma kunesidingo, ngokuvamile angasetshenziswa ukwelapha lokhu. 

Ekuqaleni, ukudla okuwuketshezi kungase kwelulekwe, kancane kancane kushintshele ekudleni okuthambile. Imithi yokusiza ukuphulukiswa nokuvimbela izinkinga ingase inqunywe. Ama-endoscopies okulandelela ahlelelwe ukuqapha indawo ephathwayo. Ikakhulukazi, uma isiguli singaphansi kwe-intravenous sedation, kufanele sigweme ukusebenzisa imishini esindayo. Lapho isiguli sicwiliswa ngomjovo, kufanele sigweme ukusebenzisa imishini esindayo. Ngokufanayo, kungcono kakhulu ukuyeka imisebenzi yokunaka njengokushayela lapho ukhathele futhi usayine amaphepha omthetho. 

Izinzuzo ze-Endoscopic Submucosal Dissection

I-Endoscopic Submucosal Dissection (ESD) inikeza izinzuzo ezimbalwa ezibalulekile, okuyenza ibe inketho yokwelashwa ekhethwayo ezimweni ezithile zesisu:

• I-ESD ayihlaseleki kakhulu kunokuhlinzwa kwendabuko, okuholela ekunciphiseni ukuhlukumezeka, ukuhlala isikhathi esifushane esibhedlela, kanye nokululama ngokushesha kweziguli.
• I-ESD ivumela ukuhlukaniswa okunembile, okuvumela ukususwa okuphelele kwezilonda ezinkulu noma izicubu ezingavamile ngenkathi kunciphisa ingozi yokushiya noma yisiphi isifo esisele ngemuva.
• Ngokukhetha ngokukhetha izicubu ezingajwayelekile ngenkathi kugcinwa izicubu ezinempilo nokusebenza kwesitho, i-ESD isiza ekugcineni ukusebenza kwepheshana lesisu.
• Uma kuqhathaniswa nokuhlinzwa okuvamile, i-ESD ithwala ubungozi obuphansi bezinkinga ezinjengokutheleleka, izinhlungu zangemva kokuhlinzwa, nezibazi, okuthuthukisa umuzwa ongcono wesiguli.

Imiphumela Emibi Ye-Endoscopic Submucosal Dissection

Nakuba i-Endoscopic Submucosal Dissection (ESD) ngokuvamile ibhekwa njengenketho ephephile, njenganoma iyiphi inqubo yezokwelapha, kunemiphumela emibi engase ibe khona kanye nezingozi ezihlobene nayo:

• Ukopha ngokushesha noma okubambezelekile endaweni yezicubu ezikhishiwe kuwumphumela ovamile. Ama-Endoscopists alawula lokhu phakathi nenqubo futhi ngezinye izikhathi ngokungenelela okwengeziwe.
• Kukhona ubungozi bokudala imbobo noma ukubhobozwa komgudu wamathumbu phakathi nenqubo yokuhlinza. Lokhu kuyinkinga enkulu edinga ukunakwa ngokushesha.
• Iziguli zingase zibe nokungaphatheki kahle okumaphakathi kuya kokumaphakathi, ukucasuka emphinjeni, noma ubuhlungu besisu ngemva kwe-ESD, evame ukuxazululeka phakathi nezinsuku ezimbalwa.
• Nakuba kungavamile, kunethuba elincane lokutheleleka endaweni yokuhlinzwa, ikakhulukazi uma ulwelwesi oluvikelayo lwepheshana lamathumbu luphulwa uma kunesikhathi sokuphulukiswa esithatha isikhathi eside.
• Ezimweni ezithile, izibazi ngemva kwe-ESD kungase kubangele ukuncipha (imicu) emgudwini wokugaya ukudla, okuholela ebunzimeni bokugwinya noma ukuhambisa amathumbu.
• Ezinye Izinkinga ezingavamile zingabandakanya ukungezwani komzimba nazo i-anesthesia, ukusabela okungekuhle emithini esetshenziswa phakathi nenqubo, noma izinkinga ezingavamile ezihlobene nesimo sempilo yesiguli esithile.

Umehluko Phakathi Kwe-Endoscopic Mucosal Resection (EMR) kanye Ne-Dissection (ESD)

Nakuba kokubili i-EMR ne-ESD kuyizinqubo ezihlasela kancane ezisetshenziselwa ukususa izicubu ezingavamile emgudwini wamathumbu, umehluko oyinhloko usesuni kanye nobukhulu bezilonda ezingakwazi ukuzilawula ngokuphumelelayo.

• I-endoscopic mucosal resection isetshenziswa odokotela be-gastroenterologist ukwelapha izimila ezikhula ku-mucosa, ulwelwesi lwangaphakathi oluhlanganisa uhlelo lwamathumbu. Uma udokotela enza i-endoscopic mucosal excision, ususa isilonda nge-metal loop ngenkathi kanye kanye ejova uketshezi ngaphansi kwaso. Izimila ezikhula zijule ku-mucosa yakho, kanye nalezo ezikuwo, ziphathwa nge-Endoscopic submucosal dissection.  
• Yonke indlela inezinzuzo nezinkinga zayo. I-EMR inomlando omude wokusebenza ngempumelelo kwezilonda eziningi eziyingozi, kulula ukuyisebenzisa, futhi idinga amathuluzi ambalwa. Umphumela omkhulu walokhu kwelashwa ukuthi abanye abantu bangadinga ukuhlinzwa okwengeziwe ngemuva kokuthola ukwelashwa ngakho. Ngakolunye uhlangothi, kungenzeka ukuthi baye balulama uma benikezwe i-ESD. Enye yezingqinamba eziyinhloko ze-EMR izinga layo eliphezulu lokuphindaphinda kwesilonda, esingasukela ku-15% siye ku-20% futhi sidinga ukwelashwa okwengeziwe.
• Inzuzo eyinhloko ye-ESD ukuthi ivumela ukuhlakazwa okuphelele kwanoma iluphi uhlobo lwesilonda, kungakhathaliseki usayizi. Idinga, nokho, ubungcweti be-endoscopic obuyindida futhi idinga kakhulu ngokobuchwepheshe kune-EMR. Ukuqhathanisa i-ESD ne-EMR, futhi kuyinqubo ebandakanyeka kakhulu enezinga elikhulu lokubhoboza. Ngokujabulisayo, i-endoscopy ingakwazi ukwelapha ngempumelelo iningi lezimbobo ezikhiqizwa i-ESD ngaphandle kokudinga ukuhlinzwa.

I-gastroenterologist yakho ingasusa izimila noma ukukhula okungavamile kusuka ezingqimbeni ezingaphezulu zesistimu yakho yokugaya isebenzisa i-endoscopic submucosal dissection ngaphandle kokusika noma yisiphi isikhumba. I-ESD izohlinzeka ngokwelashwa okuphumelelayo kwezilonda zamathumbu ezisanda kuzalwa njengoba ubuchwepheshe buthuthuka, kuthuthukise imiphumela yesiguli futhi kunciphise nesidingo sokuhlinza ngokugxambukela.