Amasu Okuhlola I-Biopsy Yamazinyo
I-Pendahuluan
I-biopsy kudokotela wamazinyo inqubo yokuthatha isampula yezicubu ukuze kuhlolwe i-histopathological ukuze kutholakale ukuxilongwa. Nakuba igama elithi "i-biopsy yamazinyo" livame ukuzwakala, empeleni, i-biopsies ivame ukwenziwa ezicutshini ezizungeze izinyo (i-gingiva, i-oral mucosa, ithambo le-alveolar, izicubu ze-periapical) noma ezilondeni ezihlobene namazinyo (isb., ama-radicular cyst, ama-periapical granulomas), kunokususa njalo "izingcezu zamazinyo" njenge-enamel. Indlela efanele yokuthatha amasampula ibalulekile ukuze kutholakale ikhwalithi yokuxilongwa, njengoba izicubu ezonakele, ezincane, noma ezingameleli zingaholela ekuchazeni okungalungile. Lesi sihloko sixoxa ngezinkomba, ukulungiselela, izinhlobo zamasu, izinyathelo zenqubo, kanye nokuphathwa kwamasampula e-biopsy kudokotela wamazinyo.
Izinkomba ze-Biopsy ku-Dentistry
I-biopsy iyacatshangelwa uma kukhona isilonda noma ukukhubazeka kwezicubu okungenakuqinisekiswa ngokuhlolwa kwezokwelapha kanye ne-x-ray kuphela. Izinkomba ezivamile zifaka:
1. Izilonda ze-mucosal eziqhubekayo isikhathi esingaphezu kwamasonto amabili (izilonda, ama-plaque amhlophe/abomvu, amaqhubu).
2. Ukusolwa kwezilonda ezingaphambi komdlavuza noma ezibangelwa umdlavuza (i-leukoplakia, i-erythroplakia, izilonda eziqhubekayo, ukopha kalula).
3. Ukwanda kwezicubu ezifana ne-fibroma, i-papilloma, i-pyogenic granuloma.
4. Ukukhubazeka kwe-periapical okungathuthuki ngemva kokwelashwa kwe-endodontic noma okubonisa ukubukeka okungaqondakali kwe-radiolucent.
5. Ama-cyst nama-tumors abangela i-Odontogenic noma angenawo ama-Odontogenic adinga ukuqinisekiswa kwe-histological.
6. Izinkinga zamathambo omhlathi (isib. izilonda ze-fibro-osseous, i-osteomyelitis engapheli) ezimweni ezithile ezidinga amasampula ethambo.
Izimiso Eziyisisekelo Nokulungiselela
Ngaphambi kwenqubo, udokotela wamazinyo kumele enze izinto eziningana ezibalulekile:
– Umlando ophelele (umlando wesifo somzimba, imithi—ikakhulukazi imithi yokunciphisa ukugabha kwegazi, ukungezwani komzimba, imikhuba yokubhema).
- Ukuhlolwa okuphelele kwezokwelapha kanye nokubhalwa kosayizi, indawo, umbala, ukuqina, ubuso, kanye nobudlelwano namazinyo.
– Ukuhlolwa okusekelayo: i-periapical radiographs, i-panoramic, i-CBCT uma kudingeka, ikakhulukazi izilonda ezingaphakathi kwamathambo.
– Imvume enolwazi: chaza injongo ye-biopsy, inqubo, izingozi (ubuhlungu, ukopha, ukutheleleka, i-paresthesia), kanye nezinyathelo ezingase zilandelwe.
– I-Asepsis–antisepsis: indawo yokusebenza iyahlanzwa, umqhubi usebenzisa imishini yokuzivikela, kanti imishini ayinamagciwane.
Ukukhethwa kwendlela yokucubungula izicubu kuthonywa ubukhulu besilonda, ukujula, indawo yokwakheka komzimba, izinsolo zomdlavuza, kanye nokufinyelela enkambisweni.
Izinhlobo Zezindlela Zokwelapha Amazinyo
1. Ukuhlolwa Kwe-Incisional Biopsy
I-biopsy yokusika iwukususwa kwengxenye encane yezicubu esilondeni, ngokuvamile eyenziwa ezilondeni ezinkulu noma okusolwa ukuthi ziyingozi. Umgomo uwukuthola isampula emele ngaphandle kokususa sonke isilonda. Le ndlela ifaneleka kakhulu uma:
– Isilonda sibanzi futhi asivumeli ukususwa ngokuphelele esigabeni sokuqala.
– Kunokusolwa komdlavuza ngakho-ke kudingeka ukuxilongwa kuqala ngaphambi kokuhlela ukuhlinzwa okuqondile.
Isimiso esibalulekile: isampula evela endaweni emele kakhulu—ngokuvamile umngcele phakathi kwezicubu ezivamile nezingavamile. Gwema izindawo ezine-necrosis enzima ezingalimaza ikhwalithi yokuxilongwa.
2. I-Excisional Biopsy
I-excisional biopsy ihilela ukususa lonke inxeba futhi iyisinyathelo sokwelapha. Ifanele izilonda ezincane, ezingenabungozi, nezisendaweni ezifana ne-fibromas encane noma ama-papillomas. Izinzuzo zayo:
– Ukuxilongwa kanye nokwelashwa kungatholakala ngesenzo esisodwa.
– Amamajini angahlolwa uma enziwa kahle.
Izingozi: Uma isilonda sibi kakhulu, ukususwa ngaphandle kokuhlela okwanele komdlavuza kungenza kube nzima ukwelashwa okwengeziwe. Ngakho-ke, ukukhetha icala kubalulekile.
3. I-Punch Biopsy
I-punch biopsy isebenzisa ithuluzi elibukhali eliyindilinga (i-punch) ukuthola inani elilinganisiwe lezicubu ze-mucosal (ngokuvamile 3-6 mm). Isetshenziswa kabanzi ku-mucosa yomlomo yezilonda ezisicaba noma ama-plaque. Izinzuzo zayo zifaka phakathi inqubo esheshayo kanye nesampula enhle uma yenziwe kahle. I-punch ivumela ukuqoqwa okuphelele kwezicubu ze-epithelial kanye nezicubu ezixhumeneyo ezingaphansi.
4. I-Fine Needle Aspiration Biopsy (FNAB)
I-FNAB ivame ukusetshenziselwa izicubu ezithambile ezifana nokukhula kwezindlala zamathe noma amaqhubu entamo ahlotshaniswa nendawo ye-maxillofacial. Ngokwesimo se-biopsy yamazinyo, i-FNAB ingasiza ekuhlukaniseni phakathi kwezilonda ze-cystic ezigcwele uketshezi, amathumba, kanye nezimila. Kodwa-ke, i-FNAB inikeza amasampula e-cytological, hhayi i-histology yomzimba wonke, ngakho-ke i-biopsy yezicubu ezisemthethweni ngezinye izikhathi iyadingeka.
5. Ukuhlolwa Kwamathambo/Izilonda Ezingaphakathi Kwethambo
Izilonda ze-Periapical noma isimila somhlathi Ngezinye izikhathi, kudingeka ukusampula izicubu zamathambo noma ezicutshini ngokuhlinzwa. Ezimweni ze-periapical, amasampula angathathwa ngesikhathi sokususwa kwezicubu noma ukukhishwa kwezicubu. Ezilondeni ezinkulu, kwenziwa i-biopsy yokusika izicubu ngaphakathi kwezicubu ngokudala ifasitela ku-bone cortex, kususwe izicubu zezilonda, bese kuvalwa indawo.
Izinyathelo Ezijwayelekile Zenqubo Yokuhlola Izicubu (Izicubu Ezithambile)
Okulandelayo ukugeleza okuvame ukusetshenziswa emitholampilo ye-biopsy yezicubu ezithambile:
1. Ukunquma indawo yesampula
Khetha indawo emele kakhulu. Ngezilonda ezingalingani, thatha amasampula angaphezu kwelilodwa uma kudingeka (isib., izindawo ezibomvu, ezimhlophe, nezinezilonda).
2. Ukubulala izinzwa kwendawo
Sebenzisa ukungena okuzungeze isilonda. Gwema ukujova ngqo esilonda uma kungenzeka, ngoba lokhu kungaphazamisa ukwakheka kwezicubu futhi kuthinte ukuchazwa kwe-histological.
3. Ukusikwa nokuqoqwa kwezicubu
– Kokusikwa: yenza ukusikwa okusaqanda noma okufana ne-wedge, okuhlanganisa ingxenye yesilonda kanye nenani elincane lezicubu ezivamile emaphethelweni.
– Ukuze kukhishwe: yenza ukusika okusaqanda okuzungeze isilonda ngemingcele efanele.
– Ukuze ushaye: cindezela bese uphendula i-punch kuze kube yilapho ifinyelela ekujuleni okwanele kwezicubu, bese ususa isampula nge-forceps encane.
4. Ukuphathwa kwenethiwekhi
Gwema ukubopha isampula kakhulu usebenzisa ama-tweezers. amazinyo ngoba kungabangela into yobuciko echotshoziwe. Kungcono ukusebenzisa i-hook encane noma ama-tweezers angasebenzi kahle.
5. Ukuvalwa kwe-Hemostasis kanye nokuvalwa kwenxeba
Faka ingcindezi, u-cauterization omncane uma kudingeka, bese uthunga indawo. Qaphela izicubu zomlomo eziphuma igazi kalula; qinisekisa ukuthi kulawulwa kahle ukopha.
6. Imiyalelo yangemva kwesenzo
Nikeza isiqondiso ngokudla okuthambile, inhlanzeko yomlomo, imithi yokunciphisa ubuhlungu uma kudingeka, kanye nezimpawu eziyisixwayiso ezifana nokopha okuqhubekayo, ubuhlungu obukhulu, umkhuhlane, noma ukuvuvukala okuqhubekayo.
Ukuphathwa Nokulungiswa Kwesampula
Iphutha elivamile ekuhlolweni kwe-biopsy ukuphathwa kabi kwamasampula. Ukuze kutholakale imiphumela emihle:
– Faka izicubu ku-formalin ene-buffer engu-10% ngokushesha okukhulu. Ukulibaziseka kungabangela i-autolysis.
– Sebenzisa ivolumu eyanele ye-formalin (ngokuvamile ephindwe kayishumi kunevolumu yezicubu).
– Ukulebula okuphelele: igama lesiguli, usuku, indawo yokwakheka komzimba, kanye nohlobo lwe-biopsy.
– Faka ifomu lesicelo se-pathology elinolwazi: incazelo yezokwelapha, ubude bezilonda, izimpawu, imikhuba (ukubhema/utshwala), umlando wezokwelapha, kanye nokutholakele kwe-x-ray, uma kukhona. Ulwazi lwezokwelapha luwusizo kakhulu kudokotela wezifo ekunqumeni incazelo.
Ezifweni okusolwa ukuthi zidinga ukuhlolwa okukhethekile (isb., i-immunofluorescence eqondile esifweni se-vesiculobullous), amasampula kufanele aphathwe ngezindlela ezikhethekile, hhayi nge-formalin. Ngakho-ke, ukusola kwezokwelapha kufanele kuphakanyiswe kusenesikhathi.
Izinkinga Okufanele Uzilindele
Ezinye izinkinga ze-biopsy emlonyeni zihlanganisa:
– Ukopha: ingozi enkulu ezigulini ezinezinkinga zokugaya igazi noma ukusetshenziswa kwemithi yokunciphisa igazi.
– Ukutheleleka: akuvamile uma i-asepsis ilungile, kodwa kungenzeka ezindaweni ezithintekile noma ezingahlanzekile.
– Ubuhlungu kanye nokuvuvuka: ngokuvamile kuncane futhi kungaphathwa ngemithi yokunciphisa ubuhlungu kanye nokucindezela okubandayo.
– Ukulimala kwemizwa: ikakhulukazi uma i-biopsy iseduze ne-mental foramen, ulimi (i-lingual nerve), noma izindawo ezithile ezingaphakathi kwamathambo.
– Izinto zobuciko eziyisampula: ezonakele, ezishile (ngenxa yokushisa ngokweqile), noma izicubu ezingajulile kakhulu kungenza ukuxilongwa kube nzima.
Isiphetho
Amasu okuthatha amasampula e-biopsy kudokotela wamazinyo ayikhono elibalulekile lokwelapha ukuze kutholakale ukutholakala kwezilonda ezahlukahlukene zezicubu zomlomo nezemihlathi. Ukukhetha indlela (incisional, excisional, punch, aspiration, noma intraosseous biopsy) kumele kuhambisane nezici zezilonda kanye nokusolakala kwezokwelapha. Ngaphezu kobuchwepheshe bokuhlinzwa obufanele, isihluthulelo se-biopsy ephumelelayo sisekukhetheni indawo yesampula emele, ukuphathwa kwezicubu ze-atraumatic, kanye nokulungiswa okufanele kanye nemibhalo. Ngezinqubo ezifanele, ama-biopsies anganikeza ulwazi olunembile lwe-histopathological, okuholela ekwelashweni kwesiguli okunembile, okuphephile, nokuqondiswe kukho.
Uma ufisa, ngingaguqula lesi sihloko sibe yinguqulo yezemfundo (enezincwadi/izingcaphuno zejenali), noma ngisenze sibe wusizo kakhulu njengesiqondiso sesinyathelo ngesinyathelo sabasizi/abafundi bamazinyo.
