Ngā Tikanga Tātari Niho Biopsy
Pendahuluan
Ko te koiora niho he tikanga tango tauira kiko hei whakamātautau histopathological hei whakatū i tētahi mate. Ahakoa e rangona pinepinetia ana te kupu "koiora niho", i roto i te mahi, ka mahia ngā koiora ki ngā kiko e karapoti ana i te niho (gingiva, mucosa waha, wheua alveolar, kiko periapical) ki ngā whara e pā ana ki te niho rānei (hei tauira, ngā cysts radicular, ngā granuloma periapical), kaua ki te tango noa i ngā "wāhanga niho" pērā i te enamel. He mea nui te tikanga tauira tika mō te kounga o te mate, nā te mea ka taea e te kiko kua pakaru, he iti te rahi, he kore rānei e whakaatu i te āhua o te kiko te arahi ki ngā whakamaoritanga hē. Ka matapakihia e tēnei tuhinga ngā tohu, te whakarite, ngā momo tikanga, ngā mahi tukanga, me te whakahaere i ngā tauira koiora i roto i te mahi niho.
Ngā Tohu mō te Biopsy i roto i te Niho
Ka whakaarohia he koiora ina he whara, he rerekētanga rānei o te kiko e kore e taea te whakaū mā te whakamātautau haumanu me te whakamātautau x-ray anake. Ko ngā tohu noa ko:
1. Ngā whara kiriuhi e mau tonu ana mō ngā wiki neke atu i te 2 (ngā mate pukupuku, ngā papa mā/whero, ngā puku).
2. Te whakapae kei te pāngia koe e ngā whara o mua i te matepukupuku, e te matepukupuku rānei (leukoplakia, erythroplakia, whara whakapakari, ngawari te toto).
3. Te whakanui ake i ngā kiko pērā i te fibroma, te papilloma, te pyogenic granuloma.
4. Ngā āhuatanga rerekē o te periapical e kore e pai ake i muri i te maimoatanga endodontic, e whakaatu ana rānei i te āhua radiolucent kāore i te tino mārama.
5. Ngā whēkau me ngā pukupuku odontogenic, kore-odontogenic rānei e hiahia ana kia whakaūhia e te histological.
6. Ngā mate o te wheua kauae (hei tauira, ngā whara fibro-osseous, te osteomyelitis mau tonu) i roto i ētahi āhuatanga e hiahia ana kia tangohia he tauira wheua.
Ngā Mātāpono Taketake me te Whakarite
I mua i te mahi, me mahi e te taote niho ētahi mahi nui:
– Te hītori o ngā mate pūnaha katoa (te hītori o ngā mate pūnaha, ngā rongoā—ina koa ko ngā rongoā ārai toto, ngā mate pāwera, ngā whanonga momi hikareti).
– He whakamātautau haumanu hōhonu me te tuhi i te rahi, te tauwāhi, te tae, te ōritetanga, te mata, me te whanaungatanga ki ngā niho.
– Ngā whakamātautau tautoko: ngā whakaahua X-ray periapical, te panoramic, te CBCT mēnā e tika ana, inā koa mō ngā whara intraosseous.
– Whakaaetanga whai whakaaro: whakamāramahia te kaupapa o te koiora, te tikanga, ngā mōrearea (mamae, toto, mate, paresthesia), me ngā mahi whai muri pea.
– Asepsis–antisepsis: ka horoia te wāhi e mahihia ana, ka whakamahia e te kaiwhakahaere ngā taputapu tiaki, ā, ka parakore ngā taputapu.
Ko te whiriwhiri i te tikanga koiora ka pāngia e te rahi o te whara, te hohonu, te wāhi o te tinana, te whakapae he mate pukupuku, me te huarahi e taea ai te tango i te tikanga.
Ngā Momo Tikanga Koiora i roto i te Mahi Niho
1. Ko te Biopsy Tapahanga
Ko te koiora tapahi he tango i tētahi wahi kiko iti mai i tētahi whara, e mahia ana i te nuinga o te wā ki ngā whara nui, ki ngā whara kino rānei e whakapaetia ana. Ko te whāinga he tiki i tētahi tauira whai mana me te kore e tango i te whara katoa. He pai tēnei tikanga ina:
– He whānui te whara, ā, kāore e taea te tango katoa i te wāhanga tuatahi.
– Ki te whakapaetia he mate pukupuku, nō reira me kimi he tātaritanga i mua i te whakamahere i te pokanga whakamutunga.
He mātāpono nui: tangohia he tauira mai i te wāhi tino kitea—ko te rohe i waenga i te kiko noa me te kiko rerekē. Āta karohia ngā wāhi e tino kino ana te mate ka pā kino ki te kounga o te tātaritanga.
2. Ko te Biopsy Whakakore
Ko te tango i te whara katoa i roto i te koiora tangohanga he tikanga rongoā anō hoki. He pai mō ngā whara iti, ngawari, me ngā whara ā-rohe pērā i ngā fibromas iti, ngā papillomas rānei. Ko ōna painga:
– Ka taea te tautuhi me te whakaora i te mate i roto i te mahi kotahi.
– Ka taea te aromatawai i ngā tawhē mēnā ka tika te mahi.
Ngā Mōrearea: Mena he kino te whara, ka uaua pea te maimoatanga atu mēnā ka tangohia te whara, me te kore he mahere matepukupuku e tika ana. Nō reira, he mea nui te whiriwhiri i te take.
3. Te Pūnaha Koiora
Ka whakamahia he taputapu porotaka koi (pū) hei tiki i te nui o te kiko mucosal inehia (te nuinga o te wā 3–6 mm). He whānuitia te whakamahinga ki te mucosa waha mō ngā whara papatahi, ngā papa rānei. Ko ōna painga ko te tere o te tukanga me te pai o te tauira mēnā ka tika te mahi. Mā te pū ka taea te kohikohi katoa i te kiko epithelial me te kiko honohono kei raro.
4. Te Kohikohi i te Ngira Pai (FNAB)
He maha ngā wā ka whakamahia te FNAB mō ngā puranga kiko ngohengohe pērā i te whakanui i te repe huware, ngā puku kaki rānei e pā ana ki te rohe maxillofacial. I roto i te horopaki o te koiora niho, ka taea e te FNAB te āwhina ki te wehewehe i waenga i ngā whara cystic kī tonu i te wai, ngā whewhe, me ngā pukupuku. Heoi, ka whakaratohia e te FNAB ngā tauira cytological, ehara i te histology tinana katoa, nō reira he mea tika te koiora kiko whaimana i ētahi wā.
5. Te Kohikohi Wheua/Ngā Whara Intraosseous
I ētahi wā, me tango tauira wheua, kiko rānei i roto i te tinana mā te pokanga mō ngā whara periapical, ngā pūkahukahu kauae rānei. I ngā take periapical, ka taea te tango tauira i te wā apicoectomy, i te wā e tangohia ai te pūkahukahu. Mō ngā whara nui, ka mahia he koiora tapahi i roto i te tinana mā te hanga i tētahi "matapihi" i roto i te cortex wheua, ka tangohia te kiko whara, kātahi ka kati i te rohe.
Ngā Hipanga Whānui o te Tukanga Koiora (Kiko Ngāwari)
Koinei te rerenga e whakamahia ana i roto i te mahi haumanu mō te koiora kiko ngohengohe:
1. Te whakatau i te wāhi tauira
Kōwhiria te wāhi e tino whakaatu ana i te āhua. Mō ngā whara kāore i te ōrite, tangohia kia neke atu i te kotahi tauira mēnā e tika ana (hei tauira, ngā wāhi whero, mā, me ngā wāhi kua puta he puku).
2. Te rongoā whakamoe ā-rohe
Whakamahia he werohanga ki te taha o te whara. Āta karohia te werohanga tika ki roto i te whara mēnā ka taea, nā te mea ka taea e tēnei te whakararuraru i te hanganga kiko, ā, ka pā ki te whakamaoritanga histological.
3. Te tapahi me te kohikohi kiko
– Mō te tapahi: tapahia he tapahi porowhita, he tapahi porowhita rānei, kia kapi ai tētahi wāhanga o te whara me tētahi wahi iti o te kiko noa i ngā taha.
– Mō te tango: tapahia he tapa porowhita huri noa i te whara me ngā tapa e tika ana.
– Mō te wero: pēhi, ka huri i te wero kia tae rā anō ki te hohonutanga o te kiko e tika ana, kātahi ka tangohia te tauira mā te whakamahi i ngā kuku angiangi.
4. Te whakahaere whatunga
Kaua e pupuri rawa i te tauira ki te whakamahi i te kuku niho, nā te mea ka pakaru pea. He pai ake te whakamahi i te matau ngohengohe, i te kuku rānei e kore e whara.
5. Te whakaheke toto me te katinga o te patunga
Pēhia, tahuna mārire mēnā e tika ana, ka tuitui i te wāhi. Kia tūpato ki ngā kiko o te waha e tere ana te toto; kia tika te whakahaere i te toto.
6. Ngā tohutohu i muri i te mahi
Hoatu he aratohu mō ngā kai ngohengohe, te akuaku o te waha, ngā rongoā mamae mēnā e tika ana, me ngā tohu whakatūpato pēnei i te toto tonu, te mamae nui, te kirika, te pupuhi haere rānei.
Te Whakahaere me te Whakamau i te Tauira
Ko tētahi hapa noa i roto i ngā koiora ko te whakahaerenga tauira koretake. Hei whakatutuki i ngā hua tino pai:
– Whakatakotoria te kiko ki roto i te formalin 10% kua whakapūmautia i te wā e taea ai. Ka taea e te whakaroa te whakaputa i te autolysis.
– Whakamahia he nui o te formalin (te tikanga kia 10 ngā wā o te nui o te kiko).
– Te tapanga katoa: te ingoa o te tūroro, te rā, te wāhi o te tinana, me te momo koiora i tangohia.
– Tāpirihia he puka tono mate pāwera: he whakaahuatanga haumanu, he roa o te whara, he tohu, he whanonga (momi hikareti/waipiro), he hītori hauora, me ngā kitenga ira-X, mēnā he mea kei roto. He tino āwhina ngā mōhiohio haumanu mō te tākuta mate pāwera ki te whakatau i te whakamaoritanga.
Mō ngā mate e whakapaetia ana e hiahia ana ki te whakamātautau motuhake (hei tauira, te immunofluorescence tika i roto i te mate vesiculobullous), me whakahaere ngā tauira i roto i ngā rauemi motuhake, kaua i te formalin. Nō reira, me whakaara wawe i te whakapae haumanu.
Ngā raruraru hei matapae
Ko ētahi o ngā raruraru o te koiora i roto i te waha ko:
– Te toto: he nui ake te mōrearea i roto i ngā tūroro e pāngia ana e ngā mate toto toto tiketike, e whakamahi ana rānei i ngā rongoā anticoagulant.
– Te mate urutā: he onge mēnā he pai te ārai mate, engari ka pā pea ki ngā wāhi kua whara, kāore rānei i te pai te akuaku.
– Mamae me te pupuhi: he ngawari te nuinga, ā, ka taea te whakahaere mā te whakamahi i ngā rongoā mamae me ngā kōpeke makariri.
– Te kino o ngā io: inā koa mēnā kei te tata te koiora ki te foramen hinengaro, ki te arero (io reo), ki ētahi wāhi rānei o roto i te wheua.
– Mā ngā tauira taonga: kua pakaru, kua wera (nā te nui rawa o te werohanga), he papaku rawa rānei te kiko e uaua ai te tautuhi mate.
Whakamutunga
He pūkenga haumanu nui ngā tikanga kohi tauira koiora i roto i te mahi niho hei whakatū i te tautuhi i ngā whara kiko o te waha me te kauae. Me whakarite te kōwhiringa tikanga (kohikohi tapahi, kohikohi tapahi, kohikohi punch, kohikohi mimi, kohikohi intraosseous rānei) ki ngā āhuatanga o te whara me te whakapae haumanu. Haunga te tikanga pokanga tika, ko te kī ki te kohikohi angitu kei roto i te whiriwhiri i tētahi wāhi tauira e tika ana, te whakahaere kiko attractive, me te whakatikatika me te tuhi tika. Mā ngā tikanga tika, ka taea e ngā kohikohi te whakarato i ngā mōhiohio histopathological tika, ka hua ake he maimoatanga tūroro tika ake, haumaru ake, me te arotahi.
Ki te hiahia koe, ka taea e au te whakarerekē i tēnei tuhinga hei putanga mātauranga ake (me ngā tohutoro pukapuka/hautaka), ka taea rānei e au te hanga kia whai hua ake hei aratohu taahiraa-i-te-taahiraa mā ngā kaiawhina niho/ākonga.
