tag:blogger.com,1999:blog-57188425644842028432024-02-20T00:03:06.220+08:00陳志典醫師(大腸直腸專科)舒眠無痛腸胃鏡/
減痛痔瘡切除/
微創肛門廔管切除/
慢性肛裂治療/
癌症篩檢
大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.comBlogger21125tag:blogger.com,1999:blog-5718842564484202843.post-43871455196898518212021-01-10T11:40:00.007+08:002021-01-10T12:12:14.462+08:00後腹腔腫瘤病友會<p> </p><h1 style="text-align: center;"> <span style="font-size: x-large;">後腹腔腫瘤病友會</span></h1><h3 style="text-align: center;"><span style="font-size: large; font-weight: normal;">腸道切除術後影響與照護</span></h3><h2><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy1_WOOgjMHJtY7aqRLHckDEDx7WFG0kjM4LenxcIOFT48evZKoFXd4dDNgPFhyjEpyyrNoKrvOoxHk1AZZasTUv-9Y9qtFsQqUQ7Le9BU6Kl8QBvCbXs0grqh3R_OXKBut_o5iPXYfwo/s1478/retroperitoneal+tumor%25E7%2597%2585%25E5%258F%258B%25E6%259C%25832.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1478" data-original-width="1108" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy1_WOOgjMHJtY7aqRLHckDEDx7WFG0kjM4LenxcIOFT48evZKoFXd4dDNgPFhyjEpyyrNoKrvOoxHk1AZZasTUv-9Y9qtFsQqUQ7Le9BU6Kl8QBvCbXs0grqh3R_OXKBut_o5iPXYfwo/s320/retroperitoneal+tumor%25E7%2597%2585%25E5%258F%258B%25E6%259C%25832.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div></h2><div style="text-align: center;"><span style="font-size: medium;"><span> </span><span> 後腹腔腫瘤跟大腸有什麼關係!?怎麼會跟志典醫師有關係呢!</span></span></div><div style="text-align: center;"><span style="font-size: medium; text-align: left;"><br /></span></div><div style="text-align: center;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><span>當然有關係囉~大家可以先看一下</span><a href="https://ctchen2019.blogspot.com/2019/11/blog-post_36.html" target="_blank">大腸解剖構造及生理功能</a><span>這篇。</span></span></div><div style="text-align: left;"><span style="font-size: medium;"><span>裡面</span><span>。。。。。。。。。。。。。。。。沒有提到XDD</span></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><span><br /></span></span></div><div style="text-align: left;"><span style="font-size: medium;"><span><span>不過,還是有相關的喔!</span></span></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><span><span>話說我們的大腸除了盲腸、乙狀結腸及橫結腸以外的部分其實是『 後腹腔器官 』。</span></span></span></div><div style="text-align: left;"><span style="font-size: medium;"><span><span>所以一旦後腹腔腫瘤長得比較大了(很不幸的這點常常發生),</span></span></span></div><div style="text-align: left;"><span style="font-size: medium;"><span><span>往往會影響到大腸而需要做到腸斷的切除及吻合,</span></span></span></div><div style="text-align: left;"><span style="font-size: medium;"><span><span>甚至有建立人工肛門的可能性。</span></span></span></div><div style="text-align: left;"><span style="font-size: medium;"><span><span><br /></span></span></span></div><div style="text-align: left;"><span style="font-size: medium;"><span><span><br /></span></span></span></div><div style="text-align: left;"><span style="font-size: medium;">大腸的切除,依據部位的不同,對生活有程度不一不同的影響。</span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQBRp-_PHK7Z0zwJ3XsyZRD0kl4NlLhNa-QaNG2b1x33ndVWjm-3sEU47LwovJcls4vw9_Q29x3t1u3G_gX3ZaALXEn8AGSBey24eRuAzCnz5DWRPY964FZlIb9trabrc2pRsXv0_rWcg/s1200/%25E6%25B2%25BB%25E7%2599%2582%25E5%25BE%258C%25E8%2585%25B8%25E9%2581%2593%25E4%25BF%259D%25E5%2581%25A5%25E8%2588%2587%25E8%25BF%25BD%25E8%25B9%25A4%25E6%25AA%25A2%25E6%259F%25A5%25E4%25B9%258B%25E5%25BF%2585%25E8%25A6%2581%25E6%2580%25A7.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="675" data-original-width="1200" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQBRp-_PHK7Z0zwJ3XsyZRD0kl4NlLhNa-QaNG2b1x33ndVWjm-3sEU47LwovJcls4vw9_Q29x3t1u3G_gX3ZaALXEn8AGSBey24eRuAzCnz5DWRPY964FZlIb9trabrc2pRsXv0_rWcg/w640-h360/%25E6%25B2%25BB%25E7%2599%2582%25E5%25BE%258C%25E8%2585%25B8%25E9%2581%2593%25E4%25BF%259D%25E5%2581%25A5%25E8%2588%2587%25E8%25BF%25BD%25E8%25B9%25A4%25E6%25AA%25A2%25E6%259F%25A5%25E4%25B9%258B%25E5%25BF%2585%25E8%25A6%2581%25E6%2580%25A7.jpg" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">大腸腸道切除常見術式</td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="color: #e69138;"><span style="font-size: medium;">右半大腸切除:</span><span style="font-size: medium;"> </span></span></div><div style="text-align: left;"><span style="font-size: medium;">因腸道吸水功能受到影響,會有<span style="color: #6aa84f;">解便不成形</span>的困擾。</span></div><div style="text-align: left;"><span style="font-size: medium;">解出來的便便稀稀散散的,</span></div><div style="text-align: left;"><span style="font-size: medium;">不過大多數的病人可以隨著時間漸漸恢復成型條狀的便便。</span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="color: #e69138; font-size: medium;">左半大腸切除:</span></div><div style="text-align: left;"><span style="font-size: medium;">術後生活上大多沒有太大影響。</span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="color: #e69138; font-size: medium;">乙狀結腸或直腸切除:</span></div><div style="text-align: left;"><span style="font-size: medium;"><span>術後可能有<span style="color: #6aa84f;">頻便</span>的狀況發生,大部分病人可以在一年內獲得緩解,但部分病人這樣的症狀會持續,稱為<span style="color: #6aa84f;">低前位切除症候群(LAR syndrome)</span>(</span><a href="https://ctchen2019.blogspot.com/2019/11/blog-post_36.html" target="_blank">大腸解剖構造及生理功能</a><span>之裡面也有提到過)</span><span>。可以用藥物控制緩解,減輕生活上的不便。</span></span></div><div style="text-align: left;"><span style="font-size: medium;"><span><br /></span></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;">除了腸道切除對生活的影響之外,</span></div><div style="text-align: left;"><span style="font-size: medium;"><span>由於位置上很靠近,</span><span>放射治療同樣可能對腸道造成影響。</span></span></div><div style="text-align: left;"><span style="font-size: medium;">最常見的是骨盆腔附近的放射治療對於直腸的傷害。</span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><span>放射治療造成的直腸黏膜受傷,在癒合的過程中組織修復、小動脈發炎、組織纖維化及血管新生的變化,使得粘膜容易破損出血,就是所謂的</span><span><span style="color: #6aa84f;">放射性直腸炎(Radiation proctitis)</span>。</span></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;">病人常常有血便的問題,除了藥物治療之外、高壓氧治療、<span style="color: #6aa84f;">大腸鏡</span><span face="arial, sans-serif" style="background-color: white;"><span style="color: #6aa84f;">氬氣電漿凝固術</span>等等,也是常見的治療方式。</span></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;">---------------我是分隔線------------------</span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><span>再次感謝泌尿科</span><span>楊晨洸醫師的邀請,</span></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;">繼去年與各位前輩</span><span style="background-color: white; color: #050505; font-family: inherit; white-space: pre-wrap;"><span style="font-size: medium;">分享後腹腔腫瘤術中腸道切除吻合技術,</span></span></div><div data-block="true" data-editor="dkqbu" data-offset-key="eg5g7-0-0" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="eg5g7-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="eg5g7-0-0" style="font-family: inherit;"><span style="font-size: medium;"><br data-text="true" /></span></span></div></div><div data-block="true" data-editor="dkqbu" data-offset-key="l7kq-0-0" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="l7kq-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="l7kq-0-0" style="font-family: inherit;"><span style="font-size: medium;">到今年後腹腔腫瘤病友會,</span></span></div></div><div data-block="true" data-editor="dkqbu" data-offset-key="28h25-0-0" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="28h25-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="28h25-0-0" style="font-family: inherit;"><span style="font-size: medium;"><br data-text="true" /></span></span></div></div><div data-block="true" data-editor="dkqbu" data-offset-key="emnne-0-0" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="emnne-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span style="font-size: medium;"><span data-offset-key="emnne-0-0" style="font-family: inherit;"><span>與各位病友及家人們聊聊腸道切除術後對生活上的影響</span></span><span style="font-family: inherit;">以及保健方式。</span></span></div><div class="_1mf _1mj" data-offset-key="emnne-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span style="font-size: medium;"><br /></span></div></div><div data-block="true" data-editor="dkqbu" data-offset-key="fon5f-0-0" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="fon5f-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="fon5f-0-0" style="font-family: inherit;"><span style="font-size: medium;">希望大家能有收獲~~^_^</span></span></div></div><div data-block="true" data-editor="dkqbu" data-offset-key="amqlo-0-0" style="background-color: white; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="amqlo-0-0" style="color: #050505; direction: ltr; font-family: inherit; position: relative;"><span style="font-size: medium;"><br /></span></div><div class="_1mf _1mj" data-offset-key="amqlo-0-0" style="color: #050505; direction: ltr; font-family: inherit; position: relative;"><span style="font-size: medium;"><br /></span></div><div class="_1mf _1mj" data-offset-key="amqlo-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span style="color: #6aa84f; font-size: medium;">延伸閱讀</span></div></div><div data-block="true" data-editor="dkqbu" data-offset-key="ci884-0-0" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="ci884-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="ci884-0-0" style="font-family: inherit;"><span style="font-size: medium;"><br data-text="true" /></span></span></div></div><div data-block="true" data-editor="dkqbu" data-offset-key="eicp3-0-0" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; white-space: pre-wrap;"><div class="_1mf _1mj" data-offset-key="eicp3-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="eicp3-0-0" style="font-family: inherit;"><span style="font-size: medium;"><a href="https://ctchen2019.blogspot.com/2019/11/blog-post_36.html" style="font-family: "PingFang TC"; white-space: normal;" target="_blank">大腸解剖構造及生理功能</a></span></span></div><div class="_1mf _1mj" data-offset-key="eicp3-0-0" style="direction: ltr; font-family: inherit; position: relative;"><span data-offset-key="eicp3-0-0" style="font-family: inherit;"><h3 class="post-title entry-title" itemprop="name" style="color: #222222; font-family: 微軟正黑體, Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0.75em 0px 0px; position: relative; white-space: normal;"><span style="font-size: medium; font-weight: normal;"><a href="https://ctchen2019.blogspot.com/2019/11/blog-post_84.html">什麼是大腸鏡?大腸鏡檢查怎麼做?</a></span></h3><div class="post-header" style="color: #222222; font-family: 微軟正黑體, Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14.4px; line-height: 1.6; margin: 0px 0px 1.5em; white-space: normal;"><div class="post-header-line-1"></div></div><div class="post-body entry-content" id="post-body-874442157121987362" style="color: #222222; font-family: 微軟正黑體, Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.6px; letter-spacing: 1.4px; line-height: 1.9em; position: relative; white-space: normal; width: 590px;"><div style="text-align: center;"></div></div></span></div></div><div data-block="true" data-editor="dkqbu" data-offset-key="ac6j0-0-0" style="background-color: white; color: #050505; font-family: system-ui, -apple-system, system-ui, ".SFNSText-Regular", sans-serif; white-space: pre-wrap;"></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: center;"><span style="font-size: medium;"><br /></span></div><div style="text-align: center;"><br /></div>大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-74867346478046276822020-12-30T23:46:00.009+08:002020-12-31T09:44:59.637+08:002020歲末 大腸直腸癌病友會記事<div class="separator" style="clear: both; text-align: center;"><span style="font-size: xx-large;">2020歲末 大腸直腸癌病友會</span></div><h4 style="text-align: center;"><span style="font-size: large;"> <span style="font-weight: 400;">信任 依賴 陪伴</span></span></h4><h2><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyJdtcRifgOB6NUPW0Bs9E1AvC83gx9Lr2glyVhgnwvE7NlPo8dYLcIwQ-1zwm1uB3bLuPpn1f7muGHG0EM-Bf7H4BcGcsvekC3iNHX0uPckt3tTwDDEw4l3iz_v0b4G5jOvTtSRZtY0I/s1044/%25E5%25A4%25A7%25E8%2585%25B8%25E7%2599%258C%25E7%2597%2585%25E5%258F%258B%25E6%259C%25831.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1044" data-original-width="937" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyJdtcRifgOB6NUPW0Bs9E1AvC83gx9Lr2glyVhgnwvE7NlPo8dYLcIwQ-1zwm1uB3bLuPpn1f7muGHG0EM-Bf7H4BcGcsvekC3iNHX0uPckt3tTwDDEw4l3iz_v0b4G5jOvTtSRZtY0I/s320/%25E5%25A4%25A7%25E8%2585%25B8%25E7%2599%258C%25E7%2597%2585%25E5%258F%258B%25E6%259C%25831.jpg" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div></h2><div><span style="font-size: medium;">今天,是個冷颼颼的寒流天。</span></div><div><span style="font-size: medium;">也是大腸直腸癌病友會的日子。</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">新聞上說,台中不但冷,陣風也強,</span></div><div><span style="font-size: medium;">路上行道樹倒了許多,</span></div><div><span style="font-size: medium;">不禁令人擔心籌備已久的病友會是否落得冷冷清清、草草收場。</span></div><div><span style="font-size: medium;">不但病友們失望,</span></div><div><span style="font-size: medium;">也讓醫療團隊們失去一次跟病友夥伴們一起加油打氣的機會。</span></div><div><br /></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">下午一點半到了,終於。</span></div><div><span style="font-size: medium;">大夥們放下手邊的工作,從醫院的各處趕來,</span></div><div><span style="font-size: medium;">門診暫停,公務暫停,</span></div><div><span style="font-size: medium;">為的就是跟病友們站在一起,</span></div><div><span style="font-size: medium;">讓大家知道,我們在同一條陣線上。</span></div><div><span style="font-size: medium;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHsTqhQ9qJOnmSPIGoSNqHp0GBOUILgqfh1j6hKt1t3Gcr8O1h6rm85RGUsvk5gmS9AdywcevkYADB41OjYknuTZ9cnmoWQ6eBXIgnwWvUvJdNrDjZf5ZkrJVjNdFZU0KUyxSpBpKcwng/s1478/%25E5%25A4%25A7%25E8%2585%25B8%25E7%2599%258C%25E7%2597%2585%25E5%258F%258B%25E6%259C%25838.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1108" data-original-width="1478" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHsTqhQ9qJOnmSPIGoSNqHp0GBOUILgqfh1j6hKt1t3Gcr8O1h6rm85RGUsvk5gmS9AdywcevkYADB41OjYknuTZ9cnmoWQ6eBXIgnwWvUvJdNrDjZf5ZkrJVjNdFZU0KUyxSpBpKcwng/s320/%25E5%25A4%25A7%25E8%2585%25B8%25E7%2599%258C%25E7%2597%2585%25E5%258F%258B%25E6%259C%25838.jpg" width="320" /></a></div><br /><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">副院長及蔣主任簡單隆重的開場之後,</span></div><div><span style="font-size: medium;">醫師們輪流上台跟大家交流。</span></div><div><span style="font-size: medium;">陳明正醫師術後營養照顧原則、</span></div><div><span style="font-size: medium;">江梓維醫師腹腔鏡技術分享、</span></div><div><span style="font-size: medium;">林俊余機械手臂成果展示、</span></div><div><span style="font-size: medium;">和我所負責的手術前後篩檢追蹤,</span></div><div><span style="font-size: medium;">無私的分享著早已整理完成,排演過數次的投影片。</span></div><div><span style="font-size: medium;">一個講者只有短短的30分鐘,</span></div><div><span style="font-size: medium;">讓大家得到豐富的收穫,</span></div><div><span style="font-size: medium;">是我們的義務與責任。</span></div><div><span style="font-size: medium;"><br /></span></div><div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5M0_ai2eSScUP1F7I3W6_P-n6J4b2R_ZtKT_gHc-jAvmgIt2MQs5eO_9EeCjqnCmlNzTBwrdBtqS9sW7eEaSQnD31TFS9pVoysPdlQ4wDYDPr02PYpDkPRny8A2htxTanYQMvk9gOXpQ/s2048/41AD1948-5E85-4E64-86C5-EBAA53DD3442.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1539" data-original-width="2048" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg5M0_ai2eSScUP1F7I3W6_P-n6J4b2R_ZtKT_gHc-jAvmgIt2MQs5eO_9EeCjqnCmlNzTBwrdBtqS9sW7eEaSQnD31TFS9pVoysPdlQ4wDYDPr02PYpDkPRny8A2htxTanYQMvk9gOXpQ/s320/41AD1948-5E85-4E64-86C5-EBAA53DD3442.jpeg" width="320" /></a></div><br /><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">會後的問答,</span></div><div><span style="font-size: medium;">讓我們感受到病友及家屬們的期盼與信任。</span></div><div><span style="font-size: medium;">大家的期望都很高,</span></div><div><span style="font-size: medium;">即使有些問題,現在還沒有答案,</span></div><div><span style="font-size: medium;">但我們仍樂於分享自身的經驗,</span></div><div><span style="font-size: medium;">希望可以從激盪中,閃爍出更好更新的想法與做法。</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">可惜門診時間衝突,</span></div><div><span style="font-size: medium;">不能讓門診</span><span style="font-size: medium;">病患們久候 而提早離場,</span></div><div><span style="font-size: medium;">無法盡情對話,</span></div><div><span style="font-size: medium;">實在萬分可惜。。。</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;">不過,會議終究是圓滿成功。</span></div><div><span style="font-size: medium;">各位,明年還是要繼續努力喔!!</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;"><br /></span></div><div><br /></div><div><br /></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;"><br /></span></div><div><br /></div><div><br /></div>大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-32206523660385675372020-12-11T00:06:00.002+08:002020-12-11T00:06:23.755+08:00組織凝集刀- 痔瘡手術的利器<p style="text-align: center;"><span style="font-size: large;">組織凝集刀</span></p><p style="text-align: center;"><span style="font-size: medium;">痔瘡手術的利器</span></p><p style="text-align: center;"><span style="font-size: large;"><br /></span></p><p style="text-align: center;"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwPuv4vJEXxz09AtVgedyRSQ7-NDS80SEpTz_Bz_LDy8mY7pyJJjV5WZ5xEt0TUnrV5TmdMFjEQFYZXwVO7eA2dAaixPTwbiyUs_yo3BXEqvIv47IA-UofPCeJ4o5rJTasdm_fZT2ooXE/s512/ligasure-exact-dissector-b+%25281%2529.webp" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="512" data-original-width="512" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwPuv4vJEXxz09AtVgedyRSQ7-NDS80SEpTz_Bz_LDy8mY7pyJJjV5WZ5xEt0TUnrV5TmdMFjEQFYZXwVO7eA2dAaixPTwbiyUs_yo3BXEqvIv47IA-UofPCeJ4o5rJTasdm_fZT2ooXE/w399-h320/ligasure-exact-dissector-b+%25281%2529.webp" width="399" /></a></div><p></p><p style="text-align: center;"><span>今天我們來談談組織凝集刀( </span>Ligasure)</p><p style="text-align: left;"><br /></p><p style="text-align: left;">組織凝集刀是由Covidien公司( 現已被Medtronic公司併購 ) 所研發,</p><p style="text-align: left;">用於血管組織及軟組織凝集的工具。</p><p style="text-align: left;">構造像是一個老虎鉗,可以夾住組織,</p><p style="text-align: left;">然後再進行切割。</p><p style="text-align: left;">夾住的組織經過凝集後,可以抵抗三倍高的血壓衝擊,</p><p style="text-align: left;">因此在切割之後比較不會有出血的狀況發生。</p><p style="text-align: left;">臨床上相當廣泛的使用在內視鏡手術。</p><p style="text-align: left;"><br /></p><p style="text-align: left;">話說回來,</p><p style="text-align: left;">我們的痔瘡其實是肛門粘膜下層的組織,</p><p style="text-align: left;">含有很多的血管。</p><p style="text-align: left;">所以把這種止血切割用的好東西用在痔瘡切除,</p><p style="text-align: left;">再恰當不過了。</p><p><br /></p><p>如今,</p><p>經過一代代改良設計,</p><p>Medtronic推出了相當適合痔瘡手術的型號。</p><p>不僅止血效果依舊,</p><p>尖頭的設計讓剝離(dissection) 痔瘡組織的時候更加靈巧,</p><p>在痔瘡切除的過程中,</p><p>更能清楚看到切割的位置,</p><p>讓手術更加精準且精緻。</p><p><br /></p><p>組織凝集刀使用在痔瘡手術的時候,有許多優點:</p><p>1. 縮短手術時間 </p><p>2. 減少手術出血量</p><p>3. 大幅減輕了短期術後疼痛</p><p>4. 減少術後排尿困難的發生率</p><p>5. 傷口癒合不良機率較低</p><p><br /></p><p>其中,病患最有感的應該還是<span style="color: #93c47d;">術後疼痛的減輕</span>。</p><p>雖然不是每一位病人都做得到完全不痛,</p><p>但可以讓痔瘡術後的疼痛,</p><p>從7~8分降到2~3分,</p><p>甚至少數人可以達到 1~2分的疼痛程度,</p><p>效果相當不錯。</p><p><br /></p><p>除了上述的優點之外,也相當重要的一點是,</p><p>病人術後<span style="color: #6aa84f;">較快恢復正常工作</span>,</p><p>這對於忙碌的現代人,也是很重要的一點。</p><p>大家都想趕快回到工作崗位,回復正常生活啊~</p><p><br /></p><p>整體來講,</p><p>除了需要<span style="color: #6aa84f;">自費</span>之外大概就沒什麼缺點了吧~XD</p><p>所以,</p><p>如果個人保險給付的話,<span style="color: #ffa400;">志典醫師</span>就會推薦給病患做使用。</p><p><br /></p><p>組織凝集刀絕對是一個痔瘡手術的利器!</p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><p><br /></p><div><font size="4"><br /></font></div><div><font size="4"> </font></div><div><font size="4"><br /></font></div><div><font size="4"> </font></div>大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-38688481804714928782020-11-24T00:44:00.007+08:002020-11-24T00:54:08.940+08:00金馬57 [ 前往明天的路上] 合集 - Scene 8 痔瘡<p> </p><h2 style="text-align: center;"><span style="font-size: x-large;"></span></h2><h4 style="text-align: center;"><span style="font-size: x-large;">痔瘡</span></h4><h4 style="text-align: center;"><span style="font-size: medium;"><span><span style="font-weight: normal;">金馬57 [ 前往明天的路上] 合集 </span></span><span><span style="font-weight: normal;">Scene 8 痔瘡 </span></span></span></h4><h4 style="text-align: center;"><span style="font-weight: normal;"><span style="font-size: medium;">FILM BY 鍾孟宏|金馬56最佳導演</span></span></h4><div style="text-align: center;">轉錄自 <a href="https://reurl.cc/zzGx0e">金馬57 [前往明天的路上] 影人共同創作12支短片合集</a></div><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /><div class="separator" style="clear: both; text-align: left;"><iframe allowfullscreen="" class="BLOG_video_class" height="266" src="https://www.youtube.com/embed/iC0vuHTJeAM" width="320" youtube-src-id="iC0vuHTJeAM"></iframe></div><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div><p class="p1" style="font-family: "Helvetica Neue"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: medium;"><span class="s1" style="font-kerning: none;">< </span><span class="s2" style="font-family: "PingFang TC"; font-kerning: none; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;">痔瘡</span><span class="s1" style="font-kerning: none;"> ><span class="Apple-converted-space"> </span></span></span></p><p class="p2" style="font-family: "Helvetica Neue"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; min-height: 12px;"><span style="font-size: medium;"><span class="s1" style="font-kerning: none;"></span><br /></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">昨天我先到了餐廳</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">看到一堆人在排隊</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">我想完蛋了</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">但沒多久收到你的訊息</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">你說要跟我分手</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="color: #6aa84f; font-size: medium;">當下我的痔瘡突然復發</span></span></p><p class="p2" style="font-family: "Helvetica Neue"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; min-height: 12px;"><span style="font-size: medium;"><span class="s1" style="font-kerning: none;"></span><br /></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">這兩天我想了很久</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">我做錯了什麼事?</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">說錯了什麼話嗎?</span></span></p><p class="p2" style="font-family: "Helvetica Neue"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; min-height: 12px;"><span style="font-size: medium;"><span class="s1" style="font-kerning: none;"></span><br /></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">我相信</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">縱使沒有你</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">我還是可以好好走在這人生路上</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span style="font-size: medium;"><span class="s1" style="font-kerning: none;">未來</span><span class="s3" style="font-family: "Helvetica Neue"; font-kerning: none; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal;"> </span><span class="s1" style="font-kerning: none;">我們還會相遇</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">到時</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">我會把我心裡的愛</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">再次告訴你</span></span></p><p class="p2" style="font-family: "Helvetica Neue"; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px; min-height: 12px;"><span style="font-size: medium;"><span class="s1" style="font-kerning: none;"></span><br /></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">現在外面下著大雨</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">我要趕去下午三點得直腸外科門診</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">這幾年來</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">你一直勸我去解決這痔瘡的問題</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">我都沒有好好聽進去</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="color: #6aa84f; font-size: medium;">現在我決定要把痔瘡處理掉</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">希望這個決定</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">能讓你少了擔憂</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">也希望你能平安健康</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;">再見</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><br /></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;"><span><span> 不只被分手,還同時痔瘡復發,有一股淡淡的哀傷啊~</span><br /></span></span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;"><span> </span>他終於決定把痔瘡處理掉了,你呢?</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;"><br /></span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;"><br /></span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;"><span style="color: #6fa8dc;">註:</span>痔瘡也是可以很有詩意的。電影人的創意讓志典醫師感到無比敬佩啊!</span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;"><br /></span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><span class="s1" style="font-kerning: none;"><span style="font-size: medium;"><br /></span></span></p><p class="p3" style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 0px;"><br /></p></div>大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-67055459691243054212020-11-12T00:01:00.004+08:002021-01-10T12:01:08.237+08:00鏡檢殺手!檢查前千萬別吃的東西<div><div style="text-align: center;"><br /></div></div><div><div style="text-align: center;"><h2><span style="font-size: x-large;">鏡檢殺手</span></h2><h4><span style="font-size: large;"> <span style="font-weight: 400;">大腸鏡的天敵!?</span></span></h4><h2><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJLCPPIjTGVzuJKLkAUSZtAANqSzme7AtgIsVtvO7pOGx57wFcn7DWnG5etqwSdE5PKpfg7pmx0ft6SkCJ-pWKipwvJnEiwuA90a5YBWYThLFv8Ls2QnOwsW6rWZ2TJt6rTdVD4UnX9sI/s640/ball-4852191_640.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="427" data-original-width="640" height="428" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJLCPPIjTGVzuJKLkAUSZtAANqSzme7AtgIsVtvO7pOGx57wFcn7DWnG5etqwSdE5PKpfg7pmx0ft6SkCJ-pWKipwvJnEiwuA90a5YBWYThLFv8Ls2QnOwsW6rWZ2TJt6rTdVD4UnX9sI/w640-h428/ball-4852191_640.jpg" width="640" /></a></div><br /><div><br /></div></h2><div style="text-align: left;"><span style="font-size: medium;"><span><span style="font-weight: 400;">不曉得大家打不打棒壘球?</span></span><span style="font-weight: normal;"><span>志典醫師可是個<span style="color: #ffa400;">喜愛棒壘球</span>的人。<br /></span></span><span>有在打棒壘球的人應該都有過這樣的經驗,<br /></span><span>用力丟出一顆球,卡在球場邊的防護網上,拔不出來。</span></span></div><div><span style="font-size: medium; font-weight: 400;"><br /></span></div><h2 style="text-align: left;"><span style="font-size: medium; font-weight: 400;">大腸鏡檢查的過程中,有一個東西也可能這樣,直接卡入鏡子裡面,造成阻塞,甚至整支鏡子必須進廠維修。</span></h2><h2 style="text-align: left;"><span style="font-size: medium; font-weight: normal;"><br /></span></h2><div style="text-align: left;"><span style="font-size: medium; font-weight: normal;">一位大叔因為最近大便有血來找志典醫師做大腸鏡檢查。做到一半突然,</span></div><div style="text-align: left;"><span style="font-size: medium; font-weight: normal;">“疑?我的抽吸功能壞了” 志典醫師說道。</span></div><div style="text-align: left;"><span style="font-size: medium;"><span>經過了一番障礙排除,依舊無法解決。要知道,大</span><span>腸鏡的抽吸功能對於檢查來說是非常必要的。除了可以把沒清乾淨的便便抽掉,也可以在操作過程中輔助我們把腸子縮短(shortening)。</span><span>沒了這個功能檢查根本無法繼續啊~</span></span></div><p style="text-align: left;"><span style="font-size: medium; font-weight: normal;"><br /></span></p><p style="text-align: left;"><span style="font-size: medium; font-weight: normal;">於是只好乖乖把大腸鏡退出來,重新換上另一隻,重新檢查。</span></p><p style="text-align: left;"><span style="font-size: large;">折騰了一番,病人辛苦,助手也忙著拆鏡換鏡弄得滿頭大汗。</span></p><p style="text-align: left;"><span style="font-size: medium;">檢查結果順利,大叔只有一個小息肉,看起來是良性的,順利切除。完成檢查後,我們開始研究到底是什麼鬼東西打亂了我們的步調。</span></p><h2 style="text-align: left;"><span style="font-size: medium; font-weight: normal;">將將將將!!謎底揭曉了。。</span></h2><div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZBmuhvozlwtvH4bItkfTxZqCmNWRWO3PVeufrcilye5bsNw0pJIVT9mKXmizIrFkUqtgUZPRmJCgFwbgrRc3vjPO2VsjSLTQzhAdomI06EqxveGxMdbyPCEqoTpe4lmowVyaj-u-p_Bg/s1478/IMG_5574.JPG" style="margin-left: auto; margin-right: auto;"><span style="font-size: medium;"><img border="0" data-original-height="1478" data-original-width="1108" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZBmuhvozlwtvH4bItkfTxZqCmNWRWO3PVeufrcilye5bsNw0pJIVT9mKXmizIrFkUqtgUZPRmJCgFwbgrRc3vjPO2VsjSLTQzhAdomI06EqxveGxMdbyPCEqoTpe4lmowVyaj-u-p_Bg/w480-h640/IMG_5574.JPG" width="480" /></span></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: medium;">安安穩穩地躺在抽吸孔下方的芭樂籽。。。</span></td></tr></tbody></table><span style="font-size: medium;"><br /><span style="font-weight: normal;"><br /></span></span></div><h2 style="text-align: left;"><span style="font-size: medium; font-weight: normal;">是顆芭樂籽呢!QQ</span></h2><h2 style="text-align: left;"><span style="font-size: medium; font-weight: normal;">就這麼剛剛好,卡在抽吸孔下方的小空間,進退不得。</span></h2><h2 style="text-align: left;"><span style="font-size: medium; font-weight: normal;">原來這位大哥平常就喜歡吃芭樂,鏡檢前想說快樂的吃一下再來接受痛苦的低渣清流食物。沒想到一顆子沒乾淨,不偏不倚就竄到這裡來。讓我們硬生生的壞掉一支大腸鏡可以用。</span></h2><div><span style="font-size: large; text-align: left;">所以各位愛吃芭樂的朋友們,鏡檢之前拜託停個四五天不要吃芭樂吧。</span><span style="background-color: #ffa400; font-size: large; text-align: left;">芭樂籽是鏡檢殺手啊~~</span></div><div><span style="font-size: medium; font-weight: normal;"><br /></span></div><h2 style="text-align: left;"><br /></h2></div></div>大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-41028969107729593842020-10-08T00:55:00.000+08:002020-10-08T00:55:07.811+08:00大腸瘜肉-小時候的大腸癌<div style="text-align: center;">
<span style="font-size: large;">大腸瘜肉-大腸癌的</span>小時候</div>
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<span style="color: #6aa84f; font-size: large;">網友Q問:</span><span style="font-size: large;">什麼是大腸瘜肉?</span></div>
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<span style="color: #e69138; font-size: large;">志典醫師:</span><br />
<span style="font-size: large;">大腸瘜肉是大腸黏膜膜增生造成的病灶,</span><span style="font-size: large;">主要大多是增生性瘜肉(hyperplastic polyp)以及腺瘤性瘜肉(adenomatous polyp)這兩大類,其他種類的瘜肉相對少見。</span><span style="font-size: large;">腺瘤性瘜肉在經過10~15年之後,就有變成大腸癌的可能性,因此</span><span style="font-size: large;">也可以說是大腸癌的前身。</span><span style="font-size: large;">雖然在大腸鏡的鏡頭下(<span style="color: #6fa8dc;">註解1.</span>),80%以上的瘜肉可以用外觀作為大致性的區分,但無法完全確定是屬於哪一種細胞型態,因此只要看到瘜肉,</span><span style="color: #6fa8dc; font-size: large;">原則上一律切除</span><span style="font-size: large;">,送交病理化驗。</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg25sV-WnkyjQpcoXg62Mxt487qW56z82YFX0tNitNF2eMkHVi9gk-4nPdup1cg2iUzbZVoAT4aC6K71zICzDUWUwIYmM60XgpPenqqIzXruiCheO8k9N-PIaOO9To9r9rpwq3snzfWRK4/s1600/polyp+5.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg25sV-WnkyjQpcoXg62Mxt487qW56z82YFX0tNitNF2eMkHVi9gk-4nPdup1cg2iUzbZVoAT4aC6K71zICzDUWUwIYmM60XgpPenqqIzXruiCheO8k9N-PIaOO9To9r9rpwq3snzfWRK4/s1600/polyp+5.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">最常見的瘜肉長這樣</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBjVu142TI6ojXyKNTe_ZBKmKf9H9V9WAIdpNVolMKJ8WYOe95kxEK-zfm0IRRWyQRpGinsS9YL1RKb6XnDjZEZDj8zS8a6wr5F9zZiZMDrRtDwnIQqDb5vsW8kD83NqJ_F60Tjvxu6gw/s1600/polyp_invisible.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBjVu142TI6ojXyKNTe_ZBKmKf9H9V9WAIdpNVolMKJ8WYOe95kxEK-zfm0IRRWyQRpGinsS9YL1RKb6XnDjZEZDj8zS8a6wr5F9zZiZMDrRtDwnIQqDb5vsW8kD83NqJ_F60Tjvxu6gw/s1600/polyp_invisible.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">增生性瘜肉</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8OfatAnzwAFnmUqwEzuXpn71PXebLNtBlluD9Pva05J-k4eyno0aV2obMWtR66SmXi5WPpu7PUw8hTv5_hjnU5aVId5JmwEQBeEpNmHZuYtKyvTyEWKeU7ClSn9HH3S1kmwHRbNa5jdM/s1600/polyp_invisible_2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8OfatAnzwAFnmUqwEzuXpn71PXebLNtBlluD9Pva05J-k4eyno0aV2obMWtR66SmXi5WPpu7PUw8hTv5_hjnU5aVId5JmwEQBeEpNmHZuYtKyvTyEWKeU7ClSn9HH3S1kmwHRbNa5jdM/s1600/polyp_invisible_2.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">還是增生性瘜肉</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnYep5PkYpZZMD6sewqmgYA_J00v1AzkOlFnpMj99yxGsPq2WlN9Fldu7SiLqUllEqo4yfyrvYK41N_Qn_hSWen2WboyhARnoXlI0NoM3OxankJSbZmqYCBfCmu0J0EO1rqebGJ2vRLFQ/s1600/polyp_invisible_hide.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnYep5PkYpZZMD6sewqmgYA_J00v1AzkOlFnpMj99yxGsPq2WlN9Fldu7SiLqUllEqo4yfyrvYK41N_Qn_hSWen2WboyhARnoXlI0NoM3OxankJSbZmqYCBfCmu0J0EO1rqebGJ2vRLFQ/s320/polyp_invisible_hide.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">躲在大腸皺褶後面的瘜肉,一個不小心就會漏掉</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbz8aHFaAN314l9uaitjQ7YMVX8XOhdjyVVoWocl2JEVyWzprHw35Ftn19DH7a1yFk6dEqUpvna0SPuN1_8Vz-7g98fQSgJNG7JnISKvfKBOYrRNwE8ezvJodokVOxSqZPloYLKLFxJy4/s1600/polyp+big.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbz8aHFaAN314l9uaitjQ7YMVX8XOhdjyVVoWocl2JEVyWzprHw35Ftn19DH7a1yFk6dEqUpvna0SPuN1_8Vz-7g98fQSgJNG7JnISKvfKBOYrRNwE8ezvJodokVOxSqZPloYLKLFxJy4/s320/polyp+big.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">腺瘤性瘜肉</td></tr>
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<span style="font-size: large;"><br /></span><span style="color: #6aa84f; font-size: large;">網友Q問:</span><span style="font-size: large;">大腸瘜肉切除會不會痛?有沒有什麼的併發症?</span><br />
<span style="font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師:</span><br />
<span style="font-size: large;">大腸是沒有痛覺神經的,因此<span style="color: #6fa8dc;">切除瘜肉不會有痛覺</span>。不過在過程中,大腸鏡可能需要打入較多的空氣,可能稍有腹脹的感覺。</span><br />
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<span style="font-size: large;">至於切除瘜肉的併發症發生機率<span style="color: #6fa8dc;">低於百分之一</span>,主要包括出血、破孔兩種。其中有柄瘜肉(pedunculated polyp)在底部有一條供應瘜肉生長的血管,在切除的過程中可能因此造成出血。針對這類瘜肉,醫師會建議病人使用內視鏡金屬止血夾做預防性的止血。</span><br />
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<span style="font-size: large;">另外針對較大的瘜肉,或者所謂扁平瘜肉(sessile polyp),建議使用<span style="color: #6fa8dc;">內視鏡黏膜切除術(Endoscopic Mucosal Resection, EMR)</span>或<span style="color: #6fa8dc;">內視鏡粘膜下剝離術(Endoscopic Submucosal Dissection, ESD)</span>,才能將瘜肉做完整的切除。這類的瘜肉切除屬於難度較高的技術,必須經由熟練且經驗豐富的醫師操作,才能將出血、破孔併發症的機會降到最低。</span><br />
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<span style="font-size: large;">以下是典型的瘜肉切除:(polypectomy)</span><span style="font-size: large;"></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUTytstL3-nE8zYwoqWbtHXsOWO5tg_j2hW5q_jN2cUDFXUlWeJnhasFiYUcz_k3vcBgljX3x0BmFS1t0xh0fV2I6UqRUZ964JYXr22u6J87cobTRe9jMGhsNlEI82gG0qyjC4L8LwrE8/s1600/polyp+5.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUTytstL3-nE8zYwoqWbtHXsOWO5tg_j2hW5q_jN2cUDFXUlWeJnhasFiYUcz_k3vcBgljX3x0BmFS1t0xh0fV2I6UqRUZ964JYXr22u6J87cobTRe9jMGhsNlEI82gG0qyjC4L8LwrE8/s320/polyp+5.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">前方看到一顆瘜肉</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicGvoJ6at6MAS5f-2pUjwj917YrPwTagpZNnpbEEK_DsIoCfKhe0Rr7haz2zIQXJ-CsaAAfykdyC5QLjGDrUC4S1zM8Poe3DmSSigZm_UYEi5lv-krG7SyzPgyOsLIt81ye3FSBd-cGwQ/s1600/polypectomy+5.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicGvoJ6at6MAS5f-2pUjwj917YrPwTagpZNnpbEEK_DsIoCfKhe0Rr7haz2zIQXJ-CsaAAfykdyC5QLjGDrUC4S1zM8Poe3DmSSigZm_UYEi5lv-krG7SyzPgyOsLIt81ye3FSBd-cGwQ/s320/polypectomy+5.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">伸出瘜肉切割環(snare)把它像套圈圈一樣圈起來</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK-NG92wY-3VpVbWNbi8KGOTj6FKqeOO9iTbbqltuL7gXtzxDuGWEebuK_gPyTlsESovUGth8rcMaNSeUbMCp3bCufZQfxMPngiJ-OB8aDOnnRDgVGYq-6hGE5TOvp_e3sCYlS33b8Qgc/s1600/polypectomy+5after.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK-NG92wY-3VpVbWNbi8KGOTj6FKqeOO9iTbbqltuL7gXtzxDuGWEebuK_gPyTlsESovUGth8rcMaNSeUbMCp3bCufZQfxMPngiJ-OB8aDOnnRDgVGYq-6hGE5TOvp_e3sCYlS33b8Qgc/s320/polypectomy+5after.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">電燒切除,留下一個小小的潰瘍</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1mWnnkcJeZdfcwR2268P5yrhus_PUy7zLSt2re-9NVq9zTUKE8mUuqzlU3FP3T6v_5Hg-0eY6MPen6wcEayn_gpFr5qJWR3FhqDpe0w9OB3FZpXteIYMC1pvDTksDplX5tfmC5vLhp8o/s1600/polypectomy+5clip.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1mWnnkcJeZdfcwR2268P5yrhus_PUy7zLSt2re-9NVq9zTUKE8mUuqzlU3FP3T6v_5Hg-0eY6MPen6wcEayn_gpFr5qJWR3FhqDpe0w9OB3FZpXteIYMC1pvDTksDplX5tfmC5vLhp8o/s320/polypectomy+5clip.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">用內視鏡止血夾夾起來,避免穿孔</td></tr>
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這個例子瘜肉雖然很小,切口也沒有流血,但切面稍微深一點點,志典醫師還是用止血夾處理了,安全為上。<br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><span style="color: #6aa84f; font-size: large;">網友Q問:</span><span style="font-size: large;">瘜肉切除後如果有使用內視鏡止血夾,夾子留在身體裡面會不會怎麼樣?</span></span><br />
<span style="font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師:</span><br />
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<span style="font-size: large;">內視鏡止血夾雖然會暫時停留在腸道裡面,不過經過兩週左右就隨著黏膜的代謝而被排出體外,因此不用過度擔心。止血夾排出的同時,黏膜也已經癒合,不會有出血、破孔的問題,達到安全切除瘜肉的目的。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><span style="color: #6fa8dc;">註解1 : </span>我們的</span><span style="font-size: large;">腸道黏膜微血管較容</span><span style="font-size: large;">易吸收光線中的藍、綠光<span style="font-family: 新細明體;"><span style="background-color: rgba(255, 255, 255, 0.9);">,由Olympus公司研發的</span></span></span><span style="font-size: large;">新式</span><span style="font-size: large;">大腸鏡大多配有NBI(Narrow Band Image)技術,可過濾掉紅光,讓藍綠光顯影更清楚</span><span style="font-family: 新細明體; font-size: large;"><span style="background-color: rgba(255, 255, 255, 0.9);">,用來閱讀微血管的走向分佈(pit pattern),藉此判斷瘜肉是否已經癌化。</span></span>大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-57306147379099632492020-05-22T20:58:00.002+08:002020-05-22T21:00:47.840+08:00木瓜牛奶阿伯~<div style="text-align: center;"><font size="4">木瓜牛奶阿伯</font></div><div style="text-align: center;"> <div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7SdKxBrYiMFISGdTxKMEBzCXE_K3RwZV9IklCuAeZeZJ8pCbW4rTGTs45aRCgKH8hZb8hsLrSLbl-DC05Zym5PtA-gZTURTJUQfSSQrGyFGt30CrAxb20Yh0NNCnDSd1Nz4GrPZwDI8s/" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="4032" data-original-width="3024" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi7SdKxBrYiMFISGdTxKMEBzCXE_K3RwZV9IklCuAeZeZJ8pCbW4rTGTs45aRCgKH8hZb8hsLrSLbl-DC05Zym5PtA-gZTURTJUQfSSQrGyFGt30CrAxb20Yh0NNCnDSd1Nz4GrPZwDI8s/s320/E76D9D64-89FD-49FA-827F-DC7E7318D447.JPG" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div></div><div style="text-align: left;"> <font size="4">一直想寫寫木瓜牛奶阿伯的故事。</font></div><div style="text-align: left;"><span style="font-size: large;"><br /></span></div><div style="text-align: left;"><span style="font-size: large;"> 話說,</span><span style="font-size: large;">這位阿伯已經在<font color="#f57c00">志典醫師</font>的門診治療好幾年了。。。</span></div><div style="text-align: left;"><font size="4"><br /></font></div><font size="4"> 阿伯是個腸癌病患,從一開始診斷到手術,到術後的化療,一直都規規矩矩地在<font color="#f57c00">志典醫師</font>的門診追蹤。<span style="background-color: white;">也許是因為信任,不論是好消息還是壞消息,阿伯都仔細聆聽,然後欣然接受建議與治療。</span></font><div><font size="4"><br /></font></div><div><font size="4"> 阿伯很可愛,從第一次門診開始,每次門診都帶著三瓶木瓜牛奶來給診間的我們。這個正字標記,連時常一起候診的病人都知道。(化療病人要兩週打一次化療,大家週期相同所以常常會遇到)有時候其他病人一進診間,也會笑笑的告訴<font color="#f57c00">志典醫師</font>:</font></div><div><font size="4"><br /></font></div><div><font size="4"> “<font color="#f57c00">志典醫師</font>啊,阿伯今天又來了喔~”</font></div><div><font size="4"><br /></font></div><div><font size="4"> “挖災啦~” <font color="#f57c00">志典醫師</font>只好ㄧ樣笑笑地回應。</font></div><div><font size="4"> </font></div><div><font size="4"><br /></font></div><div><font size="4"> 輪到阿伯了,他走了進來,手上照樣是紅白條紋塑膠袋,裝著三罐統一木瓜牛奶。</font></div><div><font size="4"><br /></font></div><div><font size="4"> “來來...醫師啊!呷一罐涼的啦!”</font></div><div><font size="4"><br /></font></div><div><span style="font-size: large;"> “阿伯你太客氣啦~以後哩麥擱架工夫啦!”</span></div><div><font size="4"><br /></font></div><div><font size="4"> “不要緊啦~”</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><font size="4"> 照理來說,病人送禮我們是應該要婉拒的。但一再推辭,反而有點不近人情了。因此到後來,乾脆就欣然接受了。於是,每兩個禮拜的某次門診,都多了一瓶木瓜牛奶可以喝。</font><span style="font-size: large;">我自己一瓶,診間護理師們也一瓶。</span></div><div><font size="4"><br /></font></div><div><font size="4"> 怪了,明明是冰的木瓜牛奶,喝起來卻心暖暖的......^^</font></div><div><font size="4"><br /></font></div><div><font size="4"> </font></div><div><font size="4"><br /></font></div><div><font size="4"> </font></div>大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com1tag:blogger.com,1999:blog-5718842564484202843.post-38903749173093963362020-01-21T15:57:00.001+08:002020-01-21T16:01:21.827+08:00吉普車病 - 小屁屁附近會痛不一定是痔瘡廔管喔!<div style="text-align: center;">
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<span style="font-size: large;">吉普車病 - 小屁屁附近會痛不一定是痔瘡廔管喔!</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEib22D-DFdFzJjGLu48BGKlS-l4eI7uKqNHpedz7kkflzliYxaKJiGNN_w9p1g2Xfe7YeLMmHfTflmsokO_GP96S_ah8q0tg1dTNA2xU9P5ssASBr_1VLctTvGyT_XVcYU6_50W-bF3UPk/s1600/bd282ef25a82fc6ff53e2b80d656deea.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1600" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEib22D-DFdFzJjGLu48BGKlS-l4eI7uKqNHpedz7kkflzliYxaKJiGNN_w9p1g2Xfe7YeLMmHfTflmsokO_GP96S_ah8q0tg1dTNA2xU9P5ssASBr_1VLctTvGyT_XVcYU6_50W-bF3UPk/s640/bd282ef25a82fc6ff53e2b80d656deea.jpeg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">吉普車坐久了會生病?</td></tr>
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<span style="font-size: large;">有的女生說,男生毛多很性感。</span></div>
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<span style="font-size: large;">BUT!!</span></div>
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<span style="font-size: large;">台灣話說,“五幾賀某𠹌賀”。性感,是要付出代價的!!</span></div>
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(這純粹是不性感的我們因為忌妒所發出的怒吼 XD)<br />
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<span style="font-size: large;">這就是我們今天的主題:吉普車病( 學名:潛毛竇 )</span></div>
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<span style="font-size: large;">毛多的人,尤其是40歲以下的年輕男性,比較容易有潛毛竇的發生。那麼,什麼是潛毛竇呢?</span></div>
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<span style="font-size: large;">潛毛竇是一種皮下的發炎反應。發生的原因並未確定,比較常被接受的一個說法是毛髮沒有往表皮方向生長,而在長在皮下的毛囊內,又因為外力的拉扯刺激,造成毛髮穿過毛囊走在皮下。皮下的毛髮刺激造成發炎反應,而形成膿瘍並向頭側潛移成為一個管道。病人大多在薦尾骨附近有疼痛,分泌物,紅腫等等的症狀。有點像肛門周圍膿瘍或是肛門廔管的表現,但是位置型態大不相同。</span><br />
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<span style="font-size: large;">人類歷史上,曾有一段時間有大量的潛毛竇病人的發生,</span><span style="font-size: large;">也就是二次世界大戰時期。根據統計,美軍在1940年代,一共有超過八萬個士兵因為這個疾病就醫,許多是因為久坐軍車,臀部毛髮拉扯而造成。這就是潛毛竇又稱為” 吉普車病 “( jeep disease )的由來。所以,長途載客的司機們其實也是好犯的族群。</span><br />
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<span style="font-size: large;">治療上以手術為主。不論是切開引流,局部切除並直接傷口縫合,局部切除並以局部皮瓣重建,局部切除加上次級癒合等等。</span><br />
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<span style="font-size: large;">今天分享的就是這樣的一個病例。</span><br />
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<span style="font-size: large;">分隔頁 </span><span style="font-size: large;">以下有手術照片 請謹慎取用 </span><span style="font-size: x-small;">就是這麼老派要用BBS的老方法來提醒大家</span><br />
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<span style="font-size: large;">分隔頁 </span><span style="font-size: large;">以下有手術照片 請謹慎取用 </span><span style="font-size: x-small;">就是這麼老派要用BBS的老方法來提醒大家</span><br />
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潛毛竇,在兩段箭頭的皮下有一條長長的通道,裡面都是化膿狀分泌物。</div>
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<span style="font-size: large;">別看圖片中病人的皮膚古溜古溜光滑光滑的,這可是術前辛辛苦苦的花了將近“ 十分鐘 ”的時間仔細剃毛的成果。</span><br />
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<span style="font-size: large;">這位病人是個性(ㄇㄠˊ)感(ㄉㄨㄛ)的25歲底迪。前胸後背都是濃密的毛髮,主訴背後尾胝骨附近疼痛好幾天,而且有分泌物。檢查的時候,看到在股溝的上端有一個紅腫的小開口,有一些膿狀分泌物,按壓有明顯疼痛感。</span><br />
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<span style="font-size: large;">這樣的病史加上這樣的表現,幾乎可以確定就是潛毛竇( pilonidal sinusitis with abscess)這個診斷了。</span><span style="font-size: large;">由於病人已經手術過而且復發兩次,本次還是建議廣泛切除並且作局部皮瓣重建,希望可以不要再復發了。</span><br />
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<span style="font-size: large;">術前,整形外科的呂醫師用麥克筆仔細地畫出皮瓣的設計,使用菱形皮瓣(rhomboid flap)來重建。</span><br />
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<span style="font-size: large;">計劃擬定好了之後,便開始我們的手術。我們</span><span style="font-size: large;">花了約15分鐘將病灶切除,但在下背部中央的位置留下一個大約 10 x 12 公分大小的表皮缺損,讓整形外科來傷腦筋。</span><br />
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<span style="font-size: large;">整形外科也很厲害,完全依照術前的皮瓣設計,幫我們把皮膚缺損給完美的補了起來。</span><br />
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<tr><td class="tr-caption" style="font-size: 12.8px;">重建完成,補得很好!</td></tr>
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<span style="font-size: large;">術後,交給專業的傷造口護理師CL姐幫病患做傷口的護理,用負壓傷口治療(Negative Pressure Wound Therapy)的方式處理,不僅降低感染的機會,病人也不用經歷每天換藥的辛苦。</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwKCLfED0gbxjg5krUpJRAll5ivSQMGDmkWKUnBjeq29rW44mDeaZJ5z4cV2klsbZfsOCRzhtsgyHy2ocXgd7gUFnEMJHjXtPSur1Qp09fg3Vye4zSfGS9G0_Wb6mcdtkr1DpTr3D1p0A/s1600/%25E7%25B0%25A1%25E5%25A0%25B11.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="675" data-original-width="1200" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwKCLfED0gbxjg5krUpJRAll5ivSQMGDmkWKUnBjeq29rW44mDeaZJ5z4cV2klsbZfsOCRzhtsgyHy2ocXgd7gUFnEMJHjXtPSur1Qp09fg3Vye4zSfGS9G0_Wb6mcdtkr1DpTr3D1p0A/s640/%25E7%25B0%25A1%25E5%25A0%25B11.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">NPWT讓病人術後很輕鬆!</td></tr>
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<span style="font-size: large;">術後第五天,移除病人的NPWT 引流管,病人順利出院。這次,目前為止一切順利!期待病人回診時給我們一切穩定的好消息!</span><br />
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大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-35164737355953028352020-01-12T18:32:00.004+08:002020-01-21T01:14:21.122+08:00一個大腸直腸科醫師的大腸鏡體驗<div style="text-align: center;">
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<span style="font-size: x-large;">一個大腸直腸科醫師的大腸鏡體驗</span></h2>
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<span style="font-size: large;"> </span><span style="font-weight: normal;"><span style="font-size: large;">原來就是這種感覺 ~啊~</span></span></h4>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi81GFcaqYv_ceWw4naew4ux2VFIMfnC9QpaIQ8ztSCVCYMMk6YkTw-ryyLH7Ud9fXuyVgoKvdYzIHr5kncOb1zDj-2JKDZOzIgO3jHXhx8ayDkZ0SKIL4UPBEgQTcjiGGTMC_b3prCeHM/s1600/%25E7%25B0%25A1%25E5%25A0%25B12.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="675" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi81GFcaqYv_ceWw4naew4ux2VFIMfnC9QpaIQ8ztSCVCYMMk6YkTw-ryyLH7Ud9fXuyVgoKvdYzIHr5kncOb1zDj-2JKDZOzIgO3jHXhx8ayDkZ0SKIL4UPBEgQTcjiGGTMC_b3prCeHM/s1600/%25E7%25B0%25A1%25E5%25A0%25B12.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px; padding-top: 4px; text-align: center;">今天,既是醫生,也是病人</td></tr>
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<span style="font-size: large;"><span style="font-weight: 400;">俗話說的好,</span></span></h3>
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<span style="font-size: large;"><span style="font-weight: 400;">“ O 人 者 人 恆 O 之 ”</span></span><span style="font-weight: normal;"><span style="font-size: large; text-align: left;">( O </span><span style="font-size: large; text-align: left;">可以填入任何動詞)</span></span></h3>
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<span style="font-size: large; font-weight: normal;">幫這麼多人做過大腸鏡檢查,篩檢過這麼多大腸疾病,自己卻沒做過大腸鏡檢,好像說不太過去。再者,看多了自己也會害怕,醫界傳有一個說法,走哪一科的醫生通常就會得到那一科的毛病,更何況我也算有家族史啊!(志典醫師自己也很怕大腸癌啊!)。因此,就在某天上班查完房的時刻,終於下定決心,排出時間,準備好好檢查一番。</span><br />
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<span style="font-size: large;"><br /></span><span style="font-weight: normal;"><span style="font-size: large;">很快地,時間來到檢查前兩天了。<span style="color: #e69138;">兩天前開始做腸道準備,只能吃低渣飲食</span>。因此志典醫師一大早就到全家便利商店買了半條土司,心想,</span><span style="font-size: large;">反正也沒時間準備其他食物,</span><span style="font-size: large;">今天餓的時候就靠它了。一大早先吞了兩片,一如既往的搭配咖啡當成早餐。早餐,</span><span style="font-size: large;">pass~</span></span><br />
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<span style="font-weight: normal;"><span style="font-size: large;">沒想到中午是最大的煎熬。科內訂了聖誕大餐準備過聖誕節,各式各樣的食物讓我好煎熬啊!不過,經過了一番仔細檢視菜色之後,發現我還是有可以吃的食物!於是大吃特吃了不帶皮烤雞肉,跟貢丸湯的清湯,</span><span style="color: #e69138; font-size: large;">還是吃得飽飽的</span><span style="font-size: large;">!大腸鏡前的腸道準備可以不用那麼辛苦!</span></span><br />
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQqhRrUI30GZ1sVkSMme-qtXkX_nu6CwVx-cd2zka45aKpGqoJPmMVH_i__h7vmRUiBSeWyS5CxN_-8wJZmpFhkkLQxhmul-GgNVbpfHLCZqizZDfnfB5-AlMsCGb7rRzRK8BoHvK9kjI/s1600/%25E7%25B0%25A1%25E5%25A0%25B14.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="675" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiQqhRrUI30GZ1sVkSMme-qtXkX_nu6CwVx-cd2zka45aKpGqoJPmMVH_i__h7vmRUiBSeWyS5CxN_-8wJZmpFhkkLQxhmul-GgNVbpfHLCZqizZDfnfB5-AlMsCGb7rRzRK8BoHvK9kjI/s1600/%25E7%25B0%25A1%25E5%25A0%25B14.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">腸道準備衛教單上面列舉的低渣食物,不過其實不只這些喔!</td></tr>
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<span style="font-size: large;"></span><span style="font-size: large; font-weight: normal;">到了晚上,因為中午吃烤雞肉吃太多,居然不餓。喝了個人喜愛的老賴紅茶配吐司就當一餐了。第一天的腸道準備順利度過~</span><br />
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<span style="font-weight: normal;"><span style="font-size: large;">第二天腸道準備就稍微辛苦一點了,</span><span style="font-size: large;">必須全天清流質飲食。早餐、午晚餐分別以咖啡跟蛤蜊湯度過。到了晚上七點,帶著萬分期待(又怕受傷害)的心情喝下第一次的保可淨瀉藥。過了半個鐘頭,拿起準備好的舒跑跟礦泉水開始一杯一杯規律的補充水分。</span></span><br />
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<span style="font-size: large; font-weight: normal;">半小時過去了。。。</span><br />
<span style="font-size: large; font-weight: normal;">一小時過去了。。。</span><br />
<span style="font-size: large; font-weight: normal;">一小時半過去了。。。</span><br />
<span style="font-size: large; font-weight: normal;">兩小時過去了。。。</span><br />
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<span style="font-size: large; font-weight: normal;">慢慢的,不知不覺已經晚上十點了,一點拉肚子的感覺也沒有。。。</span><br />
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<span style="font-size: large; font-weight: normal;">這下志典醫師開始擔心了。要知道如果沒有拉肚子把腸道內的便便解乾淨,隔天的大腸鏡檢查根本就是個悲劇啊!而且也無法發揮鏡檢預期的成效。於是,也顧不得下一個劑量是隔天凌晨才吃,當場就先再泡一包喝下去,繼續補充水份。</span><br />
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<span style="font-size: large; font-weight: normal;">半個鐘頭過去了。。。</span><br />
<span style="font-size: large; font-weight: normal;">一個鐘頭過去了。。。</span><br />
<span style="font-size: large; font-weight: normal;">一個半鐘頭過去了。。。</span><br />
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<span style="font-size: large; font-weight: normal;">咦?</span><br />
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<span style="font-weight: normal;"><span style="font-size: large;">就在這個moment,肚子好像有點感覺了,</span><span style="font-size: large;">趕緊跑去廁所等。</span><span style="font-size: large;">最後,終於在半夜十二點</span><span style="font-size: large;">開始拉肚子,讓我鬆了好大一口氣。。。</span></span><br />
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<span style="font-size: large; font-weight: normal;">“Well, better late than never.” 我暗想。帶著忐忑不安的心情上床睡覺去。今天,總共喝了大約5000cc的液體,終於達到預期清腸的效果。</span><br />
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<span style="font-weight: normal;"><span style="font-size: large;">隔天一大早到了醫院,找到一向信賴的張醫師準備開始了。不過,因為臉皮太薄,不好意思叫眾家學弟助理們走開,沒有進行清場的動作。只好安慰自己這是</span><span style="font-size: large;">“ 秉持著教學醫院的精神,把自己當教材” 奉獻給醫學教育</span>(<span style="font-size: small;">好吧我承認我是百般不願啊~)</span></span><br />
<span style="font-weight: normal;"><span style="font-size: large;">於是就在好幾位學弟、助理們的眾目睽睽之下,開始了我的檢查。</span><span style="font-size: small;">(應該不會有人跟我一樣在七八個人,十幾雙眼睛的注目下做大腸鏡檢查吧QQ)</span></span><br />
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<span style="font-weight: normal;"><span style="font-size: large;">因為覺得身為大腸直腸科醫師,應該要實際體驗ㄧ下大腸鏡檢查過程中的感覺,因此沒有選擇做無痛大腸鏡檢查而是直接做一般大腸鏡檢。過程中,因為自己知道檢查到哪個位置,更能實際感受到病人在過程中可能遇到哪些不舒服。跟過往的經驗一樣,乙狀結腸的部位會有拉扯的感覺而感到不適,骨盆腔有點酸脹感的,另外在施做到脾</span><span style="font-size: large;">彎曲的部位也稍有不適,其他並沒有太大的痛感。整個過程中,的確在轉彎的時候較不舒服,在此也要特別謝謝張醫師技術高超!(<span style="color: #3d85c6;">註</span>)</span></span><br />
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<span style="font-size: large; font-weight: normal;">檢查十分順利,很幸運的,過程中也沒有發現大腸瘜肉或是其他問題。除此之外,實際體驗了檢查過程中的各種感覺,在之後施做大腸鏡檢查時,更能用自己的親身經驗感受與病患們溝通,算是我最大的一個收穫。</span><br />
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<span style="font-size: large; font-weight: normal;">終於放下心中的大石頭了。定期的檢查,至少可以確保我可以繼續安心的吃我最愛的串燒好幾年。划算!</span><br />
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD2iqdbsTOMiHAouv_RQn0_-RAheRslaDNisYIcE_4FdLwwq7yJ5L5IlImSDLsjVQRDmSyXSnIT-FXxFXPXGJudqEBwyMnxSB5bWXxP0KywqAKauTUlsC5yehQhUZ4rLV__9hROQqW-u8/s1600/%25E7%25B0%25A1%25E5%25A0%25B13.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="675" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD2iqdbsTOMiHAouv_RQn0_-RAheRslaDNisYIcE_4FdLwwq7yJ5L5IlImSDLsjVQRDmSyXSnIT-FXxFXPXGJudqEBwyMnxSB5bWXxP0KywqAKauTUlsC5yehQhUZ4rLV__9hROQqW-u8/s1600/%25E7%25B0%25A1%25E5%25A0%25B13.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">被做檢查 V.S. 施做檢查</td></tr>
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<span style="font-weight: normal;"><span style="color: #3d85c6; font-size: large;"><br />註:</span><span style="font-size: large;">大腸鏡檢查中,病人感受到疼痛與否,除了醫師技術技巧之外,也與病人的大腸本身的狀態有關。有開過刀,經歷過剖腹產,子宮內膜異位。。。等等病史的病人,</span><span style="font-size: large;">可能因為腹腔內沾黏而造成腸道較為彎曲,造成大腸鏡檢查過程中比較疼痛。然而,由於無法事先預知腸道沾黏狀況,或是腸道彎曲的程度,因此需不需要做無痛大腸鏡避免過程中過度疼痛,還是需要由醫師依照個人狀況評估。</span></span><br />
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大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-11657295333994399332019-12-03T15:54:00.002+08:002019-12-07T17:38:27.698+08:00小小痔瘡,大大不便<div style="text-align: center;">
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<span style="font-size: large;">小小痔瘡,大大不便</span></h2>
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<span style="font-size: large;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0Y5fmT9vdJCTlYKYe2I3Fl0Wke2MRviKntLBZmRJ6a99hVTnEHHg49Ej5RNJ9deFDfy8cYU3kdD8oWaNHjpge-MWysggf4zXxfi4cVMYi6uaJPnvkUFqmRJvH4yeEvTh_6T39VKUIB8g/s1600/hemorrhoids-2790200_640.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="426" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh0Y5fmT9vdJCTlYKYe2I3Fl0Wke2MRviKntLBZmRJ6a99hVTnEHHg49Ej5RNJ9deFDfy8cYU3kdD8oWaNHjpge-MWysggf4zXxfi4cVMYi6uaJPnvkUFqmRJvH4yeEvTh_6T39VKUIB8g/s1600/hemorrhoids-2790200_640.jpg" /></a></span></div>
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<span style="font-size: large;">痔瘡雖是小病,但</span><span style="font-size: large;">盛行率高,超過一半的人一生中至少有一次痔瘡發作。俗話說“十人九痣”,便是這個道理。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">不過,就像哈利波特裡面的佛地魔一樣,痔瘡是一般民眾難以啟齒不願掛在嘴邊的疾病。也像佛地魔一樣,不說他依然存在,而且總是在不可預期的時刻突然發作,讓患者坐立難安,影響日常生活。雖然痔瘡不像佛地魔一樣破壞力十足,但小病仍會造成大困擾,門診時還是有不少朋友因此前來看診,尋求解決。</span><span style="font-size: large;">但嚴格來說,</span></div>
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<span style="font-size: large; text-align: center;">每一個人都有痔瘡 </span><span style="font-size: large; text-align: center;">每一個人都有痔瘡 </span><span style="font-size: large; text-align: center;">每一個人都有痔瘡</span></div>
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(因為很嚇人所以要講三次,但了解之後就不嚇人了)</div>
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<span style="font-size: large;">所以如果懷疑有這樣的問題,不要害怕,還是建議就醫處理。</span></div>
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<span style="font-size: large;"><span style="color: #6aa84f;">所以</span>痔瘡到底是什麼?</span></h3>
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<span style="font-size: large;"><span style="color: #e69138;">志典醫師: </span> </span></div>
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<span style="font-size: large;">痔瘡是人體<span style="color: #3d85c6;">正常的組織正常的組織正常的組織</span></span><span style="text-align: right;">(因為很重要所以也要講三次)</span><span style="font-size: large;">,由肛門口周圍的結締組織(包括黏膜、黏膜下組織、血管...等等)所構成。負責的功能有點像氣密窗周圍的封條,或是保鮮盒蓋子裡面的橡皮墊圈一樣,是維持肛門口密閉(seal-off)的功能。它像一個軟墊(cushion)把我們的腸道內容物封閉在腸道之中,與外界隔開,讓我們在平時不會有排泄物滲出的問題發生。</span>(可以想看看,如果我們的氣密窗關不緊,或是保鮮盒沒有橡膠墊圈,是不是就會漏?同樣的道理)</div>
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<span style="font-size: large;">所以我怎麼知道我有沒有痔瘡?</span></h3>
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<span style="color: #e69138; font-size: large;">志典醫師:</span>(都說了每個人都有痔瘡...)</div>
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<span style="font-size: large;">來說說痔瘡的症狀。痔瘡平常是沒有症狀的,症狀只發生在痔瘡組織有了形態上的變化之後才會出現。而相關的症狀也很容易理解:</span></div>
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<span style="font-size: large;">當痔瘡組織腫大,會有</span><span style="color: #3d85c6; font-size: large;">腫脹不適甚至疼痛</span><span style="font-size: large;">的感覺。</span></div>
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<span style="font-size: large;">當氣密功能受損,就比較會有腸道內分泌物漏出造成<span style="color: #3d85c6;">搔癢,皮膚炎</span>等症狀。</span><br />
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<span style="font-size: large;">當底下血管組織或是黏膜破損,就可能有<span style="color: #3d85c6;">血便</span>的狀況發生。</span><br />
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<span style="font-size: large;">所以我便便的時候常常會流血,是不是痔瘡發作了?</span></h3>
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<span style="font-size: large;"><br /></span><span style="font-size: large;"><span style="color: #e69138;">志典醫師:</span></span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;">有可能,但也不一定是。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">便便有血其實是個重要的議題。除了痔瘡之外,還有太多其他原因可能造成血便。其中,大腸直腸癌、大腸憩室發炎、各種原因造成的大腸直腸發炎、肛裂,都</span><span style="font-size: large;">可能是造成血便的原因。為了排除其他原因,建議有危險因子的病患先做</span><span style="color: #3d85c6; font-size: large;">大腸鏡檢查</span><span style="font-size: large;">確定不是其他原因造成的出血,才能安心當成痔瘡來治療,真正對症下藥。</span><br />
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<span style="font-size: large;">所以什麼樣的人比較容易痔瘡發作?</span></h3>
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<span style="font-size: large;"><br /></span><span style="font-size: large;"><span style="color: #e69138;">志典醫師:</span></span><br />
<span style="font-size: large;">痔瘡組織裡含有血管組織,一旦血管內壓力上升,就可能造成痔瘡發作。包括久坐、久站、熬夜、便秘、肝硬化、懷孕</span><span style="font-size: medium;">(孕婦媽媽們是很辛苦的)<span style="font-size: large;">都是痔瘡的好發因子。門診時遇到痔瘡發作的病人,病史一問,常常會發現有最近工作比較累或是熬夜的狀況。所以坐辦公桌的朋友或是因為工作需要久站朋友們記得隔一段時間稍微動一動。</span></span><span style="font-size: large;"></span><br />
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<span style="font-size: large;">我的痔瘡嚴不嚴重,需不需要開刀?</span></h3>
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<span style="font-size: large;"><span style="color: #e69138;">志典醫師:</span></span><br />
<span style="font-size: large;">痔瘡依照脫垂(prolapse)的程度分成四級:</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">第一級 <span style="color: #3d85c6;">沒有脫垂</span>症狀,可能以無痛性出血作為表現。</span><br />
<span style="font-size: large;">第二級 輕微脫垂症狀,但<span style="color: #3d85c6;">不需外力</span>即可回復正常狀態。</span><br />
<span style="font-size: large;">第三級 中度脫垂症狀,<span style="color: #3d85c6;">需外力推</span>回才能恢復平常狀態。</span><br />
<span style="font-size: large;">第四集 重度脫垂症狀,以外力仍<span style="color: #3d85c6;">無法推回</span>到平時狀態。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">一般而言,</span><span style="font-size: large;">第一度、第二度不見得需要手術治療,可以用<span style="color: #3d85c6;">藥物(註1)</span>,<span style="color: #3d85c6;">盆浴</span>,或者是<span style="color: #3d85c6;">橡皮筋結紮術</span>(<span style="color: #3d85c6;">註2</span>)做處理。而第三度、第四度則可以考慮<span style="color: #3d85c6;">手術治療</span>(見<span style="color: #3d85c6;"><a href="https://cct-basicmedical.blogspot.com/2019/10/21.html">21世紀痔瘡的手術治療</a></span>)。然而這只是一個通則,究竟需不需要手術,還需考慮病人本身的條件。症狀困擾程度、年紀、慢性病的有無、術後照顧能力...等等,都是必須考量的因素。因此還是需要大腸直腸科<span style="color: #3d85c6;">專科醫師</span>做完整的評估才能給予適切的建議。</span><br />
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<span style="font-size: large;"><span style="color: #6aa84f;">那應該如何預防</span></span><span style="font-size: large;">痔瘡發作呢?</span></h3>
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<span style="font-size: large;"><span style="color: #e69138;">志典醫師:</span></span><br />
<span style="font-size: large;">痔瘡的預防,其實就是<span style="color: #3d85c6;">去除掉好發因子,</span>並預防<span style="color: #3d85c6;">便秘</span>的發生。多吃蔬菜水果、攝取足量水分、適度運動、避免久坐久站,都是老生常談但重要的觀念。然而,對於嚴重便秘或是長期便秘的病人(chronic idiopathic constipation, CIC),搭配口服的軟便劑會更有療效。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">但值得注意的是,千萬不要將血便自行判斷為痔瘡發作,如果常有血便的問題,還是必須<span style="color: #3d85c6;">由醫師評估</span>是否單純是由痔瘡造成,才不會拖延了治療時機。</span><br />
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<span style="font-size: large;"><span style="color: #3d85c6;">註1</span>:</span><br />
<span style="font-size: large;">除了軟便劑之外,痔瘡常用藥物包括軟膏和栓劑。其中成分大多包含局部麻醉劑 ( lidocaine ) 、收斂劑(zinc oxide)、血管收縮劑 ( ephedrine )及類固醇 ( hydrocortisone ) 。這些成分對於痔瘡的疼痛、搔癢、腫脹、腫脹、刺激感有一定程度的幫助。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><span style="color: #3d85c6;">註2</span> :</span><br />
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<span style="font-size: large;">橡皮筋結紮術是一個有效處理內痔的方法。利用橡皮筋將內痔結紮,經過7-10天之後痔瘡將會脫落,對於痔瘡程度不嚴重的病人的確是選項之一。</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic6-_nVJ4Cxwyiw760KHXT5u7TS_ls4q3UL0xoJR3faAEK8CpyakNmTCCG0peQJyR56CfcCFvCUSX1qiXZKK_ricKscYSWcVvrxksxhe6MWRDfc0_lymBtWbVTS6ouEUaeQsuLJqC9c2w/s1600/IMG_20191013_205651.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1051" data-original-width="1600" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic6-_nVJ4Cxwyiw760KHXT5u7TS_ls4q3UL0xoJR3faAEK8CpyakNmTCCG0peQJyR56CfcCFvCUSX1qiXZKK_ricKscYSWcVvrxksxhe6MWRDfc0_lymBtWbVTS6ouEUaeQsuLJqC9c2w/s1600/IMG_20191013_205651.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">橡皮筋結紮槍,在右側槍頭發射橡皮筋,內痔在橡皮筋緊套後會自行脫落,達到痔瘡移除的效果。</td></tr>
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<span style="font-size: large;">然而橡皮筋結紮對於外痔的病患並不適用。由於外痔的位置在表皮,用橡皮筋結紮就像皮被用手用力捏著一樣,會有相當程度的痛感,甚至造成表皮壞死。另外,對於有出血傾向的病患也不適合,因此在能不能結紮的評估上仍須小心。</span><br />
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延伸閱讀<br />
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<h3>
痔瘡案例解析</h3>
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大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-75189782463380533782019-12-02T12:43:00.002+08:002019-12-07T11:12:14.332+08:00醫師簡介 Education<span style="white-space: pre;"> </span><br />
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台北醫學大學醫學系<br />
中山醫學大學臨床醫學研究所博士<br />
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Career<span style="white-space: pre;"> </span><br />
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台灣外科醫學會專科醫師<br />
台灣外科醫學會會員<br />
台中榮總大腸直腸外科研究醫師<br />
中華民國大腸直腸外科專科醫師<br />
中華民國大腸直腸外科醫學會會員<br />
台中榮總大腸直腸外科主治醫師<br />
台中榮總重症醫學部主治醫師<br />
國防醫學院臨床教師<br />
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Board certification<br />
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台灣醫師執照<br />
台灣外科專科執照<br />
中華民國大腸直腸外科專科執照<br />
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進修訓練<br />
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日本國立癌症中心消化道內視鏡進修<br />
韓國峨山醫學中心Asan Medical Center達文西機器手臂進修<br />
韓國延世大學達文西機器手臂進修<br />
<br />大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-88894680237579617252019-12-02T11:01:00.000+08:002019-12-02T11:01:48.232+08:00大腸癌是什麼? <div style="text-align: center;">
<span style="font-size: large;">這是個聞癌色變的年代,不過</span></div>
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<span style="color: #6fa8dc; font-size: large;">大腸癌並非不治之症</span></div>
<span style="color: #6fa8dc; font-size: large;"><br /></span><span style="font-size: large;">大腸癌已經連續11年成為國人癌症發生率的第一位,每年平均有14000人罹患大腸癌。值得慶幸的是,<span style="color: #6fa8dc;">大腸癌並非不治之症</span>。隨著化療及標靶藥物的蓬勃發展,不但末期的病患有相對於其他癌症更多的藥物可供使用,第一、第二、第三期的病患,更有相當高的機會完全根治。因此,<span style="color: #6fa8dc;">預防重於治療</span>一直是大腸癌治療的最高準則。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><span style="color: #93c47d;">網友Q問:</span>大腸癌到底是什麼?</span><br />
<span style="font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師:</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo-idJxc_hQF03kfgxBQB5S9rKi8MgAaRlXpoYYAa66AWb7j2dF3o7saCn-sb4SAXMYgymKB42OXWtesHs-ZYlWAbXmdHqQ4ewfJnvp4i1xl2yiLEufsf8N6UTjZI7Q5ugoigEqWkUQ6M/s1600/colon+cancer.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgo-idJxc_hQF03kfgxBQB5S9rKi8MgAaRlXpoYYAa66AWb7j2dF3o7saCn-sb4SAXMYgymKB42OXWtesHs-ZYlWAbXmdHqQ4ewfJnvp4i1xl2yiLEufsf8N6UTjZI7Q5ugoigEqWkUQ6M/s400/colon+cancer.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">大腸鏡之下,大腸癌的外觀</td></tr>
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<span style="font-size: large;"> 大腸癌是大腸黏膜層因基因突變而形成瘜肉,經由10~15年的過程癌變而形成大腸癌。危險因子包括家族史、年齡、西式飲食、抽菸、紅肉、高油脂食物、自由基、亞硝酸鹽(防腐劑)...等等。</span><br />
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<span style="font-size: large;"><br /></span><span style="color: #93c47d; font-size: large;">網友Q問:</span><span style="font-size: large;">大腸癌有什麼症狀嗎?</span><br />
<span style="font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師:</span><br />
<span style="font-size: large;"> 大腸癌為常見的症狀就是<span style="color: #6fa8dc;">沒有症狀</span>。其他相關症狀因腫瘤位置不同而異。</span><br />
<span style="font-size: large;"> 若腫瘤位在<span style="color: #6fa8dc;">右側</span>大腸,症狀大多以<span style="color: #6fa8dc;">貧血</span>為表現,病患會覺得時常頭暈。然而女性因為有月經的關係,常慢性貧血的問題,很難跟右側大腸癌造成的貧血做區分。</span><br />
<span style="font-size: large;"> 若腫瘤位在<span style="color: #6fa8dc;">左側</span>大腸,症狀大多以<span style="color: #6fa8dc;">腹脹、腹痛、血便</span>為表現。因為左側大腸的腸腔較窄,比較容易有阻塞相關症狀發生。</span><br />
<span style="font-size: large;"> 若腫瘤位在<span style="color: #6fa8dc;">直腸</span>附近,症狀大多以<span style="color: #6fa8dc;">血便、大便變細</span>為主。因腫瘤位置靠近肛門口,腫瘤又是由血管增生豐富的組織構成,因此出血較容易被發現。而因為糞便到直腸附近會受到腫瘤的擠壓,容易有外型上的改變。</span><br />
<span style="font-size: large;"> 雖然如此,還是必須一再強調,<span style="color: #6fa8dc;">初期的大腸癌是完全沒有症狀的</span>。</span><br />
<span style="font-size: large;"><br /></span><span style="color: #93c47d; font-size: large;">網友Q問:</span><span style="font-size: large;">如何得知我有沒有大腸癌?</span><br />
<span style="font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師:</span><br />
<span style="font-size: large;"> 有鑒於國人飲食西化,大腸癌發生年齡逐漸降低,國健局已經將大腸癌篩檢的年紀由50歲下修到45歲。有糞便潛血或是任何危險因子的病人,都建議做<span style="color: #6fa8dc;">大腸鏡檢查</span>來排除大腸癌的可能性。一般而言,大腸瘜肉的檢出率約60~70%,能夠早期發現大腸瘜肉並做<span style="color: #6fa8dc;">瘜肉切除術</span>,是預防大腸癌的發生最有效的方法。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="color: #93c47d; font-size: large;">網友Q問:</span><span style="font-size: large;">除了</span><span style="font-size: large;">大腸鏡以外,有沒有其他方法得知有沒有大腸癌?</span><br />
<span style="font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師:</span><br />
<span style="font-size: large;"> 有,但有缺陷。除了大腸鏡以外,還有鋇劑攝影和電腦斷層虛擬大腸鏡。不過大腸癌、大腸息肉或是病變檢出率都較差,而且無法做瘜肉切除或病灶切片。簡單來說,如果做了鋇劑攝影之後發現有大腸瘜肉,還是<span style="color: #6fa8dc;">必須再做一次</span>大腸鏡檢查加上瘜肉切除術,才能移除病灶達到預防大腸癌的效果。</span><br />
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<span style="color: #93c47d; font-size: large;">網友Q問:</span><span style="font-size: large;">大腸癌是不是一定要化療?</span><br />
<span style="font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師:</span><br />
<span style="font-size: large;"> 大腸癌的分為第一到</span><span style="font-size: large;">第四期,而治療方式與分期息息相關。第一、第二期只需要手術治療,之後定期追蹤。第三期與高復發風險的第二期則需要接受半年的輔助性化療。第四期病患,手術仍扮演一定角色,但化療搭配標靶藥物的治療相形重要。</span><br />
<span style="font-size: large;"> 大腸癌術後,<span style="color: #6fa8dc;">定期的大腸鏡追蹤腫瘤是否復發</span>非常重要。病友必須積極配合醫師的追蹤,才能得到最好的預後甚至痊癒。</span><br />
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<br />大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-21506310899799307972019-12-01T23:16:00.003+08:002019-12-01T23:16:12.790+08:00醫療 再怎麼小心也不為過 - 一根棉花棒的故事<div style="text-align: center;">
<span style="font-size: large;">“You can never be too</span><span style="font-size: large;"> careful in front of clinical medicine.”</span></div>
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<span style="font-size: large;">今天發生了一個小故事,讓<span style="color: #6aa84f;">志典醫師</span>在萬般無奈之餘,也學到了一課,與大家分享。</span></div>
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<span style="font-size: large;">Q先生,兩年前因為直腸癌的緣故,在其他醫院接受過直腸癌手術治療。</span><span style="font-size: large;">因復發性直腸癌的緣故到志典醫師這裡做腫瘤相關的諮詢。</span><span style="font-size: large;">由於病人本身有腹部主動脈瘤的問題曾放過主動脈支架</span><span style="font-size: large;">,而且心臟功能不佳,做過心導管,</span><span style="font-size: large;">放過心臟血管支架,手術風險性較高,因此原醫師建議只能試試看化療治療。然而,復發性腫瘤已經長比較大而且侵犯膀胱,造成膀胱直腸瘻管(尿液不斷從肛門口漏出),所以病患只能長期放置導尿管。加上時常泌尿道感染,病患每週都必須到醫院做尿管的更換,而且時不時因為泌尿道感染而發燒,生活品質受到很大的影響。</span><span style="font-size: large;">在經過討論之後,幫病患進行了骨盆腔臟器全切除的手術。</span></div>
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<span style="font-size: large;">然而,就在昨天,病人發燒了。</span></div>
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<span style="font-size: large;">發燒在開完刀後的病人可說是屢見不鮮。因此志典醫師照著發燒的標準作業流程做發燒原因的搜索,倒沒什麼特別。後來,發現原來是傷口感染發炎造成。</span></div>
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<span style="font-size: large;">大腸直腸科的手術病人,傷口感染率相對是比較高的,這也算常見。不過,就在志典醫師幫病人打開傷口做棉花棒做清潔的時候,悲劇發生了。。。</span></div>
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<span style="font-size: large;">志典醫師把棉花棒戳進傷口下方清潔的時候,輕輕一拉,也沒什麼異樣感,原本準備拿下一隻棉花棒繼續清理,結果眼角一瞄,(還好我有瞄一下)</span><br />
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<span style="font-size: large; text-align: center;">“</span><span style="color: #e69138; font-size: large; text-align: center;">咦?我的棉花棒頭怎麼不見</span><span style="font-size: large; text-align: center;">”</span></div>
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<span style="font-size: large;">只見到我手裡拿著一支光溜溜的竹籤。。。棒頭的棉花掉到傷口底下卡在裡面了!</span><br />
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<span style="font-size: large;">一陣錯愕之下,開始翻找紗布,看看有沒有掉在紗布上面。</span></div>
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<span style="font-size: large;">沒有。</span></div>
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<span style="font-size: large;"> “</span><span style="font-size: large;">怎麼辦?”護理師問。</span></div>
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<span style="font-size: large;"> ”傷口打開來找“ 志典醫師無奈的說。</span></div>
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<span style="font-size: large;">打了局部麻藥,幫病人加了止痛針之後。傷口整條打開了。經歷一番辛苦,棉花被一片片夾出來。苦了病人,也苦了辛苦的醫護人員。(彎腰駝背在病床旁協助志典醫師夾棉花棒頭)</span><span style="font-size: large;">“伯伯,實在是辛苦你,但我們處理好了。”對病人的安慰是非常重要的。畢竟這不是誰的錯。是棉花棒的錯。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">“謝謝你啊醫師!” 信賴醫療團隊而體諒人的病患,總是令人心疼。</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAXETJXARWY8KCgfjcXnFiFqqXveyRql94_ujstf0WE1luSLjqxUBeqO_-CHW1VPYcvi0E9TLIBo37yBwiXeWvxYwXCNka78RT6kw1txSDin41t33Qq4_VKk-yRHNw0L6mlw2i_rYIgwYy/s1600/IMG_20191001_190807.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1200" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAXETJXARWY8KCgfjcXnFiFqqXveyRql94_ujstf0WE1luSLjqxUBeqO_-CHW1VPYcvi0E9TLIBo37yBwiXeWvxYwXCNka78RT6kw1txSDin41t33Qq4_VKk-yRHNw0L6mlw2i_rYIgwYy/s320/IMG_20191001_190807.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">這是原本棉花棒的樣子</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6TuX35nLM139cgrbOzZlojVIWVtTalux3ETYO4fCfYr-uBCgw9vAC2qbLSjGM-6b7RN1O7wIzg0olG2eSlmxji3VriXVTDGj55FSYZBtu10elzibQtOOF0GW_f8jOPfQnc9aUaUAXX2uw/s1600/IMG_20191001_190826.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6TuX35nLM139cgrbOzZlojVIWVtTalux3ETYO4fCfYr-uBCgw9vAC2qbLSjGM-6b7RN1O7wIzg0olG2eSlmxji3VriXVTDGj55FSYZBtu10elzibQtOOF0GW_f8jOPfQnc9aUaUAXX2uw/s320/IMG_20191001_190826.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">打開包裝是長這樣子</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx9atDAlqeeeF3ignhyphenhyphenzpKG3bin_yZ9UkUzPNvIjV_Sf1B59BdUbzznYZCRr3KGaEujSznB1LEriTmPJ1DcqKD6JV57DHbfdg6CyKvwHuOoVmvKER1mGiFKiHO7S6DA54sCgxROlc-1w6L/s1600/IMG_20190930_113354_1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhx9atDAlqeeeF3ignhyphenhyphenzpKG3bin_yZ9UkUzPNvIjV_Sf1B59BdUbzznYZCRr3KGaEujSznB1LEriTmPJ1DcqKD6JV57DHbfdg6CyKvwHuOoVmvKER1mGiFKiHO7S6DA54sCgxROlc-1w6L/s320/IMG_20190930_113354_1.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">悲劇是長這樣子,上面是夾碎掉的棉花碎屑,下面是光溜溜的棉花棒</td></tr>
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<span style="font-size: large;">醫療不就是這樣?意外無所不在。在醫療面前,再怎麼小心都不為過。</span></div>
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<span style="font-size: large;">為什麼do no harm會放在effective treatment之前?這就是為什麼。</span></div>
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<span style="font-size: large;">特別感謝辛苦幫忙的護理師們,大批人馬幫東幫西,完成任務。</span></div>
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<span style="font-size: large;"> 但,我只有一個註解:</span></div>
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<span style="font-size: large;">“<span style="color: orange;">明天叫廠商來找我罰站。。。</span>”</span></div>
大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com1tag:blogger.com,1999:blog-5718842564484202843.post-17175516433008806022019-12-01T23:13:00.004+08:002019-12-01T23:13:57.847+08:00心臟不跳怎麼辦- 一個團隊合作的成功案例<div style="text-align: center;">
<span style="font-size: large;">這是一個團隊合作的成功案例</span></div>
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說在前頭:</div>
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我相信這是個有分享價值的例子,所以會有一點點醫學名詞在裡面,但大家應該還是可以看得懂。</div>
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<span style="font-size: large;">一個重大手術的成功,手術本身只佔了一部分,更重要的是整個<span style="color: #6fa8dc;">團隊的默契與互相支援</span>。</span><span style="font-size: large;">這位病患治療的成功,靠的是一整個團隊將近十多個人的通力合作。麻醉科、心臟外科、大腸直腸科兩組人馬、心臟內科、麻醉科術後快速恢復小組(ERAS team)。對於大家全力的支援,</span><span style="font-size: large;">除了感謝,還是感謝。</span></div>
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<span style="font-size: large;">這是一位47歲的男性病患,本身心臟功能非常差。有多差呢?我們可以想像一個47歲的壯男,身體裡面居然有一顆比9</span><span style="font-size: large;">9歲老人家還要差的心臟。心臟輸出量差就算了( LVEF 18% with generalized hypokanesia),</span><span style="font-size: large;">左心室還有一個4公分大的血塊(thrombus),只要這個血塊從心臟跑出去,跑到腦血管,就會中風; 跑到手腳,就會手腳壞死截肢; 跑到腸子血管,就會腸壞死。簡直就是心臟疾病大亂鬥的一個病人。</span></div>
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<span style="font-size: large;">在這樣一個軀殼裡面,居然還裝得下低位直腸癌這個疾病(rectal adenocarcinoma, 3cm above anal verge)。</span><span style="font-size: large;"> </span><br />
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<span style="font-size: large; text-align: center;">”或許是上天給我的考驗吧。“ 我不禁這樣想。</span></div>
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<span style="font-size: large;">在分院做過放射治療跟術前化療之後轉到本院。我們開始了術前的檢查。的確,狀況跟分院醫師告訴我們的一樣糟。</span></div>
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<span style="font-size: large;">心臟內科建議,趁放射治療的等待期間(<span style="color: #3d85c6;">註1.</span>)</span><span style="font-size: large;">趕快吃抗凝血劑,看看有沒有機會讓心臟的血塊溶掉。於是我們跟病人溝通,先讓他回家吃藥,之後再過來醫院手術。</span><br />
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<span style="font-size: large; text-align: center;">沒想到病人回家之後,藥只吃了一半。</span></div>
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<span style="font-size: large;">帶著一大塊完整的心臟血塊回來追蹤,還樂天的說,“我覺的應該還好吧?”,志典醫師除了傻眼之外也莫可奈何。但放射治療等待期已過,再不開刀腫瘤說不定開始準備慢慢變大了,將錯過保留肛門的黃金時期。</span></div>
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<span style="font-size: large;">"我們還是做手術吧!但心臟的風險你必須要完全了解,這是生與死的分別。" 我無意嚇唬病人,但這是事實。誰都不希望手術成功但病人醒不過來。</span></div>
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<span style="font-size: large;">病人住院之後,會診了心臟內科、心臟外科、麻醉科,大家約定好時間,共同對病患做說明。</span><span style="font-size: large;">包括術中可能遇到的風險、防範措施、發生問題的解決方法,可能的後果。</span></div>
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<span style="font-size: large;">詳細來說,大腸直腸科找齊了兩組人, 包括兩位主治醫師,兩位總醫師,一位住院醫師。心臟外科及內科說明了心臟風險性及葉克膜的隨時準備。麻醉科說明了術後快速恢復的流程,預防措施、術中心臟血塊的監控,心律不整相關處置。大張旗鼓只為了病人可以手術順利。</span></div>
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<span style="font-size: large;">手術開始了,大家小心翼翼,各司其職,嘴巴不忘兩句玩笑話,緩解緊張的氣氛。</span></div>
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<span style="font-size: large;">終於結束了。心臟沒有心律不整,心臟血塊沒有跑出去造成中風,葉克膜準備著沒用到(但是兩位心臟外科總醫師隨侍在側)。</span></div>
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<span style="font-size: large;">而手術是<span style="color: #3d85c6;">成功</span>的</span><span style="font-size: large;">。</span></div>
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<span style="font-size: large;">術後一個禮拜,在調整完抗凝血藥的劑量之後,病人順利回家了。心裡的大石頭終於放下。</span></div>
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<span style="font-size: large;">“<span style="color: #3d85c6;">彷彿白了兩根頭髮</span>。” 我想</span></div>
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<span style="font-size: large;">團結合作,讓今天這位病患的得到了最好的醫療成果。特別感謝麻醉科S、L醫師,心臟外科W、H、L醫師,大腸直腸科J、J、L、C醫師,還有其他幫忙大小事情的住院醫師們。當然也別忘了旁邊迅速支援的流動刷手護理師們。</span></div>
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<span style="font-size: large;"> 也許這才是<span style="color: #6fa8dc;">醫療價值</span>的展現吧!</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZUDyV4URmCUIxJFxhR-Fs7jhXQiaA1d-mTfD_HeC74p55IKzJfB2msbCctBFm-wHH_HorU0yZNrbZ3kg3qi-x919pllL29lp9a0kHfNHWtsyeOfXgltFa98Saij1Xhxzv8ahH8d6agcsj/s1600/IMG_20190918_123214.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjZUDyV4URmCUIxJFxhR-Fs7jhXQiaA1d-mTfD_HeC74p55IKzJfB2msbCctBFm-wHH_HorU0yZNrbZ3kg3qi-x919pllL29lp9a0kHfNHWtsyeOfXgltFa98Saij1Xhxzv8ahH8d6agcsj/s400/IMG_20190918_123214.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">術前大家各司其職,做最好的準備。</td></tr>
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<span style="font-size: large;"><span style="color: #3d85c6;">註解1 </span>: 直腸癌術前的放射治療等待時間約8~12週,這段期間腫瘤都還有機會持續縮小,可以讓保留肛門的機率上升。</span></div>
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大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-32067749889493587172019-12-01T23:12:00.005+08:002019-12-01T23:12:50.370+08:00這位阿伯您簡直就是大腸鏡的教科書圖譜吧!?<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: large;">N個願望 一次滿足</span></div>
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就像複習圖譜一樣- 琳瑯滿目的一次大腸鏡檢查</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhY5aW6CLCb6XTPmMzifKIHUqJsqtyaJA79dF-ndH4VvvY5lZg4VuBOqD4S95mMDmSC3Bg3tN2vfxpalAaHc03jcO4QYQVDWKNMFwDzsH7l6k2tr_xEWPXCTetp9stkScRqZuaTwAFnX2fX/s1600/boy-1300226_640.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="534" data-original-width="640" height="267" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhY5aW6CLCb6XTPmMzifKIHUqJsqtyaJA79dF-ndH4VvvY5lZg4VuBOqD4S95mMDmSC3Bg3tN2vfxpalAaHc03jcO4QYQVDWKNMFwDzsH7l6k2tr_xEWPXCTetp9stkScRqZuaTwAFnX2fX/s320/boy-1300226_640.png" width="320" /></a></div>
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<span style="font-size: large;">嚴格講起來,這是個哀傷的故事,因為這位60歲的伯伯被診斷了直腸癌。不過,他的大腸鏡檢查影像簡直可以當成大腸鏡的教學圖譜,與大家分享。</span></div>
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<span style="font-size: large;">這位伯伯有<span style="color: #3d85c6;">血便</span>的問題,因此到志典醫師診間就醫,經過一番問診之後,進入肛門指診的部分。肛門指診一直是大腸直腸科中無可取代的一項簡單、方便、又可以得到相當多臨床資訊的檢查。(<span style="color: #3d85c6;">註解1</span>)</span></div>
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<span style="font-size: large;">指診之後,不妙,直腸裡頭似乎有一個硬塊,可能是腫瘤。加上手套上的血絲,大腸鏡檢查恐怕是無可避免的了。於是志典醫師立刻安排檢查時間,並且提醒伯伯一定要來接受檢查,避免病情拖延。</span></div>
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<span style="font-size: large;">接下來就是檢查日當天的情形了。話不多說,我們直接看圖。</span><span style="font-size: large;">(以下圖多)</span></div>
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<span style="font-size: large;">志典醫師提過,大腸鏡檢查一定要做到大腸頭,也就是闌尾開口的位置。</span></div>
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCoV_sT-Nff4sZufGQALy_8bmNtQokLlMLHYVCbA9GmwzDb-OOAtwS6lcQptUdOfB6WiiwykD2NSCh1XxPHTfIP3ga-ju0Skt98Ixg0KPrm01MWjMUq0fvkNfbJ3kpsqzNwQlpjtSkhns1/s1600/1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCoV_sT-Nff4sZufGQALy_8bmNtQokLlMLHYVCbA9GmwzDb-OOAtwS6lcQptUdOfB6WiiwykD2NSCh1XxPHTfIP3ga-ju0Skt98Ixg0KPrm01MWjMUq0fvkNfbJ3kpsqzNwQlpjtSkhns1/s320/1.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">這是所謂的大腸頭的位置,半月型的是闌尾開口的地方。</td></tr>
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<span style="font-size: large;">在這我們可以看到大腸小腸交界的位置。</span><br />
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2Y3Jcl1ccMfum4avx5ylCZz807XRki0No1GPjL9MsbEk3I4EkSlNUn6djU7hUO3VPOvi071qbIxr0OgGU1ofMZEBvqdjHUI8YX6gHcqennP8XyerWVra7zpZyfalMgyvaR5QKW8y8Gi0j/s1600/2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2Y3Jcl1ccMfum4avx5ylCZz807XRki0No1GPjL9MsbEk3I4EkSlNUn6djU7hUO3VPOvi071qbIxr0OgGU1ofMZEBvqdjHUI8YX6gHcqennP8XyerWVra7zpZyfalMgyvaR5QKW8y8Gi0j/s320/2.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">左方一個火山口形狀的地方就是大腸小腸的交界,旁邊有一個小小的大腸憩室。</td></tr>
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<span style="font-size: large;"> 在升結腸的位置出現了很多大腸憩室(<span style="color: #3d85c6;">註解2</span>)</span></div>
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQP5F1nT0ruiX6PBExBYTHvob4IxS5ndotYSO42rEkKxhMnoEUhiXbgKnPgbIyte7flSjCD571XK3rNtWt3n8Od8DGd2nI0kYJU6UOWsCDU57mq0VH_QWmrf14_is2ogzg_co3F7bjX_EV/s1600/3.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQP5F1nT0ruiX6PBExBYTHvob4IxS5ndotYSO42rEkKxhMnoEUhiXbgKnPgbIyte7flSjCD571XK3rNtWt3n8Od8DGd2nI0kYJU6UOWsCDU57mq0VH_QWmrf14_is2ogzg_co3F7bjX_EV/s320/3.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">一顆一顆的小泡泡就是大腸憩室,有些還被糞石卡住了。</td></tr>
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbKXyjLblP1I7EvIIHNsEQiTJJbz_Z1sLo_gUIrRQe7fZMKYf5qjIcVtJ4EwgvWWHFVC7GQ1CcOIfFoLuxAziVT4nDTl70T_j1T26dwE_cUMgdc2T0xr39p2KE2kDCuBTy_XQzkh5g-ZMC/s1600/4.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbKXyjLblP1I7EvIIHNsEQiTJJbz_Z1sLo_gUIrRQe7fZMKYf5qjIcVtJ4EwgvWWHFVC7GQ1CcOIfFoLuxAziVT4nDTl70T_j1T26dwE_cUMgdc2T0xr39p2KE2kDCuBTy_XQzkh5g-ZMC/s320/4.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">遠端橫結腸的地方也有憩室的蹤跡。</td></tr>
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<span style="font-size: large;"> 接下來是大腸瘜肉圖譜連發。</span><br />
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinrKJGYbwouHU6upN5SNqPYBPufT7Y8tF8Y2Ls9omPGw_dVwGN5lcnMR_Mk2g1AqPUNZKLLJ1s7APmBgAdcZTaC6ufsShCycWn9dpEOB8vCn0yhUNAhBMcLwOUgLpoE6dNCzZYP6coBhLB/s1600/5.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinrKJGYbwouHU6upN5SNqPYBPufT7Y8tF8Y2Ls9omPGw_dVwGN5lcnMR_Mk2g1AqPUNZKLLJ1s7APmBgAdcZTaC6ufsShCycWn9dpEOB8vCn0yhUNAhBMcLwOUgLpoE6dNCzZYP6coBhLB/s320/5.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">看似風平浪靜的一段正常的大腸。</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXyRRgd7Hh1cLE2-KxHPl6cRKuglZbDwZKLYBKfyq8L5y5dh7SgZdqaGfz14Bcq74jr2WqtplCvbHva12KvA9ujl-FSQRXNs51Bx3X74C0-lvwXiCsxCtQEZ6gHF17kt3wAwl2jW4QAfdd/s1600/6.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiXyRRgd7Hh1cLE2-KxHPl6cRKuglZbDwZKLYBKfyq8L5y5dh7SgZdqaGfz14Bcq74jr2WqtplCvbHva12KvA9ujl-FSQRXNs51Bx3X74C0-lvwXiCsxCtQEZ6gHF17kt3wAwl2jW4QAfdd/s320/6.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">沒想到轉個彎,差點就沒看到躲在後面的瘜肉。</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPyVpYdDFKk83UWIGsOSb68GjMANXJBzfn2avBvPlZnZyjwXV0NusUCXuMfptMhTx6yGeHMHPdkP8dGXVT4aUBBg5GPq79vljLO6eSpERE6CNlD9k0AXZEYwD-6Q747mMPSalw8QjcwBVW/s1600/7.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPyVpYdDFKk83UWIGsOSb68GjMANXJBzfn2avBvPlZnZyjwXV0NusUCXuMfptMhTx6yGeHMHPdkP8dGXVT4aUBBg5GPq79vljLO6eSpERE6CNlD9k0AXZEYwD-6Q747mMPSalw8QjcwBVW/s320/7.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">看到了嗎?調皮的瘜肉就躲在皺褶的後面。</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD_tFYJBQJ-LlPERMnvMDiA3dPHY-WHuq0-OBc8ObpdBwmOvWpyT2bx1j_59Ux-tJIE-ZoVB2yAqnU3B9vfNINqohyphenhyphenCfrZAeyTUOcl6Huxd8_gyd3lGF0UMdKHswbvSMy85LzB6uNlIC02/s1600/8.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjD_tFYJBQJ-LlPERMnvMDiA3dPHY-WHuq0-OBc8ObpdBwmOvWpyT2bx1j_59Ux-tJIE-ZoVB2yAqnU3B9vfNINqohyphenhyphenCfrZAeyTUOcl6Huxd8_gyd3lGF0UMdKHswbvSMy85LzB6uNlIC02/s320/8.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">瘜肉本尊現身。</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEialiQeb1UP2T-QqVzHpBCNJ6iPkya3npJ0nAWazkxJIV10nytHmoPaolxu7qIXjJSgXsYXfpSJT68aCVaeKh5XoFtU_hIB6yLrLfML4QXOMpOuC8tgt3PEMcbLyO7rddHJ7ZzRm_lMi5N9/s1600/9.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEialiQeb1UP2T-QqVzHpBCNJ6iPkya3npJ0nAWazkxJIV10nytHmoPaolxu7qIXjJSgXsYXfpSJT68aCVaeKh5XoFtU_hIB6yLrLfML4QXOMpOuC8tgt3PEMcbLyO7rddHJ7ZzRm_lMi5N9/s320/9.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">另一個瘜肉,用黏膜下打水的方式進行切除,避免腸子破裂的風險性。</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4wQR_ogSm_2KtMamZ5LftwkvDzejhBmz_sUJiZXMHBS5gSK4bGzEjDfBtYUvl7cPKhDmh5kiuipCFumyd5pOdru8fYuxC9pKpXR9Iasr-4GPvXEzVgn-u6mvn_2v_s_wloF_ifG3Z4f_0/s1600/10.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4wQR_ogSm_2KtMamZ5LftwkvDzejhBmz_sUJiZXMHBS5gSK4bGzEjDfBtYUvl7cPKhDmh5kiuipCFumyd5pOdru8fYuxC9pKpXR9Iasr-4GPvXEzVgn-u6mvn_2v_s_wloF_ifG3Z4f_0/s320/10.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">拿出瘜肉套環,切除。</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaN-NR9rRLVd8dnJLq-6YmImi7P7O4dUz3AfPin4mxP8GoQh8nTufi3bU87mIst93g2v32lUEnYFsHE9sj_gssPvmpqaYfSF-8ehFCdhe1JINDbUqrHK3bii9_nm-SB_opC2OX1VylfPET/s1600/11.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaN-NR9rRLVd8dnJLq-6YmImi7P7O4dUz3AfPin4mxP8GoQh8nTufi3bU87mIst93g2v32lUEnYFsHE9sj_gssPvmpqaYfSF-8ehFCdhe1JINDbUqrHK3bii9_nm-SB_opC2OX1VylfPET/s320/11.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">瘜肉切除後切面,中間好像有一條小血管。</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH6yb58iFZv3J4zJ6KsWj_n8z7k1ZAua5SDoJY4_3Lt9IUBceUL-ZmkTEkWflHEBKew2AmwkGE6sJM11watQjHkOgrQO5xxjfX7JQ8Ic_1l9VCjB24k69OVpSTH-wLX68z67ECuULwvcHj/s1600/12.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjH6yb58iFZv3J4zJ6KsWj_n8z7k1ZAua5SDoJY4_3Lt9IUBceUL-ZmkTEkWflHEBKew2AmwkGE6sJM11watQjHkOgrQO5xxjfX7JQ8Ic_1l9VCjB24k69OVpSTH-wLX68z67ECuULwvcHj/s320/12.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">伸出內視鏡止血夾,對瘜肉的血管進行處理,避免切除後出血。</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2HOEFqBm1IM_lgC4AOYJgd6-WVj1xGIEA81JWEtlodKe1H2nMZSdcTP1ddxeDaLv1nuIYg_j6NsUYC-DXeVV69Nz6zsIDX0jnAvHYWi3-GKSWPKm0MYOXMYB7J4iLxoer9stbJLmvvIoV/s1600/13.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2HOEFqBm1IM_lgC4AOYJgd6-WVj1xGIEA81JWEtlodKe1H2nMZSdcTP1ddxeDaLv1nuIYg_j6NsUYC-DXeVV69Nz6zsIDX0jnAvHYWi3-GKSWPKm0MYOXMYB7J4iLxoer9stbJLmvvIoV/s320/13.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">夾住血管,就不會出血了!</td></tr>
</tbody></table>
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYCZNTFwtM-C4JgmT9gXt1xpZeyEG4OKOlEbLRNoH5ssJLpv29oGlMxhjjLbqHErRaIWoOeq5arcWDVlF5lVKLUQb3UVl8Cu1EQoXVTa3N3dKyI02FbIYpxqMmdbhFVp0Z_-YCVUqOPSEV/s1600/14.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYCZNTFwtM-C4JgmT9gXt1xpZeyEG4OKOlEbLRNoH5ssJLpv29oGlMxhjjLbqHErRaIWoOeq5arcWDVlF5lVKLUQb3UVl8Cu1EQoXVTa3N3dKyI02FbIYpxqMmdbhFVp0Z_-YCVUqOPSEV/s320/14.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">又是瘜肉,這個惡形惡狀的瘜肉當然一定要切除。</td></tr>
</tbody></table>
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<div class="separator" style="clear: both; text-align: center;">
<br /></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoFJHRqhwwkMYEvVaXyV7JcBatt_B6Yg3FLsdV_RoJ7bNkl9CZEXH-HgR9RKQC1bWWySUX8Za4R5LoFVX9ycS0N_gbZAgFKGs8mMrAYtXK7Eb0hD6TQ-alUcb39p9rR4ueiFGRInG_vn20/s1600/16.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhoFJHRqhwwkMYEvVaXyV7JcBatt_B6Yg3FLsdV_RoJ7bNkl9CZEXH-HgR9RKQC1bWWySUX8Za4R5LoFVX9ycS0N_gbZAgFKGs8mMrAYtXK7Eb0hD6TQ-alUcb39p9rR4ueiFGRInG_vn20/s320/16.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">沒想到夾完止血釘後,在大瘜肉下方還躲了一個小瘜肉。</td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRjFbdFvYr7G7J8-VLap57Ten624ag1peEsV_3uqo4vEhUC9msXTk-X-rYtzvGuVawSkPTST3sLqBKG4p-WhC7AQujkyRuq82n7r0xg3gAusHJLmpJNyANCCqlCw_Wj9pqH458sy8sIrYW/s1600/17.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRjFbdFvYr7G7J8-VLap57Ten624ag1peEsV_3uqo4vEhUC9msXTk-X-rYtzvGuVawSkPTST3sLqBKG4p-WhC7AQujkyRuq82n7r0xg3gAusHJLmpJNyANCCqlCw_Wj9pqH458sy8sIrYW/s320/17.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">雖然你是小瘜肉,但同樣躲不了被切除的命運。</td></tr>
</tbody></table>
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<div class="separator" style="clear: both; text-align: center;">
<br /></div>
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh44ojxXfJx8iaYtfYTKcLbkkIb46xQZkoJ6-uTlbTQRYHw9eYarunBXIxUS9RN8lyDwmmnnzzuhEuERGpxSZ53_EGt1_LuHNY4XB9Ipb_BmO4SHYTX7RMwcSmDoDtxf0W4UjOtcNNsLm7E/s1600/19.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh44ojxXfJx8iaYtfYTKcLbkkIb46xQZkoJ6-uTlbTQRYHw9eYarunBXIxUS9RN8lyDwmmnnzzuhEuERGpxSZ53_EGt1_LuHNY4XB9Ipb_BmO4SHYTX7RMwcSmDoDtxf0W4UjOtcNNsLm7E/s320/19.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">居然還有瘜肉,殺敵殺到有點累了。</td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4KtrjlIzUHpaooXvFDiCLxs4SpxX5KouDJzgJtJFwqQe3TzG6ph4QGdTwUEE8fotXH1m2n9vak6NW9Ai-IVsTTfS4AKjMoV5YHmGZsNTrz2mnwItAAYSDmUDVkQVRq2G6iL-S3qLhwP2E/s1600/20.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4KtrjlIzUHpaooXvFDiCLxs4SpxX5KouDJzgJtJFwqQe3TzG6ph4QGdTwUEE8fotXH1m2n9vak6NW9Ai-IVsTTfS4AKjMoV5YHmGZsNTrz2mnwItAAYSDmUDVkQVRq2G6iL-S3qLhwP2E/s320/20.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">繼續努力的切除吧!不然放久了可是會變成大腸癌的!</td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEju0jPXdnkqQ9cJ6d2TfEzer1blZEx3EqLuEioKESjg7y2X6q0dhn7PZi-yS1uo9F4SG5FBFDXkzbAWpaRsQwhe9qm59AB8R5041MztndOUJLRJhthfdyLwgfC2ouBtk69iQV2gDNb8OjXn/s1600/21.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEju0jPXdnkqQ9cJ6d2TfEzer1blZEx3EqLuEioKESjg7y2X6q0dhn7PZi-yS1uo9F4SG5FBFDXkzbAWpaRsQwhe9qm59AB8R5041MztndOUJLRJhthfdyLwgfC2ouBtk69iQV2gDNb8OjXn/s320/21.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">切完這個大瘜肉,還發生了出血的小插曲,同樣用內視鏡止血夾完美處理。(<span style="color: #3d85c6;">註解3</span>)</td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwP_sxX9O2XWR3M_ws6LAyAz4Mdt_DYub5_ZeGfvtaKzi5Zzit9OphB899E7y9O6uqZbS6VW5Qh9_SRMzQUrdst6Ggc6_Nl_f05EFTL6Q7AmHkXgNWKNNFNon8cZuEaLy7Y3Vk_OGyrOHJ/s1600/22.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwP_sxX9O2XWR3M_ws6LAyAz4Mdt_DYub5_ZeGfvtaKzi5Zzit9OphB899E7y9O6uqZbS6VW5Qh9_SRMzQUrdst6Ggc6_Nl_f05EFTL6Q7AmHkXgNWKNNFNon8cZuEaLy7Y3Vk_OGyrOHJ/s320/22.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">第N個瘜肉。</td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieJPZvK0t8bm3hUlaBntQu9R2eUcsEma4hMJP03MJFptNRJN2h0yBqO8nfQLaPHkpLBWZEcdlb7SnetTzdou5BuZ9Fip0C7eII4oFi_N0fbcSr5IwJygpxPAhe-GHaKdNrDOMuwUtgiX4g/s1600/23.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieJPZvK0t8bm3hUlaBntQu9R2eUcsEma4hMJP03MJFptNRJN2h0yBqO8nfQLaPHkpLBWZEcdlb7SnetTzdou5BuZ9Fip0C7eII4oFi_N0fbcSr5IwJygpxPAhe-GHaKdNrDOMuwUtgiX4g/s320/23.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">第N+1個瘜肉。。</td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWSO8GpTcMI-NC5SbdOmRSkogiS9is61oqYMgAPwWA5tyGk7CWbFxFVYDQ-2lF5aeNSbYDR4o0QeNU9TaVfa_Lgz28R7mmYyt_G3pKlk4N8itHREokyse3CmjT2VPdioHUtHBRXRChyphenhyphencRb/s1600/24.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgWSO8GpTcMI-NC5SbdOmRSkogiS9is61oqYMgAPwWA5tyGk7CWbFxFVYDQ-2lF5aeNSbYDR4o0QeNU9TaVfa_Lgz28R7mmYyt_G3pKlk4N8itHREokyse3CmjT2VPdioHUtHBRXRChyphenhyphencRb/s320/24.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">第N+2個瘜肉。。。</td></tr>
</tbody></table>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicbnJgLPGzVQwQbDAWVMQXmT8xEfQ0UMjbJMq98drKzGIgFG-VjNkb6pHrW8wLdJ6a_IpxYT7GFCKRh_I9XHnA2x8cBGnazqsQg6obKlbMqa_BAvZMj-OoNWkt1sqqp_vNVu_A4z6t7-MM/s1600/25.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicbnJgLPGzVQwQbDAWVMQXmT8xEfQ0UMjbJMq98drKzGIgFG-VjNkb6pHrW8wLdJ6a_IpxYT7GFCKRh_I9XHnA2x8cBGnazqsQg6obKlbMqa_BAvZMj-OoNWkt1sqqp_vNVu_A4z6t7-MM/s320/25.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">第N+3個瘜肉。。。。</td></tr>
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrvOcCSSJqRFxcPxzCECBYSl3ufN5GrMY95tK3VxWlIpqY5UjgyJLmFJYIaGRzYUaot9wiE8dpCoXddQDg94Ob3FoUpKd1NMyYZmHtc-w9ALr7IlIhhWbBvAyBUdrV71MNA6tOC7Qlk18F/s1600/26.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrvOcCSSJqRFxcPxzCECBYSl3ufN5GrMY95tK3VxWlIpqY5UjgyJLmFJYIaGRzYUaot9wiE8dpCoXddQDg94Ob3FoUpKd1NMyYZmHtc-w9ALr7IlIhhWbBvAyBUdrV71MNA6tOC7Qlk18F/s320/26.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">最後在直腸的位置遇到了大魔王,直腸癌出現。</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivxHy1uHmk0xonNl1550iro0CyK4SJ2VJiqbUWhhcNMFZ5Rw85ZOeIwpCFkEOczlEzngxaiq6msr-ysW80gcz9AeIgrl5F0IGRLImgPejmd_P26CBAAuQVVD8q1HP9QnaopJF2CPRxl688/s1600/27.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivxHy1uHmk0xonNl1550iro0CyK4SJ2VJiqbUWhhcNMFZ5Rw85ZOeIwpCFkEOczlEzngxaiq6msr-ysW80gcz9AeIgrl5F0IGRLImgPejmd_P26CBAAuQVVD8q1HP9QnaopJF2CPRxl688/s320/27.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">做個切片,並安排手術抽血及其他術前檢查。</td></tr>
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<span style="font-size: large;"> 這位伯伯的大腸鏡檢查簡直就像在幫志典醫師複習大腸鏡圖譜一樣,琳瑯滿目。<span style="color: #3d85c6;">一般大腸憩室、糞石卡住的大腸憩室、有柄</span></span><span style="font-size: large;"><span style="color: #3d85c6;">大腸瘜肉、無柄大腸瘜肉、增生性大腸瘜肉、躲在皺褶後面的瘜肉,</span>還有<span style="color: #3d85c6;">直腸癌。</span>甚至<span style="color: #3d85c6;">黏膜下打水瘜肉切除,</span>以及<span style="color: #3d85c6;">瘜肉切除後出血的止血動作</span>,都一併幫我複習了一輪。</span></div>
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<span style="font-size: large;">做完覺得好累!但專注於當下,為病人解決問題的成就感,實在<span style="color: red;">無可比擬</span>!</span></div>
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<span style="font-size: large;">結論:</span><span style="font-size: large;"><span style="color: red;">I LOVE MY JOB</span> !</span><span style="font-size: large;">!</span></div>
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<span style="font-size: large;">後記:</span></div>
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<span style="font-size: large;">然而這位伯伯的考驗尚未結束,志典醫師仍需要為他安排直腸癌的手術,希望伯伯可以好好接受治療,才能得到最好的結果。</span></div>
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<span style="font-size: large;"><span style="color: #3d85c6;">註解1: </span></span></div>
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<span style="font-size: large;"><span style="color: #3d85c6;">肛門指診</span>是一個大腸直腸科醫師可以得到相當多臨床資訊的重要檢查,不僅可以知道痔瘡、肛裂、大腸炎、直腸癌等問題,甚至對於男性的攝護腺問題,以及女性的子宮頸陰道問題,都可能因為肛門指診而意外發現。因此病患來到門診一定要做好心理建設,不要因為害羞而拒絕。</span></div>
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<span style="font-size: large;"><span style="color: #3d85c6;">註解2</span>: </span></div>
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<span style="font-size: large;"><span style="color: #3d85c6;">大腸憩室</span>是大腸壁的一些凸起來的小洞,有的是先天的,有的是後天造成。憩室洞裡容易卡住糞便在成憩室炎,造成腹痛的症狀。若常因此有腹痛症狀,可能需要手術處理。</span></div>
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<span style="font-size: large;">ㄖ</span></div>
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<span style="color: #3d85c6; font-size: large;">註解3:</span></div>
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<span style="font-size: large;">有柄瘜肉在底部會有一條供應瘜肉生長的血管,切除時容易有流血的狀況發生。最常見的處理方式就是使用<span style="color: #e69138;">內視鏡止血夾</span>。<span style="color: #e69138;">內視鏡止血夾</span>可以將血管夾住加壓達到止血的效果。</span></div>
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<span style="font-size: large;"> 就像下圖一樣:</span></div>
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<tr><td><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2HOEFqBm1IM_lgC4AOYJgd6-WVj1xGIEA81JWEtlodKe1H2nMZSdcTP1ddxeDaLv1nuIYg_j6NsUYC-DXeVV69Nz6zsIDX0jnAvHYWi3-GKSWPKm0MYOXMYB7J4iLxoer9stbJLmvvIoV/s1600/13.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2HOEFqBm1IM_lgC4AOYJgd6-WVj1xGIEA81JWEtlodKe1H2nMZSdcTP1ddxeDaLv1nuIYg_j6NsUYC-DXeVV69Nz6zsIDX0jnAvHYWi3-GKSWPKm0MYOXMYB7J4iLxoer9stbJLmvvIoV/s320/13.jpg" width="320" /></a></td></tr>
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<span style="font-size: large;"> 不過大家可能擔心,<span style="color: #3d85c6;">一個鐵夾夾在腸道裡面會不會怎麼樣?</span>其實不用擔心,經過一段時間之後,止血夾會自動脫落並排出體外,所以不會留在腸子裡面喔!</span></div>
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大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com1tag:blogger.com,1999:blog-5718842564484202843.post-60464594521045245392019-12-01T23:11:00.004+08:002019-12-01T23:11:41.392+08:00Yo! Rocker阿嬤!<div style="text-align: center;">
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<span style="font-size: x-large;">誰說阿嬤不能當Rocker!</span></div>
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<span style="font-size: large;">Let's rock the world!!</span></div>
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<span style="font-size: large;">這禮拜有一位可愛的阿嬤,因為大腸癌造成長期貧血的關係來找志典醫師開刀。因為年紀大,手術時間也比較久,因此術後到加護病房觀察。</span></div>
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<span style="font-size: large;">隔天,順利拔管,可以說話的阿嬤相當開心的在病床上找醫護人員們聊天,口沫橫飛,比手畫腳。</span></div>
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<span style="font-size: large;">辛苦的</span><span style="font-size: large;">阿嬤年輕的時候因為工作的關係手指頭受過傷,於是,留下了這個很<span style="color: #3d85c6;">搖滾的畫面</span>。</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-dKBdWWIsE4JY6dy627jHjmakc11pWgdU57E9j8-3XEJHB2sQ0AKu4mDQ_4hIHlYhGIbTBf6iMCkkihyGO9wi3-yWkRvbxAeum4KLEcS05q3vKhMKB7X9irIyQjtcwqTkE8A58w3Z-1wd/s1600/1572070635931.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1201" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-dKBdWWIsE4JY6dy627jHjmakc11pWgdU57E9j8-3XEJHB2sQ0AKu4mDQ_4hIHlYhGIbTBf6iMCkkihyGO9wi3-yWkRvbxAeum4KLEcS05q3vKhMKB7X9irIyQjtcwqTkE8A58w3Z-1wd/s400/1572070635931.jpg" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">Ya!!</td></tr>
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<span style="font-size: large;">用這張圖說阿嬤曾經也有個搖滾的夢想,應該沒有人不相信吧!</span></div>
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<span style="font-size: large;">“ <span style="color: #3d85c6;">Rocker!! Ya!!!</span> ”</span></div>
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<span style="font-size: large;">每天志典醫師巡房的時候,開朗</span><span style="font-size: large;">的阿嬤</span><span style="font-size: large;">都笑嘻嘻地握著我的手講東講西,好像把我當成自己孫子一樣了。而我也總是忍不住多跟他聊兩句,感覺</span><span style="font-size: large;">很親近,很溫暖,很窩心。</span></div>
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<span style="font-size: large;">在這個時代,醫師最需要的,也許只是這樣的回饋吧!!</span></div>
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大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-60562532516625749292019-12-01T23:11:00.001+08:002019-12-03T23:11:02.872+08:00這瘤好大!良性的不用怕!<div style="text-align: center;">
<span style="font-size: large;">這瘤好大!良性的不用怕!</span></div>
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一個大腸脂肪瘤的案例<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiv2bjwFluT48aB9nC5mqeuUjvEgvOM-qk-i1xn-E0l021s7cx3K2g4b6pofAq2uHEqdX40FAzgWHpZ1u0LBbm6lVECyLIQdzZBRf_x6k2vr9elMxrGtdxZl_esaTp3eLKqttwQY9G337E/s1600/%25E7%25B0%25A1%25E5%25A0%25B11.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="675" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiv2bjwFluT48aB9nC5mqeuUjvEgvOM-qk-i1xn-E0l021s7cx3K2g4b6pofAq2uHEqdX40FAzgWHpZ1u0LBbm6lVECyLIQdzZBRf_x6k2vr9elMxrGtdxZl_esaTp3eLKqttwQY9G337E/s1600/%25E7%25B0%25A1%25E5%25A0%25B11.jpg" /></a></div>
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<span style="font-size: large;">本週有個相對少見的大腸鏡檢案例。是大腸脂肪瘤。</span><br />
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<span style="font-size: large;">這是位60歲的大哥。在衛生所做了糞便潛血的檢驗,發現糞便潛血呈現陽性,因此到一般</span><span style="font-size: large;">診所做了大腸鏡檢查。診所的醫師順利完成了全大腸鏡的檢查,發現有一個大大的有柄瘜肉,因此轉診到志典醫師門診做進一步治療。</span></div>
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<span style="font-size: large;"><br /></span><span style="font-size: large;">因為轉診單上面資訊相對較少,儘管再做一次檢查病人會比較辛苦,但志典醫師仍需要重新安排一次大腸鏡檢,才能有足夠的參考資料對病人的情況做處置上的建議。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">檢查的日子到來,這位大哥準時出現在檢查室門口,神情之中帶有一點不安。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">檢查開始,過程一切順利,</span><span style="font-size: large; text-align: center;">然而,這個瘜肉有點特別。</span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB_GJUPSpgMY271AKi1XTF0NWNJ8z5n_DuiCGUKY5iQlBB0bFW5KI5R5CVBAHI0FFT-xq_PPt6Fk70ES1yMso834N037RDhZTMQ4mHMh8Nt2KfclVVXVJOvqDulDiV7NtMjZ8QRKE3-YSo/s1600/IMG_2427.jpg" imageanchor="1" style="font-size: x-large; margin-left: auto; margin-right: auto; text-align: left;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB_GJUPSpgMY271AKi1XTF0NWNJ8z5n_DuiCGUKY5iQlBB0bFW5KI5R5CVBAHI0FFT-xq_PPt6Fk70ES1yMso834N037RDhZTMQ4mHMh8Nt2KfclVVXVJOvqDulDiV7NtMjZ8QRKE3-YSo/s400/IMG_2427.jpg" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">一個圓滾滾軟軟ㄉㄨㄞㄉㄨㄞ的可愛身影就這樣出現在面前</td></tr>
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<span style="font-size: large; text-align: center;"> 圓滾滾軟嫩軟嫩的大瘜肉,可愛之餘甚至還有點療癒!?</span></div>
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<span style="font-size: large; text-align: center;"> 一看就知道是脂肪瘤</span></div>
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<span style="font-size: large; text-align: center;"> 這脂肪瘤還有個長長的柄,長柄裡面藏有供應脂肪瘤生長的血管,切除過程中若有不慎,可能造成較大量的出血。</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhV19ijBcTGd0QQOoLnsh7b2SCb3oJXScykt3egIL8ykh0vYGcK8C3ipvWY5q7ZSpPLwW7j6UlyyXerGRN0gx14G7yVhiPmvtSyPVeMvHAi2V0Uxd1Zg-RjcQvao81ddqD2Eht5B-SznVIP/s1600/IMG_2430.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhV19ijBcTGd0QQOoLnsh7b2SCb3oJXScykt3egIL8ykh0vYGcK8C3ipvWY5q7ZSpPLwW7j6UlyyXerGRN0gx14G7yVhiPmvtSyPVeMvHAi2V0Uxd1Zg-RjcQvao81ddqD2Eht5B-SznVIP/s320/IMG_2430.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">脂肪瘤有個長長的柄,裡面有供應生長的血管,沒有小心處理易有出血的狀況發生。</td></tr>
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<span style="font-size: large; text-align: center;"> 懷抱著謹慎的心情,志典醫師開始進行脂肪瘤的切除。</span></div>
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<span style="text-align: center;"><span style="font-size: large;"> 先在長柄上夾兩個內視鏡止血夾,減少供應的血流量,降低大量出血的可能性。</span></span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg74mmcND_XCHlVpx7Jqm8rPGJeyD4ls8D19PT6CWw7EBoUYfAcBJzpc9kA8R-PjyLiMeLuu6Ch6E3H_-4j7QqD8tIMPgSmAlfTLK8hYzVOjLw39wFUojxpQTvVWpssEJA_wDPR06m7QDHq/s1600/IMG_2428.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg74mmcND_XCHlVpx7Jqm8rPGJeyD4ls8D19PT6CWw7EBoUYfAcBJzpc9kA8R-PjyLiMeLuu6Ch6E3H_-4j7QqD8tIMPgSmAlfTLK8hYzVOjLw39wFUojxpQTvVWpssEJA_wDPR06m7QDHq/s320/IMG_2428.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">先在長柄上夾兩個內視鏡止血夾,減少供應的血流量,降低大量出血的可能性。</td></tr>
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<span style="text-align: center;"><span style="font-size: large;"> 用瘜肉切除環套住脂肪瘤,進行切除。</span></span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSDbG4RBmMFK3bokVvnj9deusKWaTCH7Vk6qeAskBTuXUvZfpGdreT_iaVIYfORZgSR5OBT1s8U99_j5uY3BiMD-zhS8zGVPSe_GAaf2Pt4TP9R1b6VFH_IEydbyusMflCRrl-C-THGu9y/s1600/IMG_2427.jpg" imageanchor="1" style="font-size: x-large; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSDbG4RBmMFK3bokVvnj9deusKWaTCH7Vk6qeAskBTuXUvZfpGdreT_iaVIYfORZgSR5OBT1s8U99_j5uY3BiMD-zhS8zGVPSe_GAaf2Pt4TP9R1b6VFH_IEydbyusMflCRrl-C-THGu9y/s320/IMG_2427.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">用瘜肉切除環套住脂肪瘤,進行切除。</td></tr>
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<span style="font-size: large;"> 切除完成。</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhetNYZBX8A8Qo7m5S_hZW_tndPq_3ESDXj58uYFNkIPSKyxjwZwS1R4HhVAHP55LkOApCbIbRbwkZ9C7h0QtBSDpSbTyvOEQzmilh5EuL6AGsM0xL1Onr5HGemfoebXDrwEdqUL3gLPkYb/s1600/IMG_2426.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhetNYZBX8A8Qo7m5S_hZW_tndPq_3ESDXj58uYFNkIPSKyxjwZwS1R4HhVAHP55LkOApCbIbRbwkZ9C7h0QtBSDpSbTyvOEQzmilh5EuL6AGsM0xL1Onr5HGemfoebXDrwEdqUL3gLPkYb/s320/IMG_2426.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">脂肪瘤切除完成,偌大的一顆脂肪瘤就靜靜的躺在大腸皺摺的角落。</td></tr>
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<span style="font-size: large;"> 脂肪瘤切除了,雖然已經預先在長柄上夾了止血夾,但仍有些微滲血情形。</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmxXXaSxLUe1jbtz019c9nh3zIL2FUqiDRnmSOel3NMu0Pql4YJooQ-lZ3uj9lR_nFecUwMpu77rE5sVed32k99FET7j8zPl-9GSzSdK3M5RaF1FruA2GGx1hPHj2x-x6oxAIkT-FN-JJW/s1600/IMG_2424.jpg" imageanchor="1" style="font-size: x-large; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmxXXaSxLUe1jbtz019c9nh3zIL2FUqiDRnmSOel3NMu0Pql4YJooQ-lZ3uj9lR_nFecUwMpu77rE5sVed32k99FET7j8zPl-9GSzSdK3M5RaF1FruA2GGx1hPHj2x-x6oxAIkT-FN-JJW/s320/IMG_2424.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">脂肪瘤切除完成,有滲血狀況。</td></tr>
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<span style="font-size: large;"> 在滲血的切面再多加一支止血夾,確實做好止血。</span><span style="font-size: large;">“安全”才是所有醫療行為的第一考量。</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjfaGRGfQV7Nvnq5PiFU2nznSTe-4xmuTzWanyf91vkopmWl5tm_mzyLEobkIZKFJmoAoBw2v4D8Nq8H4ugnl4d2ScbuH8boP_emXUMtfi8ewMD78CagpNqrmKW3zzOluKZcpHQRasIlhA/s1600/IMG_2432.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjfaGRGfQV7Nvnq5PiFU2nznSTe-4xmuTzWanyf91vkopmWl5tm_mzyLEobkIZKFJmoAoBw2v4D8Nq8H4ugnl4d2ScbuH8boP_emXUMtfi8ewMD78CagpNqrmKW3zzOluKZcpHQRasIlhA/s320/IMG_2432.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">脂肪瘤切面多加一支止血夾,可以清楚看到滲血狀況獲得改善。</td></tr>
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<span style="font-size: large;"> <span style="text-align: center;">這麼大一顆脂肪瘤怎麼拿出來?用瘜肉切除套環夾出來!</span></span><span style="font-size: large;"> 雖然一看就知道是脂肪瘤,但還是要送病理檢驗確定診斷。</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjz7pqQaLbhV7n2T-ANlytb0N0wZ6dGlO91SYap5jPxzVNisdDkI8_Y3_VyLb0AUePbAHMvVVQaKrcXM-ccbZoAUb3v4hR_dpG09zGwiUVsDfXn_yzj60-dVh4eB1ng4RA9OwShNlaW7oC0/s1600/IMG_2434.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjz7pqQaLbhV7n2T-ANlytb0N0wZ6dGlO91SYap5jPxzVNisdDkI8_Y3_VyLb0AUePbAHMvVVQaKrcXM-ccbZoAUb3v4hR_dpG09zGwiUVsDfXn_yzj60-dVh4eB1ng4RA9OwShNlaW7oC0/s320/IMG_2434.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">用瘜肉切除套環夾出來!</td></tr>
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<span style="font-size: large;"> 圓滾滾的脂肪瘤,你看看ㄉㄨㄞ ㄧㄠ ㄉㄨㄞ ㄧㄠ 的很像圓形的果凍。</span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAkDUKkeKb4goi6qQp42_v2iN82C7ce9-FELVQBZz3ssLCzPA4mSPsn56w8ePL26WnvzaN_nnD0OPd6CUng3RRM5F2CiLMfR06n7E_mZEKYCpOd2t_-nNy7W95BP2MwATCUQxgtHbcKxo-/s1600/IMG_2435.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAkDUKkeKb4goi6qQp42_v2iN82C7ce9-FELVQBZz3ssLCzPA4mSPsn56w8ePL26WnvzaN_nnD0OPd6CUng3RRM5F2CiLMfR06n7E_mZEKYCpOd2t_-nNy7W95BP2MwATCUQxgtHbcKxo-/s320/IMG_2435.jpg" width="240" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">大約3公分大小的脂肪瘤。</td></tr>
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大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-36484668841467785672019-12-01T23:10:00.000+08:002019-12-01T23:10:45.204+08:00大腸鏡的準備及注意事項--飲食/瀉劑/代餐<div style="text-align: center;">
<span style="font-size: large;">大腸鏡不辛苦,<span style="color: #6fa8dc;">喝瀉藥拉肚子</span>比較辛苦</span><br />
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“ 做大腸鏡的時候沒什麼感覺,不過吃瀉藥拉肚子實在非常痛苦啊!”</div>
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“志典醫師啊,我拉肚子拉到屁股好痛啊!”</div>
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<span style="font-size: large;">這一點志典醫師也很無奈啊!部分病人大腸相對較直,彎曲度較小,做大腸鏡並不辛苦,稍微忍耐一下就能夠完成全大腸鏡的檢查。但如果說到鏡檢前的清腸,卻普遍怨聲載道,哀鴻遍野。</span><br />
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<span style="font-size: large;">然而,清腸的品質對於大腸鏡檢的重要性非常高。以下幾張圖我們可以看到清腸做的好不好絕對會影響大腸鏡對於瘜肉及病灶的診斷率。</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUr4FsU_ie_zgJ3PU3SOBp6A1Si8KOxTDu1R06PTBR4j6blebM54teLS8v7jRMxRJA-qSqPmv4P-zAOHF-gKSBvogFZORQzDEnxvO-NhmSwDsostsj5FKNpUIGvsUquwe_X1GOSumWaqg/s1600/good+prepare.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUr4FsU_ie_zgJ3PU3SOBp6A1Si8KOxTDu1R06PTBR4j6blebM54teLS8v7jRMxRJA-qSqPmv4P-zAOHF-gKSBvogFZORQzDEnxvO-NhmSwDsostsj5FKNpUIGvsUquwe_X1GOSumWaqg/s1600/good+prepare.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">清腸程度100分的腸子,檢出病灶沒問題!</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcS3bzmPa5NpnruDNWwVJbc5GnrRdPNWB7_SK3JyUlhLsZaNIz1kKmVE2UJTJKOatLiU42J5WUqBKAo_njMVoR1PtGfoa76_xDG0TJ46eCCfPMSp3gOd2iexcX8_MKOYMDo33WyHvAR9A/s1600/poor+prepare+2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcS3bzmPa5NpnruDNWwVJbc5GnrRdPNWB7_SK3JyUlhLsZaNIz1kKmVE2UJTJKOatLiU42J5WUqBKAo_njMVoR1PtGfoa76_xDG0TJ46eCCfPMSp3gOd2iexcX8_MKOYMDo33WyHvAR9A/s1600/poor+prepare+2.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">清腸程度不佳,增加內視鏡操作醫師找瘜肉的難度,。</td></tr>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLBSpHuhBK1Ad5xDpBYr8jZ3JpNb79apbPiXxoS66gahX6YWSs2D9PFw5ZFeCJ8wv2Bca4qv65RlLBBLMUZqtqkyVFCBsXsBoeHNo-_QNtce8hArEVqOYNkemT22DyXGsQagcBsvm0OtE/s1600/poor+prepare.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="480" data-original-width="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLBSpHuhBK1Ad5xDpBYr8jZ3JpNb79apbPiXxoS66gahX6YWSs2D9PFw5ZFeCJ8wv2Bca4qv65RlLBBLMUZqtqkyVFCBsXsBoeHNo-_QNtce8hArEVqOYNkemT22DyXGsQagcBsvm0OtE/s1600/poor+prepare.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;">清腸程度極差,連大腸鏡都被糞便阻擋住,只能重新安排另一時間,重新檢查。</td></tr>
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<span style="font-size: large;">因此,喝瀉劑拉肚子幾乎是大腸鏡檢的必要之惡。</span></div>
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<span style="font-size: large;"><span style="color: #93c47d;">網友Q問:</span><span style="color: #93c47d;">那麼</span>檢查前腸道要怎麼準備才能乾淨,是不是不能吃東西?</span></div>
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<span style="color: #e69138; font-size: large;">志典醫師:</span></div>
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<span style="font-size: large;"><span style="color: #6fa8dc;">不需要完全禁食!</span>只要依照以下準備方式,就不會餓得頭昏眼花:</span></div>
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<span style="font-size: large;">1. 檢查<span style="color: #6fa8dc;">兩天前可以吃低渣食物</span>,包括: <span style="color: #6fa8dc;">米飯、饅頭、吐司、煮爛的瘦肉、蒸蛋、過濾過的蔬果汁</span>。為了配合檢查,青菜類這時反而要少吃。低渣飲食跟清淡飲食不同。清淡飲食如果搭配的是高渣的食物,清腸效果一樣不佳,需特別注意。</span></div>
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<span style="font-size: large;">2. 檢查<span style="color: #6fa8dc;">前一天必須清流質飲食,</span>簡單來說,看起來是透明的湯、水、飲料都可以。例如:<span style="color: #6fa8dc;">運動飲料、冬瓜茶、魚湯、稀飯湯、蛤蜊湯</span>這類的食物。不透明的湯、水、飲料包括玉米濃湯、牛奶、豆漿、米漿都是禁止的。</span></div>
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<span style="font-size: large;">3. 檢查前一天傍晚七點,喝<span style="color: #6fa8dc;">第一次瀉劑</span>,喝完之後會開始拉肚子,持續約1~2小時,這個期間,需大量補充水分,一方面加強清腸效果,一方面也可避免身體脫水太厲害。</span></div>
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<span style="font-size: large;">4. 檢查時間前4~5小時,喝<span style="color: #6fa8dc;">第二次瀉劑(註解1.)</span>,喝完後一兩小時內同樣補充大量水份。</span></div>
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<span style="font-size: large;">5. 做一般<span style="color: #6fa8dc;">清醒式大腸鏡檢查</span>的病患,一直<span style="color: #6fa8dc;">到檢查之前都可以吃清流質食物</span>。對於糖尿病病人,因擔心低血糖的發生,甚至建議吃完半量早餐,再依約定時間前往醫療院所進行檢查。</span><br />
<span style="font-size: large;">5'. 針對安排<span style="color: #6fa8dc;">舒眠無痛大腸鏡</span>的病患,在第二次清腸完之後仍然可以喝水,一直到<span style="color: #6fa8dc;">檢查前2小時才開始禁水禁食</span>。</span><br />
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<span style="font-size: large;"><span style="color: #93c47d;">網友Q問:</span></span><span style="font-size: large;">做大腸鏡前</span><span style="font-size: large;">還要準備特殊食物好麻煩而且又不好吃,有沒有別的方法?</span></div>
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<span style="color: #e69138; font-size: large;">志典醫師:</span></div>
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<span style="font-size: large;">的確有喔!針對大腸鏡檢,許多廠商已經開發出許多代餐,可供鏡檢前的病患選購使用。志典醫師覺得口味還算可以<span style="color: #6fa8dc;">(註解2)</span>。如果覺得低渣清流飲食準備麻煩,或是口味嚴格的美食家(例如Gordon Ramsay這種刁嘴),可以到各大藥局選購這類產品。</span><br />
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<span style="font-size: large;"><span style="color: #6fa8dc;">註解1</span>:分兩次喝瀉劑(split dose),對於清腸的效果較單一次瀉劑(single dose)優秀許多。因此陳醫師都建議以split dose作為標準的清腸方式。</span><br />
<span style="font-size: large;"><span style="color: #6fa8dc;">註解2</span>:志典醫師的嘴很不挑,所以意見僅供參考。。^^</span></div>
大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-68200788958766798062019-12-01T22:39:00.004+08:002021-01-10T12:11:17.757+08:00文章總覽<br />
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認識疾病</h3>
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<a href="https://ctchen2019.blogspot.com/2019/12/blog-post_2.html">大腸癌是什麼?</a></div>
<a href="https://ctchen2019.blogspot.com/2019/11/blog-post_36.html">大腸的解剖構造及生理功能</a><br />
<a href="https://ctchen2019.blogspot.com/2019/12/blog-post_3.html">痔瘡是小病,發作起來要人命</a><div><a href="https://ctchen2019.blogspot.com/2019/12/blog-post.html">大腸瘜肉-小時候的大腸癌</a><br />
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內視鏡檢查</h3>
<a href="https://ctchen2019.blogspot.com/2019/12/blog-post_66.html">大腸鏡的準備及檢查事項--飲食/瀉劑/代餐</a><br />
<a href="https://ctchen2019.blogspot.com/2019/11/blog-post_84.html">什麼是大腸鏡?大腸鏡檢查怎麼做?</a><br />
<a href="https://ctchen2019.blogspot.com/2020/01/blog-post.html" style="background-color: white; letter-spacing: 1.4px; text-transform: uppercase;">一個大腸直腸科醫師的大腸鏡體驗</a></div><div><a href="https://ctchen2019.blogspot.com/2019/12/blog-post_30.html">這位阿伯您簡直就是大腸鏡的教科書圖譜吧!?</a><br /><div><br />
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<h3 style="text-align: left;">儀器設備</h3></div><div><a href="https://ctchen2019.blogspot.com/2020/12/blog-post.html">組織凝集刀- 痔瘡手術的利器</a><br />
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經典案例</h3>
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<a href="https://ctchen2019.blogspot.com/2019/12/blog-post_62.html">這瘤好大!良性的不用怕!</a></div>
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<a href="https://ctchen2019.blogspot.com/2019/12/yo-rocker.html">Yo!Rocker阿嬤!</a></div>
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<a href="https://ctchen2019.blogspot.com/2019/12/blog-post_30.html">這位阿伯您簡直就是大腸鏡的教科書圖譜吧!?</a></div>
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<a href="https://ctchen2019.blogspot.com/2019/12/blog-post_13.html">心臟不跳怎麼辦?一個團隊合作的成功案例</a></div><div><a href="https://ctchen2019.blogspot.com/2019/12/blog-post_82.html">醫療 再怎麼小心也不為過 - 一根棉花棒的故事</a><br />
<a href="https://ctchen2019.blogspot.com/2020/01/blog-post_21.html">吉普車病 - 小屁屁附近會痛不一定是痔瘡廔管喔!</a></div><div><a href="http://ctchen2019.blogspot.com/2020/05/blog-post.html">木瓜牛奶阿伯</a></div><div><a href="https://ctchen2019.blogspot.com/2021/01/blog-post.html">後腹腔腫瘤病友會</a></div><div><a href="https://ctchen2019.blogspot.com/2020/12/2020.html">2020歲末 大腸直腸癌病友會記事</a></div><div><br /></div><div><br /></div><h3 style="text-align: left;">醫學之外 生活之上</h3><div><a href="https://ctchen2019.blogspot.com/2020/11/57-scene-8.html">金馬57 [ 前往明天的路上] 合集 - Scene 8 痔瘡</a></div><div><br /></div>
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<br /></div></div>大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-8744421571219873622019-11-30T22:00:00.000+08:002019-11-30T22:00:05.864+08:00什麼是大腸鏡?大腸鏡檢查怎麼做?<div style="text-align: center;">
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<span style="font-size: large;"><span style="color: #6fa8dc;">大腸鏡</span>是作為腸道健康篩檢最重要的工具</span></div>
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<span style="color: #6aa84f; font-size: large;">網友Q問:</span><span style="font-size: large;">什麼是大腸鏡?</span><br />
<span style="font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師:</span><br />
<span style="font-size: large;">下圖就是大腸鏡。大腸鏡是一根由光纖跟鏡頭組成的管子。用來檢查我們的大腸內壁黏膜層的病灶。我們的腸壁分為四層,分別是黏膜層(mucosa),黏膜下層(submucosa),肌肉層(muscularis propia)跟漿膜層(serosa)。超過九成以上的大腸病變都是由黏膜層開始發生,所以用大腸鏡檢查大腸黏膜的健康狀況是非常直觀、準確而有效的。</span><br />
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<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-size: small;">大腸鏡及主機</span></td></tr>
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<span style="color: #e69138; font-size: large;"><span style="color: #6aa84f;">網友Q問:</span><span style="color: #6aa84f;">大腸鏡檢查要如何進行呢?</span></span><br />
<span style="color: #e69138; font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師:</span><span style="font-size: large;"> </span><br />
<span style="font-size: large;">大腸鏡檢查<span style="color: #6fa8dc;">無法在第一次到診間就診的時候就立刻進行</span>。原因在我們的大腸有許多糞便囤積,若沒有經過<span style="color: #6fa8dc;">喝瀉藥清腸</span>的動作,在大腸鏡檢查的過程中會有許多被糞便硬塊蓋住的地方,無法檢查清楚。所以大部分的狀況是需要另外安排一個時間,做完<span style="color: #6fa8dc;">腸道準備</span>之後再檢查。</span><br />
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<span style="font-size: medium;"><a href="https://cct-basicmedical.blogspot.com/2019/09/blog-post_21.html">(鏡檢前如何清腸)</a></span></div>
<span style="font-size: large;">檢查之初醫師會請您躺在診療床上,調整姿勢為平躺或左側臥並膝蓋彎曲,以利於檢查進行。在大腸鏡進入的過程之中,建議閉起眼睛放鬆。當大腸鏡在體內時,會有些許腹脹及腹痛的感覺,程度因人而異。在腹部不適時,可以<span style="color: #6fa8dc;">手掌壓住腹部疼痛的位置</span>,疼痛程度將因此減輕,也有利於檢查的進行。</span><br />
<span style="font-size: large;"><br /></span><span style="font-size: large;">在操作的過程中醫師可能會要求您左側臥,平躺跟右側臥,藉由如此<span style="color: #6fa8dc;">姿勢的調整</span>,可以調整大腸彎曲的角度,來達到我們深入大腸的效果。</span><br />
<span style="font-size: large;"> </span><br />
<span style="font-size: large;">大腸鏡必須深入闌尾開口處,也就是所謂cecal intubation,才算是完整的檢查。大腸鏡深入腸道的過程是整個大腸鏡檢查中最不舒服的部分,腹部會有程度不一的脹痛,痠痛。之後,</span><span style="font-size: large;">大腸鏡會慢慢拉出,並在拉出的同時檢查大腸腸道內有無異常狀況。</span><br />
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<span style="font-size: large;">等到大腸鏡依序由盲腸,升結腸,橫結腸,降結腸,乙狀結腸,直腸,肛門退出後,大腸鏡檢便圓滿結束</span><span style="font-size: large;">。在</span><span style="font-size: large;">拉出的過程是完全</span><span style="color: #6fa8dc; font-size: large;">不會疼痛</span><span style="font-size: large;">的,而</span><span style="font-size: large;">在過程中如果發現瘜肉,超過90%</span><span style="font-size: large;">可以立即做瘜肉切除的處理。在瘜肉切除的過程中不會有疼痛感,可以不用過度擔心。</span><br />
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<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-size: small;">志典醫師操作大腸鏡檢查</span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL1-Mywnu92JK0gFVYl8LfNLCgkr83IpmEttR5bfCIIuZAsc_cEZz8aHqirnN_hRsYnt7EkRArtTXlXgBSHsR-0XcC71hc5YIlxCMGIRCLR-KX-OwDj2gmCCd5YoBseWAp4fNvrxLNhKI/s1600/IMG_20190925_103542.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgL1-Mywnu92JK0gFVYl8LfNLCgkr83IpmEttR5bfCIIuZAsc_cEZz8aHqirnN_hRsYnt7EkRArtTXlXgBSHsR-0XcC71hc5YIlxCMGIRCLR-KX-OwDj2gmCCd5YoBseWAp4fNvrxLNhKI/s1600/IMG_20190925_103542.jpg" /></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-size: small;">大腸深入時,有時需要助手幫忙腹部按壓以減輕病患不適感。</span></td></tr>
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<span style="font-size: large;"><span style="color: #6fa8dc;"><br /></span></span><span style="font-size: large;"><span style="color: #6fa8dc;">備註1: </span>針對特定疾病(例如:克隆氏症,下消化道出血,特殊的血便狀況),甚至必須將大腸經由迴盲瓣(ileocecal valve)深入小腸末端的迴腸(terminal ileum)檢查,以達到最完整的檢查效果。</span><br />
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<span style="font-size: large;"><span style="color: #6fa8dc;">備註2: </span>關於瘜肉及瘜肉的處理我們會有另一篇專文介紹,敬請期待。</span></div>
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<span style="font-size: medium;"><a href="https://cct-basicmedical.blogspot.com/2019/09/blog-post_5.html">(大腸瘜肉及瘜肉切除)</a></span></div>
<span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span><span style="font-size: large;"><br /></span>大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0tag:blogger.com,1999:blog-5718842564484202843.post-61206758695317959052019-11-30T21:53:00.000+08:002019-11-30T21:53:36.999+08:00大腸解剖構造及生理功能<div style="text-align: center;">
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<span style="background-color: white; font-size: large;">了解大腸直腸專科,讓我們從一個小問題開始~</span></div>
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<span style="font-size: large;"><span style="background-color: white; font-weight: normal;">文:陳志典</span></span><br />
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<span style="background-color: white; font-size: large;"><span style="color: #38761d;">網友Q問:</span><span style="color: #38761d;">大腸到底是什麼?</span></span><br />
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<span style="font-size: large;"><span style="color: #e69138;">志典醫師:</span></span><br />
<span style="font-size: large;">我們俗稱的大腸包含了大腸跟直腸兩個部分。大腸英文叫做 colon,是承接小腸排出的食物殘渣並且運送至直腸(rectum) 儲存的器官。在我們的腹腔內呈現一個ㄇ字形。<span style="background-color: white;">從肚子右邊的升結腸 (ascending colon),到橫躺在上腹部的橫結腸 (transverse colon),轉個彎到肚子左側的降結腸 (descending colon),往上勾一小段 (或是一大段, <span style="color: #6fa8dc;">註解1.</span>)乙狀結腸 (sigmoid colon),最後進入直腸,這就是我們俗稱的大腸。這樣講比較抽象,</span>讓我們看個圖吧!</span><br />
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<span style="background-color: white; color: #6fa8dc; font-size: large; text-align: center;">想像一下,這是一個人” 站著面對你的方向 “(註解2.)</span><br />
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<tr><td class="tr-caption" style="text-align: center;">大腸直腸的解剖構造</td></tr>
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<span style="font-size: large;">是不是更清楚明瞭了呢?</span></div>
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<span style="background-color: white; color: #38761d; font-size: large;"><span style="color: #38761d;">網友Q問:</span>大腸、直腸、肛門用來做什麼用呢?</span></div>
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<span style="color: #e69138; font-size: large;">志典醫師</span><span style="font-size: large;"><span style="color: #e69138;">:</span></span><br />
<span style="font-size: large;">相對於小腸來講,</span><span style="font-size: large;">大腸在營養吸收方面扮演的角色並不吃重。食物經由我們的口腔,咽喉,食道,胃部,十二指腸,小腸,進入大腸,該吸收的營養份跟水分都吸收的差不多了(大多數養分水分都在小腸吸收),因此大腸主要剩下<span style="color: #6fa8dc;">吸收剩餘水分以及藉由蠕動排出食物殘渣</span>的功能。除此之外,大腸腸道內的<span style="color: #6fa8dc;">細菌菌相</span>與一些疾病的相關性目前逐漸確立,因此大腸在<span style="color: #6fa8dc;">體內環境的恆定方面</span>的功能比我們想像的更多</span><span style="font-size: large;">(後述)</span><span style="font-size: large;">。</span><br />
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<span style="font-size: large;">至於直腸則是<span style="color: #6fa8dc;">儲存糞便</span>的器官,更加不具有吸收的功能。不過儲存便便的功能重不重要?當然重要!部份直腸癌的病人在進行直腸癌的手術之後,因為直腸容量變小,會有排便頻率增加的症狀,稱之為LARS ( Low Anterior Resection Syndrome),造成生活上些許不便。可見直腸的功能對我們的生活品質還是非常重要的!</span><br />
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<span style="font-size: large;">肛門也是相當重要的一個器官。主要功能是<span style="color: #6fa8dc;">維持張力</span>讓我們可以控制便便的排出。如果肛門口內外括約肌受傷,會有排便失禁的可能性。</span><br />
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<span style="background-color: white; font-size: large;"><span style="color: #38761d;">網友Q問</span><span style="color: #38761d;">:大腸直腸專科醫師是在做什麼的啊?我什麼時候需要去找他?</span></span><br />
<span style="background-color: white; font-size: large;"><br /></span><span style="color: #e69138; font-size: large;">志典醫師</span><span style="font-size: large;"><span style="background-color: white;"><span style="color: #e69138;">:</span></span></span><br />
<span style="font-size: large;"><span style="background-color: white;">顧名思義,大腸直腸專科醫師(像志典醫師)就是照顧大家的大腸直腸肛門疾病的專科醫師。所有大腸直腸肛門疾病包括</span><span style="background-color: white;">痔瘡,肛門瘻管,肛裂,腸躁症,</span><span style="background-color: white;">大腸直腸癌(包含手術、大腸鏡篩檢及追蹤),各種原因造成的大腸直腸發炎(例如感染性大腸炎、放射性大腸炎)。。。等等。都是大腸直腸科專科醫師的業務範圍。簡單來說,幾乎只要有:</span></span><br />
<span style="background-color: white;"><span style="font-size: large;"><br /></span></span><span style="font-size: large;"><span style="background-color: white;"><span style="color: #3d85c6;">任何肚子不適:</span>腹痛、腹脹、腹鳴,裡急後重,突然的排便習慣改變,便秘,拉肚子, </span><span style="background-color: white;">或是</span></span><br />
<span style="background-color: white;"><span style="font-size: large;"><span style="color: #3d85c6;">肛門口相關症狀:</span>脫垂、疼痛、壓痛、出血、分泌物、硬塊、贅生物</span></span><br />
<span style="background-color: white;"><span style="font-size: large;"><br /></span></span><span style="background-color: white;"><span style="font-size: large;">在這個大腸癌盛行並且年輕化的年代,先找合格的大腸直腸專科醫師做諮詢評估,都是很合理的考量。</span></span><br />
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<span style="background-color: white;"><span style="font-size: large;"><br /></span></span><span style="background-color: white;"><span style="font-size: large;"><span style="color: #6fa8dc;">註解1:</span> 乙狀結腸的長度變異性相當大,在醫學圖譜裡甚至有一頁專門畫的就是乙狀結腸的長度變化。這也是造成民眾接受大腸鏡檢查時腹部疼痛的原因之一。在介紹大腸鏡的時候我們會詳細說明。</span></span><br />
<span style="background-color: white;"><span style="font-size: large;"><br /></span></span><span style="background-color: white; font-size: large;"><span style="color: #6fa8dc;">註解2:</span>醫學影像中,若照相方向是”前後“的,大多是以”正面面對看圖者“的方向作為呈現。換句話說,在圖的右側反而是人體左邊,在圖的左側反而是人體的右邊。初學者可以多加留意。</span><br />
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大腸直腸專科陳志典醫師-腸道健康資訊網http://www.blogger.com/profile/17352466574876781737noreply@blogger.com0