消化内镜检查超全讲解:胃镜、结肠镜、小肠镜、超声内镜、无痛内镜、胶囊内镜

2019-03-19 佚名 胃肠病

消化内镜检查超全讲解。内镜检查都适合哪些患者?哪些患者又不适合去做?检查之前和之后有哪些注意事项?

消化内镜检查超全讲解。内镜检查都适合哪些患者?哪些患者又不适合去做?检查之前和之后有哪些注意事项?

消化系统疾病的检查方法中,内镜是最重要的手段之一,镜、肠镜、无痛内镜等。

那么,这些检查都适合哪些患者?哪些患者又不适合去做?检查之前和之后有什么注意事项吗?

今天和大家一起讨论一下这个话题!

胃镜可以观察食管、胃、十二指肠球部和降部的黏膜,以确定病变的部位及性质,并取活体组织做检查,协助诊断上消化道炎症、溃疡、肿瘤、息肉、憩室、狭窄、畸形或异物等疾病。

适应症:

1、存在上消化道症状(如烧心、吞咽困难、上腹痛、呕吐等),怀疑有食管、胃、十二指肠病变,临床需要确诊者。

2、已确诊的上消化道病变,如消化性溃疡、食管癌、胃癌等疾病治疗后需要随访或观察疗效者。

3、消化道出血,病因及部位不明者。

4、影像学检查发现上消化道病变,需要明确性质者。

5、上消化道异物者。

6、需要进行内镜下治疗者,如食管胃底静脉曲张行套扎或注射硬化剂治疗,胃早癌行内镜下黏膜剥离术(ESD)等。

7、胃癌家族史及其他胃癌高危人群。

8、存在幽门螺杆菌感染,需要明确是否有胃黏膜病变者,或者需要进行幽门螺杆菌培养及药物敏感性试验以指导治疗者。

禁忌症:

绝对禁忌:严重心肺功能不全、处于休克等危重状态者、不能合作者、内镜插入途径有严重急性炎症和内脏穿孔者。

相对禁忌:心肺功能不全,出血倾向伴血红蛋白低于50g/L,高度脊柱畸形,食管或十二指肠巨大憩室等。

(胃镜检查示意图)

检查前准备:

1、长期口服阿司匹林、氯吡格雷、华法林等抗凝药物的患者,需与相关科室医生充分沟通,在医生检查前需停药1周,防止发生消化道大出血。

2、检查前一天晚上10:00起开始禁食、禁水至次日检查时。

3、高血压患者检查当日早晨可用一小口水送服降压药物,防止检查过程中因血压过高发生不良反应。

4、糖尿病患者检查当日早晨应暂停降糖药或胰岛素。

5、吸烟的患者,检查前1天起还需戒烟,以免检查时因咳嗽影响操作,同时,禁烟还可以减少胃酸分泌,便于观察。

6、检查前需完善血常规、肝功能、凝血功能、感筛检查。

7、年纪较大的患者还需要完善胸片、心电图、超声心动图等检查,以评估患者能否耐受内镜检查。

8、检查后由于咽部麻醉作用未消失,仍需禁食、禁水2小时,2小时后可先试饮水,若无吞咽困难及呛咳,再逐渐过渡到温软食物。

9、检查后:1-2日应避免刺激性饮食。

10、若出现严重的腹痛或黑便等情况,需及时去医院就诊。

胃镜检查的并发症和风险主要包括出血、穿孔、感染、心律失常、心肌缺血、咽喉损伤、下颌关节脱臼等,但常规检查发生几率都非常低,而且可以通过充分的术前准备和谨慎操作尽量避免。

结肠镜

结肠镜可以观察包括直肠、乙状结肠、降结肠、横结肠、升结肠、盲肠至回肠末端的肠道黏膜,主要用于诊断结、直肠炎症,良恶性肿瘤,息肉,憩室等疾病。

适应症:

原因不明的下消化道出血,包括便血和持续性便潜血阳性。

存在下消化道症状,如腹痛、腹泻、便秘、腹部包块、大便习惯改变等可疑结直肠疾病。

钡剂灌肠或影像学检查发现可疑病变不能定性。

炎症性肠病做鉴别诊断或需要确定病变范围、严重程度等以及治疗后的复查。

结直肠肿瘤术后或结直肠息肉切除术后的定期随访。

禁忌症:

除胃镜检查的禁忌症外,还包括肠梗阻、中毒性巨结肠、对肠道清洁剂成分过敏等情况。

检查前准备:

同胃镜检查相似,但是高血压患者检查当日早晨降压药物照常服用。糖尿病患者检查日晨暂停降糖药或胰岛素。

检查前1天应低渣饮食(如稀饭、面条、面包、鸡蛋羹等),以提高肠道准备的清洁度,前1天晚餐后禁食(可以饮水)。

肠镜前需完善的检查同胃镜。

肠道准备:

由于过多的肠道残留物会在检查时影响医生的判断,因此肠道准备的目的在于清除肠道内容物,充分暴露肠道黏膜以便观察。

肠道清洁剂的种类方面,目前国内多用聚乙二醇电解质散、50%硫酸镁等清洁肠道。

服药后需来回走动,否则会影响清肠效果。

如有严重腹胀或不适,可放慢服用速度或暂停服用,待症状消除后再继续服用,可以观察大便性状判断肠道准备效果,若排出大便为清水样,说明肠道准备充分。

对于不能获得充分肠道清洁的患者,可以行清洁灌肠或再次进行加强的肠道准备。

(结肠镜检查示意图)

检查后:

出现轻度腹痛、腹胀为正常现象,与检查时注入空气等操作有关,无需紧张。

若出现严重的腹痛、腹胀或便血,需及时就诊。

腹痛、腹胀等症状消失后即可进食、水,尽量食用软食,如稀饭、鱼类等,避免高纤维及辛辣食物。

结肠镜检查的并发症和风险主要包括穿孔、出血、感染、心律失常、心肌缺血、操作不成功及肠道准备过程中出现的水电解质紊乱等,但也都可以通过充分的术前准备和谨慎规范的操作尽量避免。

超声内镜

顾名思义,超声内镜就是将内镜和超声结合起来的消化道检查技术。超声内镜兴起于20世纪90年代,它通过在内镜头端安装或经操作孔道放入的微型高频超声探头,在做胃镜或肠镜检查的同时,不仅对食道、胃肠道病变的层次进行观察,还可以对临近的肝脏、胆管、胰腺等器官进行超声扫查。

消化道管壁分为许多层次,普通的胃镜和肠镜检查善于观察表面黏膜层的病变,但对黏膜层以下的病变以及胃肠道外邻近脏器的病变就束手无策了。此时应用超声内镜,便可一览无余,病变再无藏身之地。

适应证:

1、确定消化道粘膜下肿瘤的起源与性质

2、判断消化系肿瘤的侵犯深度并判断有无淋巴结转移

3、判断外科手术切除的可能性

4、胆囊及胆总管中下段良恶性病变

5、胰腺良恶性病变

6、十二指肠壶腹部肿瘤的鉴别诊断

7、显示纵隔病变

8、判断食管静脉曲张程度与栓塞治疗的效果

禁忌证:

1、患者不合作

2、怀疑有消化道穿孔

3、急性憩室炎

4、暴发性结肠炎

5、心肺功能障碍者

无痛内镜

无痛内镜就是在常规检查前,即患者摆好体位,放置口垫后,给予吸氧,由专职麻醉师静脉注射异丙酚(短效镇静剂)30 秒后使患者进入睡眠状态,然后开始进镜检查;退镜时即停止给药,操作结束后患者即刻完全清醒,恢复到检查或治疗前的状态。

适应症、检查前准备等:

基本同于普通胃镜和肠镜检查。

禁忌症:

患有严重呼吸系统疾病如急性呼吸道感染、肺炎、慢性阻塞性肺气肿和哮喘的急性发作期、阻塞型睡眠呼吸暂停综合征者,本身就存在低氧血症,不宜做无痛内镜;

张口障碍、颈项或下颌活动受限、矮胖体型者会影响呼吸道的开放,也不宜做无痛内镜;

非呼吸系统疾病如心力衰竭、心肌梗死、中风、昏迷、肝肾衰竭、严重贫血、重症肌无力以及高龄衰弱等一般情况太差者,不宜做无痛内镜;

消化系统疾病如食管、贲门、幽门和肠梗阻、呕吐或呕血者存在潴留液反流误吸风险,应先进行胃肠减压(就是插胃管)等预处理,排出潴留液后才能进行无痛内镜;

对多种药物过敏的过敏体质者不宜无痛内镜。

孕妇不宜做无痛内镜。

检查前后注意事项:

1. 检查前一天避免吸烟,以免检查时因咳嗽影响检查。

2. 要有成人亲友陪伴,术前取下假牙。

3. 检查前一天晚饭后不应再吃东西,检查当天早晨不应再喝水。

4. 告知医生您的既往病史及药物过敏史。

5. 检查后3小时内需有人陪护。

6. 检查后8小时内禁食辛辣食物,不能饮酒。

7. 检查后8小时内不得驾驶机动车辆、进行机械操作和从事高空作业,以防意外。

8. 镜下治疗的,要留院观察或遵医嘱。

小肠镜

肠道准备和检查前后注意事项,基本同于结肠镜检查。

适应证:

1、有腹泻、腹痛、贫血、腹部包块、恶心、呕吐等症状而原因不明者。

2、原因不明的消化道出血及原因不明的贫血。

3、影像学检查如钡剂造影或其它检查不能确定肠道病变性质者。

4、已确诊的肠道病变如炎症性肠病、大肠息肉病、肠结核等需定期随访复查者。

5、有消化道息肉等家族史,需要进行小肠镜检查者。

6、有其它系统疾病或临床其它发现,需要小肠镜检查进行辅助诊断者。

禁忌证:

1、消化道穿孔、严重肠炎等有出血、穿孔高度危险性者

2、肠梗阻者不得经口准备和检查者

3、严重心、肺、肾、肝及精神病患者,高血压未得到有效控制者

4、其他上消化道内镜检查禁忌者

胶囊内镜

胶囊内镜检查是指患者口服智能胶囊,借助消化道蠕动使之在消化道内运动、拍摄图像,从而了解受检者的消化道情况,对其病情做出诊断。

适应症:

包括不明原因消化道出血、不明原因缺铁性贫血、疑似小肠肿瘤、疑似或难以控制的吸收不良综合征、检测非甾体类消炎药相关性小肠黏膜损伤,及临床上需要排除小肠疾病者,还可用于监测并指导克罗恩病的治疗及小肠息肉病综合征的发展。

禁忌症:

绝对禁忌证:无手术条件或拒绝接受任何腹部手术者(一旦胶囊滞留将通过手术取出)。

相对禁忌证:已知或怀疑胃肠道梗阻、狭窄及痿管;心脏起搏器或其他电子仪器植入者;吞咽障碍者;孕妇。

术前准备:

检查前需禁食10-12小时,检查前晚行肠道清洁准备(同结肠镜准备),以提高图像的清晰度;

术前半小时可服用适量祛泡剂,以减少泡沫对视野的影响。

在服用胶囊2小时后可饮清水,4小时后可以进少许清淡食物。在胶囊电池耗尽时或胶囊经回盲瓣进入结肠后结束检查。

胶囊内镜检查的并发症包括胶囊滞留、误吸入气道等。

胶囊内镜检查后胶囊停留于胃肠道2周以上则定义为胶囊滞留,应及时就诊,通过外科手术或气囊辅助式小肠镜予以取出。

至于患者是否该做内镜检查?是否能做内镜检查?做何种检查?

需要根据患者的具体情况,由专科医生判断,做好充分准备,才能保障患者的安全和检查的质量,最后祝您胃肠道长治久安!

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#插入话题
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  2. [GetPortalCommentsPageByObjectIdResponse(id=1262068, encodeId=25b9126206883, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c30265, createdName=jiafufeng@yaho, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1323211, encodeId=30191323211fb, content=<a href='/topic/show?id=b2d765e33c2' target=_blank style='color:#2F92EE;'>#消化内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65733, encryptionId=b2d765e33c2, topicName=消化内镜)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Jr8S1dfvNyP22t32IFDXJXnpd5AGlDibiajL5cl3pxj7OPCeAeibLhzOmZn5Q2Oicc6uKOCnxGNOggdLtI3hIW7huQ/132, createdBy=66e52500008, createdName=Tamikia, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1434478, encodeId=981e14344e818, content=<a href='/topic/show?id=95de81e4889' target=_blank style='color:#2F92EE;'>#肠镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81748, encryptionId=95de81e4889, topicName=肠镜)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578960, encodeId=e47215e89608b, content=<a href='/topic/show?id=f67c84046a9' target=_blank style='color:#2F92EE;'>#胶囊内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84046, encryptionId=f67c84046a9, topicName=胶囊内镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d72b16466570, createdName=124986d2m14暂无昵称, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1625424, encodeId=19e716254248b, content=<a href='/topic/show?id=12a04e1295a' target=_blank style='color:#2F92EE;'>#小肠镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47129, encryptionId=12a04e1295a, topicName=小肠镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=008420763570, createdName=chenwq15, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=363188, encodeId=c9a23631883e, content=收藏了谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Tue Mar 19 10:05:15 CST 2019, time=2019-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=363172, encodeId=bdbe3631e275, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6d551998554, createdName=1e1c07bdm01(暂无匿称), createdTime=Tue Mar 19 06:32:38 CST 2019, time=2019-03-19, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1262068, encodeId=25b9126206883, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c30265, createdName=jiafufeng@yaho, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1323211, encodeId=30191323211fb, content=<a href='/topic/show?id=b2d765e33c2' target=_blank style='color:#2F92EE;'>#消化内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65733, encryptionId=b2d765e33c2, topicName=消化内镜)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Jr8S1dfvNyP22t32IFDXJXnpd5AGlDibiajL5cl3pxj7OPCeAeibLhzOmZn5Q2Oicc6uKOCnxGNOggdLtI3hIW7huQ/132, createdBy=66e52500008, createdName=Tamikia, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1434478, encodeId=981e14344e818, content=<a href='/topic/show?id=95de81e4889' target=_blank style='color:#2F92EE;'>#肠镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81748, encryptionId=95de81e4889, topicName=肠镜)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578960, encodeId=e47215e89608b, content=<a href='/topic/show?id=f67c84046a9' target=_blank style='color:#2F92EE;'>#胶囊内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84046, encryptionId=f67c84046a9, topicName=胶囊内镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d72b16466570, createdName=124986d2m14暂无昵称, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1625424, encodeId=19e716254248b, content=<a href='/topic/show?id=12a04e1295a' target=_blank style='color:#2F92EE;'>#小肠镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47129, encryptionId=12a04e1295a, topicName=小肠镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=008420763570, createdName=chenwq15, createdTime=Wed Mar 20 17:02:00 CST 2019, time=2019-03-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=363188, encodeId=c9a23631883e, content=收藏了谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160718/IMG578C993D395567540.jpg, createdBy=59b81918946, createdName=flysky120, createdTime=Tue Mar 19 10:05:15 CST 2019, time=2019-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=363172, encodeId=bdbe3631e275, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6d551998554, createdName=1e1c07bdm01(暂无匿称), createdTime=Tue Mar 19 06:32:38 CST 2019, time=2019-03-19, status=1, ipAttribution=)]
    2019-03-20 zhouqu_8
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    2019-03-19 flysky120

    收藏了谢谢

    0

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