Njira Zoyesera Mayeso a Mano
Pendauluan
Kuyeza mano mu mano ndi njira yotengera chitsanzo cha minofu kuti akafufuze histopathological kuti adziwe matenda. Ngakhale kuti mawu akuti "dental biopsy" nthawi zambiri amamveka, m'machitidwe, ma biopsies nthawi zambiri amachitidwa pa minofu yozungulira dzino (gingiva, oral mucosa, alveolar bone, periapical tissue) kapena pa zilonda zokhudzana ndi dzino (monga radicular cysts, periapical granulomas), m'malo mochotsa "zidutswa za dzino" monga enamel nthawi zonse. Njira yolondola yopezera zitsanzo ndiyofunikira kwambiri pakupeza matenda, chifukwa minofu yowonongeka, yochepa kukula, kapena yosayimira ingayambitse kutanthauzira kolakwika. Nkhaniyi ikufotokoza zizindikiro, kukonzekera, mitundu ya njira, njira zoyendetsera ntchito, ndi momwe zitsanzo za biopsy zimagwirira ntchito mu mano.
Zizindikiro za Biopsy mu Dentistry
Kuyezetsa magazi (biopsy) kumaganiziridwa ngati pali vuto la chilonda kapena minofu lomwe silingatsimikizidwe ndi kafukufuku wa zachipatala ndi wa X-ray wokha. Zizindikiro zodziwika bwino ndi izi:
1. Zilonda za mucous zomwe zimakhalapo kwa milungu yoposa iwiri (zilonda, zoyera/zofiira, ziphuphu).
2. Kukayikira kuti pali zilonda zomwe zingayambitse khansa (leukoplakia, erythroplakia, zilonda zochiritsira, kutuluka magazi mosavuta).
3. Kukula kwa minofu monga fibroma, papilloma, pyogenic granuloma.
4. Matenda a m'mimba omwe sasintha pambuyo pa chithandizo cha endodontic kapena kuwonetsa mawonekedwe okayikitsa a radiolucent.
5. Ma cysts ndi zotupa zomwe zimafuna kutsimikiziridwa ndi histological kapena non-odontogenic cysts.
6. Matenda a mafupa a nsagwada (monga zilonda za fibro-osseous, osteomyelitis yosatha) m'matenda ena omwe amafunika kuyesedwa m'mafupa.
Mfundo Zoyambira ndi Kukonzekera
Dokotala wa mano ayenera kuchita zinthu zingapo zofunika asanachite opaleshoniyi:
– Kulemba mbiri yonse ya matenda (mbiri ya matenda a m'thupi, mankhwala—makamaka mankhwala oletsa magazi kuundana, ziwengo, zizolowezi zosuta fodya).
- Kufufuza bwino za matenda ndi kulemba za kukula, malo, mtundu, kusinthasintha, pamwamba, ndi ubale wake ndi mano.
– Kuyezetsa kothandizira: periapical x-ray, panoramic, CBCT ngati kuli kofunikira, makamaka pa zotupa za m'mimba.
– Chilolezo chodziwitsidwa: fotokozani cholinga cha biopsy, njira, zoopsa (ululu, kutuluka magazi, matenda, paresthesia), ndi zochita zina zomwe zingatsatidwe.
– Asepsis–antisepsis: malo ogwirira ntchito amayeretsedwa, wogwiritsa ntchito amagwiritsa ntchito zida zodzitetezera, ndipo zidazo zimakhala zoyera.
Kusankha njira yopangira biopsy kumatengera kukula kwa chilonda, kuya kwake, malo ake, kukayikira kuti pali khansa, komanso mwayi wopeza njira yochizira.
Mitundu ya Njira za Biopsy mu Dentistry
1. Kufufuza kwa Kudula Mabala
Kuduladula ndi kuchotsa chidutswa chaching'ono cha minofu kuchokera ku chotupa, chomwe nthawi zambiri chimachitidwa pa zilonda zazikulu kapena zomwe zikuganiziridwa kuti ndi zoopsa. Cholinga chake ndi kupeza chitsanzo choyimira popanda kuchotsa chotupa chonse. Njira iyi ndi yabwino kwambiri pamene:
- Chilondacho ndi chachikulu ndipo sichilola kuti chichotsedwe kwathunthu pachiyambi.
- Pali kukayikira kuti pali khansa, choncho ndikofunikira kupeza kaye matenda musanakonzekere opaleshoni yeniyeni.
Mfundo yofunika kwambiri: tenga chitsanzo kuchokera kudera lodziwika bwino—nthawi zambiri malire pakati pa minofu yabwinobwino ndi yosazolowereka. Pewani malo omwe ali ndi necrosis yayikulu yomwe ingasokoneze ubwino wa matenda.
2. Kufufuza kwa Excisional Biopsy
Kuchotsa chilondacho pogwiritsa ntchito excisional biopsy kumaphatikizapo kuchotsa chilonda chonsecho ndipo ndi njira yochiritsira. Ndi yoyenera pa zilonda zazing'ono, zosavulaza, komanso zapafupi monga fibromas zazing'ono kapena papillomas. Ubwino wake:
- Kuzindikira ndi kuchiza matenda kungatheke mwa kuchitapo kanthu kamodzi.
- Malire amatha kuyesedwa ngati achitika bwino.
Zoopsa: Ngati chilondacho chili choipa, kuchotsa popanda kukonzekera bwino za khansa kungapangitse kuti chithandizo chikhale chovuta. Chifukwa chake, kusankha wodwala ndikofunikira kwambiri.
3. Kujambula ndi Kujambula Pachimake
Kujambula pogwiritsa ntchito chipangizo chodulira champhamvu (chodulira) kuti mupeze kuchuluka kwa minofu ya mucosal (nthawi zambiri 3-6 mm). Chimagwiritsidwa ntchito kwambiri pa mucosal ya mkamwa pa zilonda kapena ma plaque athyathyathya. Ubwino wake ndi monga njira yofulumira komanso chitsanzo chabwino ngati chachitidwa bwino. Kuboola kumeneku kumalola kusonkhanitsa kwathunthu minofu ya epithelial ndi minofu yolumikizirana yomwe ili pansi pake.
4. Fine Needle Aspiration Biopsy (FNAB)
FNAB nthawi zambiri imagwiritsidwa ntchito pa minofu yofewa monga kukula kwa malovu kapena zotupa za khosi zomwe zimagwirizanitsidwa ndi dera la maxillofacial. Pankhani ya biopsy ya mano, FNAB ingathandize kusiyanitsa pakati pa zilonda za cystic zodzazidwa ndi madzi, zilonda, ndi zotupa. Komabe, FNAB imapereka zitsanzo za cytological, osati histology ya thupi lonse, kotero nthawi zina biopsy yovomerezeka ya minofu imakhala yofunikira.
5. Kufufuza kwa Mafupa/Zilonda za M'mimba
Zilonda za Periapical kapena chibwano cha nsagwada Nthawi zina, kufufuza minofu ya mafupa kapena mafupa m'thupi kumafunika kudzera mu opaleshoni. Mu milandu ya periapical, zitsanzo zimatha kutengedwa panthawi ya apicoectomy kapena enucleation ya cyst. Pa zilonda zazikulu, biopsy ya intraosseous incisional imachitika mwa kupanga zenera mu fupa cortex, kuchotsa minofu ya zilonda, kenako kutseka malowo.
Masitepe Onse a Njira Yopangira Biopsy (Minofu Yofewa)
Njira yotsatirayi ndi yomwe imagwiritsidwa ntchito nthawi zambiri pochiza matenda a minofu yofewa:
1. Kudziwa malo a chitsanzo
Sankhani malo omwe ali ofunikira kwambiri. Pa zilonda zomwe sizili zofanana, tengani zitsanzo zingapo ngati pakufunika kutero (monga malo ofiira, oyera, ndi okhala ndi zilonda).
2. Mankhwala oletsa ululu am'deralo
Gwiritsani ntchito njira yolowera mozungulira chotupacho. Pewani kubaya mwachindunji chotupacho ngati n'kotheka, chifukwa izi zitha kusokoneza kapangidwe ka minofu ndikusokoneza kutanthauzira kwa histological.
3. Kuduladula ndi kusonkhanitsa minofu
– Pakudula: pangani kudula kozungulira kapena kooneka ngati mphero, komwe kumaphatikizapo gawo la chotupa ndi minofu yaying'ono yachibadwa m'mphepete.
– Pochotsa: dulani chotupa cha elliptical mozungulira chotupacho ndi m'mbali mwake zoyenera.
– Pa kubaya: kanikizani ndikuzungulira kubaya mpaka kufika pamlingo woyenera, kenako chotsani chitsanzocho ndi forceps zazing'ono.
4. Kusamalira netiweki
Pewani kukanikiza chitsanzo mwamphamvu kwambiri pogwiritsa ntchito ma tweezers. mano chifukwa zingayambitse chophwanya chinthu chopangidwa ndi chitsulo. Ndi bwino kugwiritsa ntchito mbedza yopyapyala kapena zolumikizira za atraumatic.
5. Kutsekeka kwa magazi ndi kutsekeka kwa bala
Ikani mphamvu, thira mankhwala ophera tizilombo toyambitsa matenda pang'ono ngati pakufunika kutero, ndipo sungani malowo. Samalani ndi minofu ya mkamwa yomwe imatuluka magazi mosavuta; onetsetsani kuti magazi akutuluka bwino.
6. Malangizo pambuyo pa kuchitapo kanthu
Perekani malangizo pa zakudya zofewa, ukhondo wa mkamwa, mankhwala ochepetsa ululu ngati pakufunika kutero, ndi zizindikiro zochenjeza monga kutuluka magazi kosalekeza, kupweteka kwambiri, malungo, kapena kutupa pang'onopang'ono.
Kusamalira ndi Kukonza Zitsanzo
Cholakwika chofala kwambiri mu biopsy ndi kusagwira bwino kwa zitsanzo. Kuti mupeze zotsatira zabwino:
- Ikani minofu mu 10% buffered formalin mwamsanga momwe mungathere. Kuchedwa kungayambitse autolysis.
- Gwiritsani ntchito kuchuluka kokwanira kwa formalin (nthawi zambiri kuchulukitsa kuchuluka kwa minofu nthawi 10).
– Zolemba zonse: dzina la wodwala, tsiku, malo a thupi lake, ndi mtundu wa biopsy.
– Phatikizani fomu yopempha chithandizo cha matenda: kufotokozera zachipatala, nthawi ya chilonda, zizindikiro, zizolowezi (kusuta fodya/mowa), mbiri yachipatala, ndi zomwe zapezeka pa x-ray, ngati zilipo. Chidziwitso chachipatala ndi chothandiza kwambiri kwa dokotala wa matenda podziwa tanthauzo lake.
Pa matenda omwe akuganiziridwa kuti akufunika kuyezetsa kwapadera (monga, fluorescence ya immunofluorescence mu matenda a vesiculobullous), zitsanzo ziyenera kuperekedwa m'njira yapadera, osati m'njira ya formalin. Chifukwa chake, kukayikira kwachipatala kuyenera kuyambitsidwa msanga.
Mavuto Oyenera Kuyembekezera
Mavuto ena a biopsy m'kamwa ndi awa:
– Kutuluka magazi: chiopsezo chachikulu kwa odwala omwe ali ndi vuto la magazi oundana kapena kugwiritsa ntchito mankhwala oletsa magazi oundana.
– Matenda: kawirikawiri ngati asepsis ndi yabwino, koma ingachitike m'malo omwe mwavulala kapena momwe simuli aukhondo.
– Ululu ndi kutupa: nthawi zambiri zimakhala zofatsa ndipo zimatha kuthandizidwa ndi mankhwala ochepetsa ululu ndi ma compress ozizira.
– Kuwonongeka kwa mitsempha: makamaka ngati biopsy ili pafupi ndi malo olumikizirana mafupa, lilime (mitsempha ya lingual), kapena malo ena olowa m'mimba.
– Zitsanzo za zinthu zakale: zoonongeka, zopsezedwa (chifukwa cha kutentha kwambiri), kapena minofu yosaya kwambiri zingapangitse kuti matenda azitha kuonekera mosavuta.
Mapeto
Njira zopezera zitsanzo za biopsy mu mano ndi luso lofunikira kwambiri pochiza matenda osiyanasiyana a mkamwa ndi m'nsagwada. Kusankha njira (yodula, yochotsa, yobaya, yotulutsa m'mimba, kapena yochotsa mafupa) kuyenera kusinthidwa kuti kugwirizane ndi mawonekedwe a chilondacho komanso kukayikira kwachipatala. Kuphatikiza pa njira yoyenera yochitira opaleshoni, chinsinsi cha biopsy yopambana chili pakusankha malo oyimira chitsanzo, kusamalira minofu ya atraumatic, komanso kukonza bwino ndi kulemba zikalata. Ndi njira zoyenera, biopsy imatha kupereka chidziwitso cholondola cha histopathological, zomwe zimapangitsa kuti wodwala alandire chithandizo cholondola, chotetezeka, komanso cholunjika.
Ngati mukufuna, nditha kusintha nkhaniyi kuti ikhale yothandiza kwambiri pa maphunziro (yokhala ndi mabuku/zolemba m'magazini), kapena kuipangitsa kukhala yothandiza kwambiri monga chitsogozo cha sitepe ndi sitepe cha othandizira/ophunzira a mano.
