胃肠镜检查全知道

9个月前 (05-11) 0 点赞 0 收藏 0 评论 131 已阅读

胃肠镜检查全科普

有种检查,大部分人都会从内心表示拒绝——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。

Part 1
胃肠镜检查有多重要?

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。

胃肠镜检查全科普

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。

0
1
 胃镜

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。

0
2
  肠镜

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。

Part 2
高危人群 请自觉检查
1
有下列情况的需到医院做胃肠镜检查:
  • 上腹疼痛伴有恶心、呕吐等。

  • 原因不明的消瘦、贫血、出现黑便或柏油样便。

  • X线钡餐造影或CT、B超检查怀疑胃、食管、十二指肠形态改变或局部增厚等改变时。

  • 既往患有溃疡病、胃息肉、萎缩性胃炎等病变的患者。

  • 结直肠癌术后患者,结直肠腺癌、腺瘤样增生的患者治疗后定期复查1~2年一次。

  • 家庭有结直肠癌病史、息肉病史的人2~3年一次。

  • 45~50岁以上健康人群定期3~5年筛查一次。

2
有些人不适合做胃肠镜检查
  • 严重肝肾肺功能障碍者

  • 严重冠心病及心肌损伤伴严重心肌功能不全者(室颤等)

  • 肺炎或其他感染伴有高热的人

  • 严重神经系统疾病患者(惊厥、癫痫未控制者、精神疾病)

  • 主动脉瘤患者

  • 经期女性

  • 孕妇

Part 3
检查之前 你该做的那些事儿

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。

胃肠镜检查全知道
胃镜

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。

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。

胃肠镜检查全知道
肠镜

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。

Part 4
无痛胃肠镜 做之前要评估

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。

优点

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。

缺点

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。

建议

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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