杨医生笔记：一位直肠癌病人便血的惨痛经历
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近期</span>来院化疗的一位<span style="color: black;">病人</span>中，有一位是四个月前进行直肠癌根治术的<span style="color: black;">病人</span>，<span style="color: black;">日前</span>基本<span style="color: black;">情况</span>良好，在她给我叙述<span style="color: black;">第1</span>次住院时的<span style="color: black;">状况</span>和表达对医护人员的感激之情时，想起了她<span style="color: black;">近期</span>几次的住院经过，感触颇深。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-28e7f5feb98dd03aa581e3905e7c13b4_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">1、</span>初识<span style="color: black;">病人</span></h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4月前，我接诊了一位51岁的女性<span style="color: black;">病人</span>，大便时带有<span style="color: black;">海量</span>鲜红色血液，来到我院门诊就诊，当时病人诉说，大便带血有六个月，肛门坠涨不适，在门诊<span style="color: black;">检测</span>时<span style="color: black;">发掘</span>病人直肠前壁可触及到一个菜<span style="color: black;">花招</span>肿块，表面凹凸不平，当是心头一惊，这是<span style="color: black;">近期</span>这段时间内的第5例<span style="color: black;">病人</span>了，当即<span style="color: black;">可疑</span>为恶性病变。<span style="color: black;">病人</span>平时身体比较健康，<span style="color: black;">无</span>其他<span style="color: black;">疾患</span>。入院时诊断为：直肠占位（直肠癌？）</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-679bb44704836b54cc0113a719c4bfca_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">2、</span><span style="color: black;">病人</span>的治疗过程</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病人</span>入院后，再次对其进行专科<span style="color: black;">检测</span>，FH试剂染色结果表现出强阳性，查全腹CT示：直肠肠腔占位物，符合直肠癌表现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">病理会诊结果示：（直肠）高级别绒毛-管状腺瘤，伴癌变。正式确诊为直肠癌。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">同期</span>完善入院<span style="color: black;">关联</span><span style="color: black;">检测</span>及术前<span style="color: black;">检测</span>经过充分准备，<span style="color: black;">病人</span>接受了直肠癌根治术。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">术中见：肝脾胃网膜未触及<span style="color: black;">反常</span>肿块，小肠、升结肠、横结肠及降结肠肠壁柔软，未见<span style="color: black;">反常</span>肿块，腹主动脉及肠系膜血管<span style="color: black;">周边</span>未见<span style="color: black;">显著</span>肿大淋巴结，肿块<span style="color: black;">位置于</span>直肠中下段，约2cm*3cm<span style="color: black;">体积</span>，质硬，前壁浸透粘膜层，其它未见<span style="color: black;">显著</span><span style="color: black;">反常</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">手术<span style="color: black;">连续</span>4小时，术后<span style="color: black;">病人</span>恢复良好。术后病理示：（直肠）腺癌，浸润至粘膜下层，两切缘未见癌组织，未见<span style="color: black;">知道</span>脉管内癌栓及神经侵犯，肠周淋巴结内可见癌转移（1/2）。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">为巩固术后效果，预防肿瘤转移及复发，术后给予FOLFOX6<span style="color: black;">方法</span>化疗4个疗程，后<span style="color: black;">定时</span>复查，<span style="color: black;">迄今</span>未<span style="color: black;">发掘</span>肿瘤复发和转移。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-1e5305399ea1c1bc36c5c7e457c1ed21_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">术后病理<span style="color: black;">照片</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">【科普知识点1】</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">进行手术是直肠癌<span style="color: black;">病人</span>首选的治疗方式。本例病人肿瘤生长部位距离肛门口较远（大于齿线以上5cm)，符合<span style="color: black;">保存</span>肛门的<span style="color: black;">前提</span>，于是采取了Dixon手术（经腹直肠癌切除术），<span style="color: black;">没</span>论何种术式原则上以根治性切除为前提，肿瘤下端<span style="color: black;">必要</span>扩大两厘米以上切除。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">术后<span style="color: black;">因为</span>吻合口<span style="color: black;">位置于</span>齿线<span style="color: black;">周边</span>，一段时间内<span style="color: black;">病人</span>会<span style="color: black;">显现</span>排便次数<span style="color: black;">增加</span>，排便<span style="color: black;">掌控</span>功能较差的<span style="color: black;">状况</span>，随着后期的治疗会慢慢恢复。直肠癌应遵循以手术治疗为主，<span style="color: black;">没</span>论<span style="color: black;">初期</span>或是晚期，<span style="color: black;">没</span>手术禁忌都应尽早实施直肠癌根治术，<span style="color: black;">这般</span>更有利于延长<span style="color: black;">病人</span>生命周期。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">【科普</p>
你的话深深触动了我，仿佛说出了我心里的声音。
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