Добрый день! Спасибо, что настолько тщательно описали проблему которая Вас интересует. Удаление полипов — это абсолютно плановая ситуация, которая не требует срочной госпитализации, но их обязательно нужно удалять, ведь со временем у них есть свойство перерастать в онкологическое заболевание. Действия Ваши следующие: Вам нужно найти хороший стационар который обладает высокоспециализированной эндоскопической службой, записаться на консультацию, прийти с данными колоноскопии и определится когда их будете удалять. Будьте внимательны к своему здоровью и не откладывайте в долгий ящик это решение. Удачи!
а) Полипы (одиночные и групповые): железистые полипы (аденомы); гиперпластические полипы; железисто‑ворсинчатые полипы.
б) Ворсинчатые опухоли.
в) Диффузный полипоз: семейный полипоз; ювенильный полипоз; синдром Пейтца‑Джегерса; синдром Тюрко; синдром Гарднера; синдром Вермера; синдром Кронкайта‑Кэнэдэ.
г) Воспалительные псевдополипы: воспалительный полип; поствоспалительный полип (фиброзный).
2) Неэпителиальные доброкачественные опухоли.
г) Доброкачественная лимфома.
Клиническая картина и данные объективного исследования одиночных и групповых полипов толстой кишки
У большинства пациентов доброкачественные новообразования толстой кишки протекают бессимптомно и не имеют каких‑либо специфических признаков. Возможно наличие жалоб на кишечный дискомфорт. По мере роста опухолевидных образований появляются патологические выделения из прямой кишки при дефекации в виде слизи и крови. В начале заболевания кровянистые выделения незначительные. Далее, в связи с изъязвлением полипов и их постоянной травматизацией плотными каловыми массами, кровотечения становятся более обильными. Вероятно, именно с этим связано, что кровотечения чаще наблюдаются при локализации полипов в левом фланге толстой кишки. Даже незначительная кровопотеря с течением времени может привести к анемии, головокружениям, общей слабости. При значительных размерах полипов (2–3 см) могут появляться признаки нарушения пассажа по кишечнику в виде поносов и запоров, а чаще их чередования. Другие жалобы: боли, тошнота, отрыжка, отсутствие аппетита встречаются значительно реже. В связи с отсутствием характерных клинических признаков выявление полипов на ранних стадиях заболевания представляет собой сложную задачу и возможно только при целенаправленном обследовании.
Клиническая картина и данные объективного исследования диффузного полипоза толстой кишки
Выраженность клинических проявлений при диффузном полипозе зависит от количества, размеров и локализации полипов. В клинической картине выделяют 3 периода заболевания: 1) бессимптомный период; 2) период начальных признаков; 3) период выраженных клинических проявлений. Выявление заболевания в первом периоде возможно лишь при использовании рентгенологического или эндоскопического методов. Как правило, первые признаки заболевания появляются в 16–18 лет. Пациенты предъявляют жалобы на ощущение тяжести в животе, неустойчивый стул, урчание, появление слизи и прожилок крови в кале. Обильные выделения крови и слизи при дефекации, частый неустойчивый стул малыми порциями, вздутие живота, тенезмы, боли в нижних отделах живота – основные признаки перехода заболевания в период выраженных клинических проявлений. Частый, до 15–20 раз в сутки, стул, хроническая кровопотеря, боли в животе – быстро приводят к ухудшению общего состояния. Развивается анемия, нарастает интоксикация, присоединяются нарушения электролитного и белкового обменов – все это приводит к астенизации больного. На этом фоне у детей отмечается отставание в психическом и физическом развитии, у взрослых развивается неврастенический синдром. В анализах крови выявляется анемия, гипопротеинемия, снижение уровня сывороточного железа, признаки гипокоагуляции.
В клинической практике принято выделять две группы пациентов с диффузным полипозом: 1) семейный полипоз; 2) синдромы, сопровождающиеся полипозом желудочно‑кишечного тракта
Семейный полипоз. Заболевание передается по наследству (вероятность 50 %) в первом поколении вне зависимости от пола, связано с генетическим повреждением 5 хромосомы. Частота его в США составляет 1 на 10 ООО. Полипы по гистологическому строению представляют собой аденомы с локализацией во всех отделах толстой кишки. Вероятность малигнизации – 75‑100 %.
Синдром Пейтца‑Джегерса. Заболевание наследуется по аутосомно‑доминантному типу, связано с генетическими мутациями в 19 хромосоме; характеризуется гамартомными полипами желудочно‑кишечного тракта и пигментными пятнами на коже и слизистых оболочках. Частота встречаемости в США составляет
1 на 100 000. Больные передают мутированный ген по наследству с вероятностью 50 %. Полипы представлены гамартомами – это пучки гладких мышц, исходящих из собственной мышечной пластинки слизистой кишки. Данные полипы встречаются не только в ободочной, но и в тощей и подвздошной кишке. Описаны случаи обнаружения полипов в желудке, двенадцатиперстной кишке, пищеводе, дыхательных путях. Важным проявлением данного синдрома является пигментация кожи лица: вокруг рта, носа, глаз, слизистой губ и щек. Возможно отложение пигмента на пальцах, ладонях, стопах, в области локтевых и коленных суставов. Вероятность малигнизации очень низкая. Но у данной группы больных имеется повышенный риск развития рака любой другой локализации, при этом злокачественные новообразования развиваются не из гамартомных полипов.
Синдром Гарднера. Связан с мутацией 5 хромосомы, наследуется по аутосомно‑доминантному типу. Полипы представлены аденомами с локализацией в ободочной и подвздошной кишках. Кроме семейного полипоза, у больных выявляются множественные остеомы, десмоиды, карциноиды, эпидермальные кисты. Частота малигнизации 100 %.
Синдром Тюрко – редкий вариант семейного кишечного полипоза. Клинические проявления в основном связаны с опухолью мозга (обычно глиома), которая сочетается с множественными полипами кишечника.
Синдром Кронкайта‑Кэнэдэ является ненаследственным заболеванием, которое проявляется чаще всего полипозом желудка и ободочной кишки, пятнистым витилиго, облысением, гиперпигментацией кожи, дистрофией ногтей, глосситом. В клинической картине преобладает диарея (гиперпродукция слизи на фоне многочисленных некрозов окончаний полипов), потеря массы тела, боли в животе. Летальность составляет около 60 %. Как правило, пациенты умирают в течение нескольких месяцев или лет с момента появления первых симптомов, что связано с водно‑электролитными и белковыми потерями. Колоректальные карциномы развиваются у 15 % больных (Н. А.Яицкий с соавт., 2004).
Лабораторная и инструментальная диагностика полипоза толстой кишки
Диагностировать полипоз, а тем более одиночные полипы, толстой кишки на основании только клинических данных не представляется возможным. Лабораторные исследования малоинформативны. При кровотечении можно выявить анемию. Ведущими методами диагностики являются рентгенологическое и эндоскопическое исследования. Эти два метода взаимно дополняют друг друга. Основным условием для успешного проведения исследований является хорошая подготовка кишечника. В зависимости от клинической ситуации подготовка может быть проведена либо путем приема слабительных, либо очистительными клизмами. Пациентам, которые страдают запорами, рекомендуется за 2–3 суток до процедуры прейти на бесшлаковую диету. При проведении рентгенологического исследования – ирригоскопии, используют методики тугого и полутугого заполнения кишечника контрастом; также применяют метод двойного контрастирования – раздувание воздухом заполненной контрастом кишки. В качестве контрастного вещества используется сульфат бария. Рентгенологическими признаками полипов кишечника является наличие четких округлых дефектов наполнения (рис. 180).
Данное исследование позволяет выявить полипы диаметром до 3–4 мм. При малигнизации новообразований появляются признаки «изъеденности» контуров, возможно наличие стойкого бариевого депо, ригидность и втянутость стенки кишки. При фиброколоноскопии возможно визуально осмотреть слизистую всех отделов толстой кишки, произвести биопсию подозрительных участков, а также выполнить эндоскопическую полипэктомию (рис. 181).
Это позволяет рассматривать данную процедуру не только как диагностическую, но и как лечебную. Эндоскопическими признаками малигнизации полипов являются: изъязвления, фибринозные наложения, некрозы, повышенная контактная кровоточивость, деформации просвета кишки, ригидность ее стенок. Заслуживает внимания новый метод исследования толстой кишки – виртуальная колоноскопия. При этой методике пациенту через клизменный наконечник инсуффлируют воздух до ощущения чувства «полноты» в животе.
Рис. 180. Дефект наполнения при полипе толстой кишки
Рис. 181. Электроэксцизия полипа
После этого вводят внутривенно 1 мг глюкагона (для снятия спазма мышц толстой кишки и минимизации перистальтики). Далее выполняется спиральная компьютерная томография, которая позволяет реконструировать внутреннее строение кишечника. При лабораторном исследовании кала может быть выявлена слизь, кровь. Этот признак не является специфическим, но позволяет заподозрить опухолевые заболевания кишечника.
Лечение полипоза толстой кишки
В настоящее время единственным методом лечения полипов толстой кишки является хирургический. Эндоскопическая полипэктомия
через ректоскоп или фиброколоноскоп выполняется при полипах различных размеров. Противопоказаниями для проведения данной процедуры являются: острые воспалительные изменения стенки кишки, полипы на широком основании, нарушения коагуляции. Все полипы, удаленные при эндоскопии, подлежат обязательному гистологическому исследованию. Риск малигнизации больше при полипах диметром более 9 мм на широком основании. При выявлении признаков злокачественного перерождения полипа показано проведение радикальной операции. Исключение составляют полипы с картиной рака in situ , которые требуют дальнейшего эндоскопического контроля. При семейном диффузном полипозе, в связи с практически 100 %‑й вероятностью развития рака, выполняется кол– или проктоколэктомия по возможности с сохранением сфинктерного аппарата прямой кишки и формированием кишечного резервуара из подвздошной кишки.
Для лечения гастрита и язвы наши читатели успешно используют Монастырский Чай. Видя, такую популярность этого средства мы решили предложить его и вашему вниманию.
Подробнее здесь…
Полип в пищеводе — это небольшое образование на ножке, свисающее из стенки органа, и является доброкачественным. Состоит из эпителиальных клеток. Это исключительно редкое явление, и в основном обнаруживается у мужчин до 40 лет. Локализуется в любом месте, но «излюбленное» расположение — верхняя часть отдела пищевода или ближе к кардии, имеет тонкую ножку или широкое основание.
При наличии тонкой ножки может произойти ущемление при расположении непосредственно рядом с желудком. В случае его локализации ближе к глотке иногда происходит выпадение полипа в полость глотки. В таких случаях проявляется некоторыми симптомами: дисфагией, болью, ощущением «комка».
Причины образования полипа
Причины возникновения до конца не изучены. Можно лишь предполагать, что является предрасполагающими факторами. Наиболее частые из них:
- хронический эзофагит — воспаление пищевода;
- прием алкоголя;
- микротравмы чувствительного эпителия стенки пищевода после употребления грубой пищи, некоторых лекарств;
- недостаточность пищеводно-желудочного жома, в результате чего может возникать рефлюкс: заброс соляной кислоты из желудка в пищевод;
- генетическая предрасположенность.
Образованию полипа в пищеводе способствуют и общие факторы:
- неправильное питание (грубая пища, еда «всухомятку»);
- стрессы;
- гиподинамия;
- экология.
Клинические проявления
Наличие полипа в пищеводе человек не может определить самостоятельно. В основном он обнаруживается как находка при проведении контрастной рентгеноскопии или ЭФГДС (эзофагогастродуоденоскопии) — процедур, которые делаются совершенно по другому поводу. Полип в пищеводе, как правило, имеет совсем небольшие размеры. В связи с этим он мало себя проявляет в клиническом плане. Симптоматики может вообще не быть. Общее состояние здоровья не нарушается. Небольшая дисфагия — нарушение глотания, которой раньше не наблюдалось, должна насторожить, и требует внимания.
- как лечить варикоз вен пищевода
- как избавиться от папилломы пищевода
Полипы, в отличие от злокачественных образований практически не растут и не увеличиваются. Если спазм уменьшился, глотание восстанавливается, т. к. полип не может перекрыть полностью пищевод. Его размеры этого не позволяют.
Бывают случаи, когда по определённым причинам полип в пищеводе достигает значительных размеров. Тогда появляются клинические симптомы: затрудненное дыхание и ощущение инородного тела за грудиной. Во время еды может быть боль при глотании, иногда — тошнота и рвота. Человек худеет.
Локализация
Если полип пищевода расположен в нижней трети, он может появиться и в желудке. При наличии нескольких новообразований в пищеводе и в желудке состояние называется полипозом. В желудке они в основном локализуются в кардиальном или антральном отделах, выглядят в виде гриба или цветной капусты.
При наличии полипоза не исключена возможность малигнизации — перехода в злокачественную, неконтролируемо растущую опухоль.
Считается, что любое доброкачественное образование в организме с момента его роста потенциально может малигнизироваться. Особенно это актуально, если полип в пищеводе больших размеров на толстой ножке.
Эндоскопический методы лечения
Обнаружение полипа пищевода при проведении ЭФГДС или рентгена требует хирургического вмешательства. Других методов лечения не существует. Если образование на длинной ножке, его удаляют при помощи эзофагоскопа. Через фиброскоп вводится специальная петля, которой под контролем глаза через монитор захватывается у основания образование и происходит удаление полипа.
После удаления полипа проводится электрокоагуляция ножки и сосудов для предотвращения дальнейшего кровотечения. Операция занимает несколько минут. Рана затягивается быстро, восстановительный период составляет несколько дней. Функции органов также восстанавливаются быстро.
Оперативное лечение
При наличии новообразования на толстой ножке, удаление эндоскопом не применяется. В таком случае есть опасность озлокачествления, особенно если это гиперпластический полип. Оперативное вмешательство происходит открытым методом в зависимости от уровня отдела пищевода, где расположен полип. В основном надрез делается на шее. Производится отсечение новообразования и ушивание места доступа.
Лечение при малигнизации полипа
Аналогичное оперативное лечение проводится при малигнизации полипа. Новообразование иссекается с дальнейшим гистологическим исследованием. Результатом биопсии при отсутствии малигнизации является простой полип с отеком и воспалительными инфильтрациями в строме (соединительной ткани).
По статистике большие доброкачественные образования редко становятся злокачественными. Если это происходит, прибегают к резекции пищевода. При обнаружении на ЭФГДС полипоза в нижней части пищевода и в желудке, производится операция на брюшной полости через абдоминальный разрез при невозможности иссечения при помощи эндоскопа.
Операции делаются с большим вниманием и осторожностью с целью снизить риск обсеменения окружающие ткани клетками, имея в виду, что любое новообразование — это потенциальный рак.
Удаление образования сразу при его обнаружении, на ранних стадиях, дает возможность избежать обширного оперативного вмешательства в дальнейшем. После операции рецидивы практически не встречаются.
Диета — немаловажная составляющая лечения
В плане лечения диета малоэффективна. Она важна для профилактики образования и для снижения травмирования уже имеющихся полипов, а также после перенесенной операции.
Прежде всего диета имеет следующие цели:
- снижение травматизации слизистой пищевода;
- ускорение эпителизации поврежденной слизистой;
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