胃肠镜检查全知道
9个月前 (05-11)
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有种检查，大部分人都会从内心表示拒绝——胃肠镜。甚至有人说，10分钟的检查就像一年那样漫长。
但就是这样一个让无数人感到恐惧的检查，却能“救命”。
胃肠镜检查是如何拯救你的？哪些人要做胃肠镜检查？老杜为您一一解答。
人体的消化道从口腔到肛门可分为上、中、下消化道，一般来说有90%的疾病都集中在上消化道和下消化道。这些部位的病变，胃镜和肠镜是最直接、高效的检查手段。
但就是这么重要的检查，却被很多人拒绝。临床上害怕做胃镜的现象非常普遍，主要是觉得麻烦、痛苦。
拒绝内镜检查是跟自己的生命过不去。中国排名前五的肿瘤里有4个是消化系统肿瘤，包括胃癌、食道癌、大肠癌、肝癌，但由于恐惧胃镜、肠镜，大部分人基本不会主动到医院筛查。
胃镜检查我国每年尚有2300万例，而肠镜检查仅有500万例。实际上需要胃肠镜检查的人可能超过1亿人。
胃镜检查借助一根纤细、柔软的管子（光导纤维+高清摄像头），伸入胃腔、十二指肠腔，观察黏膜、拍摄或治疗。
胃肠镜检查是食管、胃、肠疾病诊断的首选手段，也是食管、胃、肠道早期癌症筛查的金标准。
早期胃癌5年生存率高达90%以上，如发展到进展期胃癌，5年生存率则低于30%。遗憾的是，我国每年新发胃癌病例占全球40%以上，早期发现的不足10%，远低于日本的70%和韩国的50%。最主要的原因是不重视胃镜检查。
肠镜又叫电子纤维结肠镜，是一支细长可弯曲的纤维软管，直径约1厘米，前端装有一个带冷光源的高清摄像头，通过肛门进入直肠，直到大肠，可让医生直观看到肠道内部情况。
肠镜检查是目前结直肠癌筛查的首选方式，也是结直肠癌诊断的“金标准”，不仅可确诊病变，还可切除癌前腺瘤性息肉等病变。
国家癌症中心2109年发布的《2015年中国恶性肿瘤流行情况分析》显示，2015年我国结直肠癌新发病例数为38.8万人，在全部恶性肿瘤中居第3位。
李兆申院士认为，我国至少1亿人需要做肠镜。
在做胃肠镜检查前，做好充分的准备工作，才能检查结果准确无误。
检查前空腹6小时以上。如果上午检查，检查前一日建议18点前进食晚餐，之后禁食，检查当日不能吃早餐、喝水。
高血压患者检查当日清晨可少量饮水送服降压药物。
停用抗凝药物（阿司匹林至少停用7天；华法林、波立维等至少停用3天；不需要取活检和镜下治疗者，可咨询医生）。
自备无色糖块或葡萄糖水，以备低血糖时纠正血糖。
检查后一般最好两小时后进餐，以软食偏温冷为好。
如果做的是无痛内镜检查，最好有人陪伴，且当天本人不能开车、骑车或从事高危工作。
检查日前一晚，检查者晚餐禁食或只吃流质食物（无渣饮食，如清汤、白糖水、蜂蜜水等）
禁食乳制品，如牛奶、椰奶、奶油浓汤等），不吃高纤维蔬菜、水果，禁吃红色或多籽的食物，如西瓜、西红柿等。
同时要服用医生开的泻药清洗肠道，服药期间要来回走动，轻揉腹部，加快排泄速度。
如当日上午肠镜检查，清晨3-5时口服洗肠液，当日早餐禁食；
如当日下午肠镜检查，前日晚可少渣饮食、当日早餐禁食，上午8-10时口服洗肠液，中午中餐禁食，无糖尿病的病友可量糖水防止低血糖。
检查前口服泻药服泻，如甘露醇、聚乙二醇电解质，口服泻药后再口服2000ml温水，以排便为清亮水样无明显粪渣为宜。
如口服全部洗肠液后2-4时内无大便解出或解半成形大便，应来医院由医生指导下再加服聚乙二醇电解质液适量或清洁灌肠。
在口服洗肠的过程中出现腹痛、呕吐、头昏、心悸等异常情况时，请暂停口服洗肠液，并来医院与医生取得联系。
术前可服用高血压药，糖尿病药物术前可停服一次。无痛检查术后注意同上。
还有一点需要记得带好以前的资料，同时医保卡和现金或者银行卡，有一些费用是检查后支付的，或者检查后医生认为您需要住院进一步诊治。
为了减轻患者的痛苦和恐惧，很多医院都推出了“无痛”胃肠镜。
“无痛”胃肠镜，是在检查前，通过静脉给予一定量的短速效镇静剂和麻醉剂，让患者在“睡眠”中完成检查。
无痛胃肠镜可以消除患者紧张、焦虑情绪，提高对检查的耐受性，检查时由于胃肠蠕动减少，便于发现微细病变。
无痛的胶囊胃镜检查，受检者只需随水吞下一粒胶囊胃镜，经过15分钟左右便可完成胃部检查。对于老人、儿童、麻醉不耐受等生理上不支持传统胃镜和麻醉胃镜的患者，是一种最佳的选择。
以场景为例，麻醉药物易使结肠张力降低，可能增加进镜难度，延长检查时间；心肺功能差、麻醉药物过敏、哮喘、严重咳嗽咳痰、肥胖、脖子粗短的病人使用麻醉剂可能增加风险。
考虑到麻醉风险，临床上通常建议，年轻力壮、心肺功能好的病人可以选择做无痛检查，身体差、年龄大的病人则不建议做无痛检查。
如果这类病人自己强烈要求做无痛，则需要麻醉师评估能否耐受麻醉风险。
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