Колоноскопия – это один из современных диагностических и высокоинформативных методов, позволяющих проводить диагностику заболеваний ЖКТ на ранних стадиях развития.
Симптомы некоторых заболеваний желудочно-кишечного тракта очень похожи. Поэтому у специалистов возникают затруднения при диагностике. Пациентам с жалобами на проблемы с кишечником делают колоноскопию. Она помогает определить причину заболевания и назначить лечение. Врач-диагност проводит визуальный осмотр слизистой оболочки прямой, ободочной, подвздошной кишки, чтобы оценить их состояние и выявить патологические изменения.
Исследование проводится в специально оборудованном кабинете с помощью новейшего аппарата – колоноскопа.
Кому назначается обследование?
Процедура проводится при:
- наличии в кале слизи и крови,
- хронических поносах и запорах,
- субфебрилитете (повышении температуры на протяжении длительного периода) неясной этиологии,
- кровотечении из стенок кишки,
- кишечной непроходимости,
- похудании, анемии,
- ощущении инородного тела в прямой кишке,
- болезни Крона, язвенном колите,
- подозрениях на опухоли,
Фиброколоноскопия при полипах кишечника позволяет выполнить их удаление. Статистика свидетельствует, что при профилактических осмотрах полипы выявляются примерно у 4% пациентов. При подозрении на злокачественные новообразования колопрактологи в процессе осмотра делают забор ткани на биопсию. Во время исследования также можно устранить заворот кишечника.
Лица пожилого возраста на 3-5% чаще болеют раком кишки, чем молодые. Проверять состояние кишечника для профилактики необходимо всем людям старше 50 лет.
Колоноскопия у детей
Проверка прямой кишки может потребоваться и ребенку. Процедура отличается по нескольким параметрам и должна проходить строго в детском отделении больницы.
Основные отличия, которыми обладает колоноскопия кишечника у детей:
- Размеры зондов. Специально подбираются уменьшенные модели, которые не повредят слизистую оболочку. Они должны соответствовать особенностям детской анатомии.
- Несмотря на детский возраст пациента, ему также нужно принимать солевой раствор для очищения кишечника. Но, наряду с этим средством, применяются и другие слабительные, так как большое количество раствора детям противопоказано. Конкретное вещество подбирается лечащим врачом.
- Обследовать ребенка нужно обязательно под наркозом, иначе колоноскопия не даст результатов. Маленькие дети вырываются из-за болевых ощущений, что не позволяет полноценно осмотреть слизистую. Наркоз делается слабый, что позволяет избежать системных побочных эффектов.
- Необходима тщательная психологическая подготовка. Родителям важно показывать маленькому пациенту, что ничего страшного в процедуре нет, объяснять пользу исследования и зачем его назначили.
- В период диетического питания малышу можно давать детское пюре, так как оно не приводит к образованию газов.
- Проверяют детей в основном в больницах, с предшествующей госпитализацией на 3-7 дней. Это необходимо для помощи родителям, которые часто из жалости к ребенку делают послабления в специальном рационе питания. Детская проктология в государственных учреждениях остается на высоком уровне, поэтому опасаться снижения качества обследования не стоит.
В отличие от взрослой практики, где части пациентов старше 50 лет рекомендуют проходить процедуру в качестве скрининговой, в детской педиатрии от исследования стараются максимально отказаться. Используют неинвазивные методы, например, капсульную колоноскопию, позволяющую обследовать тонкую и сигмовидную кишку без введения датчиков, за счет проглатывания небольшой капсулы. Они позволяют выявлять отклонения ЖКТ почти без боли.
Противопоказания
Несмотря на то, что только эндоскопическое исследование даёт возможность точно оценить состояние слизистой оболочки, имеются ограничения для назначения ВКС.
Абсолютно противопоказана колоноскопия кишечника при:
- остром инфаркте,
- инсульте,
- перфорации кишечника,
- перитоните,
- молниеносной форме колита,
- тяжёлом общем состоянии пациента,
- гипертонической болезни 2 и 3 стадии,
- нарушениях сердечного ритма,
- аневризме аорты,
- выраженной лёгочно-сердечной недостаточности,
- спаечной болезни брюшной полости,
- атеросклерозе,
- язвенном колите в фазе обострения.
Процедура может негативно повлиять на состояние больного. После осмотра специалист соотнесёт риск пользы и вреда. Пациентам с искусственными клапанами сердца проводить такое исследование можно только после курса антибиотикотерапии.
ФКС лучше перенести при скоплении крови в кишечной полости и недостаточной подготовке кишечника. Какие заболевания позволяет выявить фиброколоноскопия Некоторые болезни желудочно-кишечного тракта имеют сходные симптомы, но отличаются причинами развития. Чтобы поставить диагноз и назначить лечение врач должен проверить состояние кишечника. Фиброколоноскопия с помощью специальной аппаратуры позволяет видеть кишку изнутри и оценить дефекты слизистой оболочки: трещины, опухоли, воспалённые участки, язвы.
Рентгеновский метод исследования не даёт таких точных результатов. Специалисты считают ФКС — самым современным и точным методом диагностики, позволяющим распознавать злокачественные и доброкачественные новообразования, неспецифический язвенный колит, полипы, опухоли, болезнь Крона, врождённые аномалии развития толстой кишки. Такое обследование даёт достаточно информации о тонусе кишечника и способности к сокращению. Немаловажно и то, что во время процедуры колопроктолог может взять ткани для биопсии или удалить полипы.
Чем проводят?
Современный колоноскоп – это новый уровень в диагностике желудочно-кишечного тракта. Прибор состоит из гибкого оптоволоконного кабеля, снабжённого подвижной оптической головкой. Он размещается в специальной оболочке. Там же находятся трубка для подачи воздуха, тросики для управления и кабель подсветки. Не беспокойтесь. В приборе используется холодный источник света. Во время манипуляции полностью исключается ожог слизистой оболочки. Все детали колоноскопа соответствуют гигиеническим нормам и стандартам.
Как происходит процедура
Чтобы хорошо рассматривалась слизистая оболочка, пациент соблюдает трёхдневную безшлаковую диету и накануне осмотра проводит очищение. Врач назначает специальные препараты для подготовки к эндоскопическим исследованиям.
Обследуемый человек укладывается на левый бок и сгибает ноги в коленях.
Это действие вызывает чувство распирания и лёгкой боли. Лучший совет — расслабьтесь и дышите животом. Так Вы справитесь с дискомфортом.
На мониторе врач видит стенки кишечника. Прибор позволяет разглядеть даже самые мелкие изменения в тканях. Он продвигает аппарат и фотографирует участки с патологическими изменениями.
В специальном канале эндоскопа имеются манипуляторы для забора тканей и удаления полипов. Шейка полипа захватывается петлёй и срезается. Кровоточащий участок коагулируют (прижигают) лазером или термозондом. После операции может слегка повыситься температура и появиться боль в животе.
После того как проверка завершена, воздух из кишечного тракта выкачивается через специальную трубку. Небольшое вздутие живота проходит спустя несколько часов. Манипуляции длятся 15-30 минут. После процедуры обследуемый человек отправляется домой.
В некоторых случаях перед ВКС назначают рентгенологическое исследование толстой кишки (ирригоскопия). Оно помогает выявить сужения и пороки развития в нисходящем толстом отделе кишечника. Видеоколоноскопия – безопасная процедура, осложнения случаются менее чем в 1% случаев. Кровотечение, возникающее после удаления полипов, быстро останавливается. Более серьёзные проблемы (разрывы и отверстия в исследуемых тканях) встречаются редко.
- сильная боль в животе;
- рвота;
- повышенная температура;
- кровотечение;
- вздутие живота.
Виды анестезии
Исследование проводится под анестезией. Вид обезболивания подбирается под индивидуальные особенности пациента:
- возраст;
- болевой порог;
- психологическое состояние;
- состояние сердечно-сосудистой системы (полный наркоз противопоказан пациентам с сердечной недостаточностью).
Чтобы подобрать нужный вариант анестезии, понадобится консультация врача. Наиболее популярен так называемый «сон». Пациента погружают в полусонное состояние при помощи снотворных средств. Все болевые ощущения притупляются, но при этом отсутствует нагрузка на сердце.
Вариант с общим наркозом используется реже. Он дороже, опасен для сердца, требует восстановительного периода 2-5 часов после завершения процедуры.
Ощущения пациента
При стандартной процедуре наконечник колоноскопа обрабатывается мазью с местноанестезирующеим действием. Процесс введения трубки проходит безболезненно. Не нужно переживать, что при отсекании ткани для биопсии или при удалении полипа возникнет сильная боль. Через канал эндоскопа перед операцией вводятся анестетики. Некоторые пациенты жалуются на боль, которая возникает из-за растяжения кишки при нагнетании воздуха. Болевые ощущения описываются, как средние и ярко выраженные. Они быстро проходят.
О боли при передвижении трубки тоже отзываются по-разному. Для одних она вполне терпимая, другие просят немедленно прекратить обследование. Такие разные отзывы обусловлены различным болевым порогом и врожденными особенностями строения ЖКТ.
Многих интересуют способы избежания боли.
Рекомендации после колоноскопии
Кишечник должен восстановиться после процедуры. Некоторое время после обследования пациент может страдать от болей в нижней части живота, метеоризма и нарушений стула. Особенно часто такие ощущения возникают в результате ректосигмоколоноскопии, то есть тотального осмотра всей области толстой кишки. Чтобы снизить вероятность неприятных последствий, рекомендуется придерживаться следующих правил:
- Питаться согласно диете, назначенной при подготовке к процедуре. Из рациона в течение 3-х дней после вмешательства удаляются макаронные и цельнозерновые изделия, необработанные овощи, газированные напитки. Вместо них следует употреблять легкие супы, отварное мясо и парные овощи. В противном случае кишечник из-за высокой нагрузки и раздраженного состояния слизистой оболочки будет дольше болеть.
- При развитии дискомфорта принимать симптоматические препараты. Их должен назначить врач. Допускается прием анальгетиков, а также энтеросорбентов. Самым распространенным энтеросорбентом является активированный уголь. При болевых ощущениях употребляют сразу 5-6 таблеток.
Тянущие боли могут длиться около 3-х суток. Если дискомфорт сохраняется дольше, есть повод обратиться к врачу. Причиной для повторного посещения специалиста являются следующие отклонения:
- кровяные выделения из анального отверстия;
- болевые ощущения, которые сохраняются более 7-ми дней;
- нарушения дыхания;
- жар, который не спадает в течение как минимум 2-х дней.
Все эти симптомы могут свидетельствовать о занесенной на слизистую оболочку инфекции. Чтобы справиться с заболеванием и его симптомами, нужно сдать мазок или пройти другое обследование, назначенное медицинским работником.
Стоимость процедур
Сделать колоноскопию дешевле можно в регионах РФ, но и качество оборудования там хуже. Наиболее высокие цены – в Москве и Санкт-Петербурге. Ниже будут рассматриваться расценки на примере Москвы.
Сколько стоит колоноскопия кишечника (ознакомительный прайс-лист взят в компании «СМ-Клиника»):
- колоноскопия с наркозом – 7350 рублей;
- стандартная процедура – 5250 рублей;
- дополнительная услуга видеоректоскопии – плюс 1900 рублей к базовой цене.
Сколько стоит колоноскопия, зависит не только от клиники, но и от дополнительных параметров и вида процедуры. Если, согласно показаниям, необходимо делать биопсию, взятие одного материала обойдется в 1050 рублей. Стоимость дополнительной внутривенной анестезии, которая может понадобиться чувствительным пациентам, составляет 2100 рублей. Цену определяют также в зависимости от категории пациента: некоторые медцентры предлагают скидки пенсионерам.
Услугу можно пройти не только платно, но и на безвозмездной основе в государственном учреждении, в диагностическом отделе больницы.
Альтернативы
Каждый из этих способов по-своему эффективен. Но в большинстве случаев не может заменить традиционной фиброколоноскопи. Поэтому лучше немного потерпеть боль и проверить кишечник методом ФКС.
4 минуты Автор: Любовь Добрецова 10490
В медицинской практике существует два схожих термина «колоноскопия» и «фиброколоноскопия». Они являются синонимами,обозначают обследование, которое проводит чаще всего врач-проктолог или же эндоскопист, но существует некая разница, в связи с которой их нельзя назвать идентичными вовсе. Но для того чтобы понять, в чем отличия фиброколоноскопии и колоноскопии, необходимо понимать суть этих методов исследования толстого кишечника.
Колоноскопия
Колоноскопия представляет собой метод визуализации толстого кишечника для оценки ее состояния. Для ее проведения используют зонд, достаточно гибкий и оснащенный подсветкой, небольшого размера видеокамерой, окуляром, трубками, необходимыми для подачи воздуха, и щипцами для забора тканей на исследование – это колоноскоп. Длина такого устройства около 160 см, что в сочетании с его гибкостью позволяет легко обследовать кишечник с учетом его анатомических изгибов.
Однако процедура не безболезненная, поэтому для проведения такой манипуляции требуется использовать местную анестезию, для чего берут разнообразные гели или мази, например, дикаиновую мазь. Ею обрабатывают прибор перед началом обследования. Подготовка к процедуре со стороны пациента представляет собой очищение кишечника.
Для этого за 3-4 дня до назначенной процедуры человеку необходимо посидеть на специальной диете, при этом за сутки до процедуры и в день ее выполнения вместо диеты назначают полную голодовку. Также используются слабительные препараты, вроде Эндофалька.
Поскольку толстый кишечник является конечной частью пищеварительного тракта человека, то врач, проводящий процедуру, заносит в протокол все данные со всех участков толстой кишки. Только так он может получить полноценную картину о состоянии кишечника.
По мере прохождения от прямой кишки к ободочной и к начальному отделу толстого кишечника – слепой кишке, специалист фиксирует:
- оттенок и наличие блеска слизистых оболочек;
- какова поверхность слизистой и её сосудистый рисунок;
- какие есть наложения слизистой.
Помимо письменных пометок, специалист может делать снимки некоторых участков толстой кишки, чтобы акцентировать внимания на их патологии. Длительность всего процесса обычно не превышает получаса.
Показания и противопоказания
Назначить колоноскопию могут как с диагностической, так и с терапевтической целью. Среди показаний к процедуре:
- болезненность в толстом кишечнике в определенном месте или без конкретной локализации;
- нарушения стула (диарея, запоры);
- подозрения на наличие болезни Крона;
- неспецифический язвенный колит;
- патологическое отделяемое из кишечника, вроде крови, слизи или гноя;
- внезапное похудение пациента, внезапно развившаяся анемия;
- инородное тело в толстой кишке;
- необходимость остановки кровотечения в толстой кишке;
- необходимость удаления полипа или опухоли;
- необходимость восстановления проходимости кишки при стенозе;
- необходимость забора биоптата для исследования в гистологической лаборатории.
Существует и ряд противопоказаний к осуществлению этой манипуляции, их необходимо разделить на абсолютные и относительные. В число абсолютных входят шок любой этиологии, острый инфаркт миокарда, перитонит и ишемической колит, протекающий в молниеносной форме. В свою очередь к относительным противопоказаниям относятся кишечные кровотечения, частые хирургические вмешательства в области таза, наличие больших грыж, сердечная или легочная недостаточность.
Фиброколоноскопия
Фиброколоноскопиятакже представляет собой исследование толстого кишечника, для которого используют фиброколоноскоп. В наборе с самим прибором присутствуют разного назначения щипцы для забора материала, щетки для чистки, клапаны для цилиндров и окуляры для того, чтобы визуализировать вид кишечника по мере проведения процедуры. Длина прибора может варьироваться в зависимости от того, какой отдел кишечника необходимо исследовать.
В чем разница?
В первую очередь разница между фиброколоноскопией и колоноскопией в том, что первая процедура является более современной и чаще используется в настоящее время. В отличие от колоноскопа, фиброколоноскоп имеет более сложное строение. Колоноскоп представляет собой простую резиновую трубку, а фиброколоноскоп создают с помощью сверхпрочного оптического волокна.
Помимо этого, колоноскоп достаточно толстый и менее гибкий. Следовательно, если процедура проводится современным прибором, пациент ощущает меньший дискомфорт, чем при использовании классического аппарата. Исключая особенности строения устройств, используемых для колоноскопии и фиброколоноскопии, иных отличий в этих методах диагностики нет. Они оба достаточно информативны и удобны для медицинских сотрудников в момент проведения обследования.
В клинической проктологии существует два определения процедуры — фиброколоноскопия и колоноскопия. Оба термина являются синонимами, однако существует некая разница, определяющая результаты исследования в соответствии с его целью. Многие клиницисты разделяют оба понятия, разграничивая их функциональное предназначение, несмотря на общую схожую суть. В чём же разница и каковы отличительные критерии для проведения исследования?
Фиброколоноскопия (ФКС), что это такое?
Фиброколоноскопия (иначе, нижняя эндоскопия) — метод диагностического исследования, при котором существует возможность оценить состояние кишечных отделов. Относится к типу эндоскопических исследований с погружением оптического зонда внутрь полостей изучаемых органов.
Перед осмотром в полость кишечника нагнетается воздушная атмосфера для улучшения общей визуализации, после в ректальный канал вводят зонд и проводят тщательный осмотр всех сегментов кишечника.
Фиброколоноскопия позволяет выявить следующие состояния:
- Воспаление и отёчность слизистых;
- Покраснение:
- Нарушение перистальтики;
- Очаги кровоподтёков, кровоточивости;
- Патологические новообразования: опухоли, наросты, полипозные структуры;
- Эрозии, язвенные очаги;
- Инородные тела и предметы.
Во время процедуры изображение передаётся на монитор компьютера. Специалисты с большой долей вероятности могут выполнять любые манипуляции без рисков осложнений.
Во время исследования врач оценивает:
- состояние слизистых;
- анатомическое соответствие отделов кишечника;
- сосудистый рисунок слизистых оболочек, их цвет и блеск;
- наличие застойных явлений;
- отложений застарелых каловых масс.
Процедура проводится при помощи фиброколоноскопа, оснащённого специальными биопсийными щипцами. Во время исследования врач имеет возможность удалить полипы и опухоли без следов малигнизации, метастазирования по раковому типу.
Особенности проведения
Особенных отличий в проведении процедуры ФКС не существует. Перед исследованием, так же как и перед колоноскопией, необходима подготовка. Это может быть очищение кишечника перед колоноскопией фортрансом или другим препаратом. Кроме того, пациенты соблюдают специальную трёхдневную диету, накануне обязательно делают очистительную клизму. Манипуляция производится натощак, что важно и при необходимости введения анестезии.
Во время процедуры в кабинете находятся:
- врач-эндоскопист,
- медсестра,
- анестезиолог (при необходимости).
После нагнетания воздуха в кишечные просветы, врач обрабатывает антисептиком анальное отверстие, вводит наконечник фиброколоноскопа и приступает к обследованию.
После процедуры с наркозом пациента переводят в палату для отхождения ото сна. После местного обезболивания можно возвращаться к привычной жизни. Общая продолжительность процедуры зависит от цели исследования. Профилактический осмотр длится не более 10 минут.
Во время исследования врач имеет возможность удалить полипы и опухоли без следов малигнизации, метастазирования по раковому типу.
При необходимости удаления полипов или биопсии продолжительность манипуляции может достигать 40 минут. Заключение врачи готовят 1-2 дня, после чего врач может ознакомиться с полученными результатами.
ФКС и колоноскопия — основные отличия
Суть проведения любой эндоскопической манипуляции идентична — введение оборудования внутрь полости исследуемого органа для лечебно-диагностических целей. В процессе исследования изображение передаётся на монитор компьютера, поэтому врачи могут пересматривать полученные фрагменты для подтверждения результатов описания. Во время процедуры делают видео- и фотосъёмку.
Основными неспецифическими отличиями между колоноскопией и ФКС заключаются в следующих аспектах:
- Оборудование и приборы. Современные медицинские приборы с приставкой «фибро» оснащены дополнительным инструментарием для одновременного удаления полипов и инородных тел, прижигания источников кровотечения, а также специальными биопсийными щипцами для забора биоптата на гистологическое и цитологическое исследование. Все процедуры разделяют на диагностические или лечебные, что оправдано целью изучения кишечных отделов.
- Меньший дискомфорт. Фиброколоноскоп имеет более тонкий зонд высокой гибкости. Это позволяет практически безболезненно провести манипулятивные исследования. Обычно при ФКС достаточно местной анестезии. Классическая колоноскопия — болезненная процедура, которая тяжело переносится пациентами без более серьёзной анестезии. Что такое колоноскопия с седацией читайте в этой статье. Сложное строение фиброколоноскопа облегчает работу медиков во время процедуры, что снижает любой дискомфорт.
- Характер исследования. Фиброколоноскоп работает на ксеноновой и галогеновой лампе, что полностью исключает риски ожога слизистой во время манипуляции.
- Стоимость процедуры. При профилактическом исследовании стоимость на обе процедуры варьирует от 6000 до 10000 рублей. При необходимости анестезии цена повышается в среднем на 3000-5000 рублей. Фиброколоноскопия с необходимостью биопсии, хирургических манипуляций и других лечебных процедур возрастает на 5000 рублей. Таким образом, лечебная ФКС несколько дороже классического диагностического исследования.
И колоноскоп, и фиброколоноскоп имеют оптическое оснащение, зонд, пути для хирургического инструментария. Оба метода высоко информативны, позволяют проводить достоверную оценку состояния слизистых всех отделов кишечника. Другими словами, фиброколоноскопы – усовершенствованные и современные колоноскопы.
Основные показания к ФКС
Для проведения манипуляции необходимы данные клинического анамнеза пациента, характерные жалобы, результаты пальпации и ректального осмотра. По совокупности диагностических критериев назначают фиброколоноскопию.
Основными показаниями считаются:
- Геморроидальная болезнь с осложнениями;
- Образование полипов, опухолей и внутри кишечных кондилом;
- Отягощённый наследственный анамнез по поводу онкологии кишечника;
- Подозрение на язвенный колит, воспаление слизистых кишечника;
- Нетипичные выделения при испражнениях (кровь, слизь, гной);
- Внутрикишечные кровотечения (явная или скрытая кровь в кале).
Фиброколоноскопы – усовершенствованные и современные колоноскопы.
ФКС даст однозначный ответ о характере новообразования. При помощи щипцов можно забрать ткани на гистологию для определения атипичных клеток. Биопсия позволяет оценить степень онкологических рисков для каждого пациента.
Противопоказания к процедуре
Несмотря на высокую информативность фиброколоноскопии и колоноскопии, методы не могут применять при наличии некоторых состояний и заболеваний.
При этом, противопоказания к обоим способам исследования одинаковы:
- Обострения кишечных заболеваний;
- Подозрение на кишечную непроходимость;
- Невозможность применения обезболивания у детей раннего возраста;
- Острые инфекционные заболевания любого генеза;
- Грыжи, брыжейки, перфораторные изменения слизистых оболочек:
- Спаечные процессы;
- Некоторые психические расстройства, не позволяющие применять наркоз;
- Резкое сужение просветов кишечника любой природы (приобретённое, постоперационное, врождённое).
При невозможности проведения ФКС и других эндоскопических методов исследования врачи могут прибегнуть к неинвазивным методам исследования:
- Виртуальная колоноскопия (как проводится виртуальная колоноскопия, мы писали в отдельной статье).
- МРТ. Информация о том, что лучше МРТ или колоноскопия вот здесь.
- Компьютерная томография.
- Капсульная колоноскопия, что это такое читайте тут.
Однако, многие клиницисты рекомендуют подождать благоприятного периода для проведения традиционных эндоскопических манипуляций.
Дополнительная информация об особенностях исследования ФКС в этом видео:
Фиброколоноскопия и колоноскопия имеют схожий механизм воздействия, противопоказания и показания. Специфические преимущества ФКС заключаются в новизне оборудования и расширенных возможностях обследования. Метод широко используется для исключения онкологических рисков, благодаря возможности забора тканей на гистологию.
Можно делать колоноскопию при геморрое читайте в нашей статье здесь.
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