论坛 › 上海 › 反复腹泻伴便血，是直肠癌吗？医生：这个病日前亦很难治愈

9q13nh 发表于 2024-6-25 04:39:46

反复腹泻伴便血，是直肠癌吗？医生：这个病日前亦很难治愈

    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">仅供医学专业人士阅读参考</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/WibaBBaSCjeYYCL4q23fcmT5exk16NTQnSQAaqSic7F3HA2XarPwgwwL7SuuWCAeby8oZccKY7xcjT8jG4ovqicug/640?wx_fmt=png&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1&amp;tp=webp" style="width: 50%; margin-bottom: 20px;"></p>
    <h3 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">腹泻要<span style="color: black;">警觉</span>这个病！</span></h3>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">今天病例的主角是个32岁的女性，姓徐。</p>
    <strong style="color: blue;"><strong style="color: blue;"><strong style="color: blue;"><strong style="color: blue;">腹泻，急性肠胃炎？</strong></strong></strong></strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">6个月前，徐女士有一次跟<span style="color: black;">伴侣</span>吃夜宵，喝了点酒，吃了些烤串，<span style="color: black;">次日</span>起来肚子就不舒服了，拉稀，起初以为是吃错东西了，急性肠胃炎，自己买了整肠丸吃，效果<span style="color: black;">欠好</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">继续拉，一连拉了3天。最<span style="color: black;">起始</span><span style="color: black;">每日</span>拉个4-5次，第三天直接拉到了8-9次。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">丈夫很担心，说<span style="color: black;">这般</span>拉法<span style="color: black;">亦</span>不是办法，得去医院。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">于是去了社区医院，社区<span style="color: black;">大夫</span><span style="color: black;">认识</span><span style="color: black;">状况</span>后，说是个</span><strong style="color: blue;"><span style="color: black;">急性肠胃炎</span></strong><span style="color: black;">，这跟<span style="color: black;">病人</span>的想法一致。<strong style="color: blue;"><span style="color: black;">为何</span>之前吃的整肠丸没用</strong>。好吧，那就换一种中成药，<span style="color: black;">同期</span>用了点口服的抗生素，左氧氟沙星。<span style="color: black;">非常多</span>肠胃炎可能是细菌<span style="color: black;">导致</span>的，吃抗生素会有效。社区<span style="color: black;">大夫</span>说。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">一连吃了3天抗生素，仍然没效果。</span></strong><span style="color: black;">还是拉。</span></p><strong style="color: blue;"><strong style="color: blue;"><strong style="color: blue;">腹泻<span style="color: black;">无</span>好转，又<span style="color: black;">起始</span>腹痛</strong></strong></strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">更糟糕的是，腹泻还没好，肚子又<span style="color: black;">起始</span><span style="color: black;">病痛</span>了。<span style="color: black;">重点</span>是<strong style="color: blue;">左下腹<span style="color: black;">病痛</span></strong>，<span style="color: black;">况且</span>肚子拉个<span style="color: black;">一直</span>，最严重的一天拉了12次，刚提上裤子，这便意又来了，有一次来不及脱裤子，内裤黄了一片，都是粪水。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">拉肚子拉得生<span style="color: black;">没</span>可恋了。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">经过了好几天的<span style="color: black;">药品</span>治疗，<span style="color: black;">最终</span>好了一点，<strong style="color: blue;">腹泻的次数少了<span style="color: black;">有些</span>，肚子<span style="color: black;">亦</span>没<span style="color: black;">那样</span><span style="color: black;">病痛</span>了</strong>。徐女士松了一口气。急性肠胃炎<span style="color: black;">每一个</span>人都会经历，徐女士当然<span style="color: black;">亦</span>经历过，但这次有点特殊，很少拉这么<span style="color: black;">长期</span>，差不多1个星期了。</span></p><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;">难道不只是急性肠胃炎这么简单？</span></strong></strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肚子刚舒服一点，徐女士<span style="color: black;">起始</span>放松了，恢复了上班。徐女士的工作有点特殊，<span style="color: black;">必须</span>上夜班的。刚上完夜班的那个早晨，徐女士的肚子又不舒服了，肚子咕噜噜响，感觉大便马上就要出来了，忍不住。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">跑去厕所蹲了<span style="color: black;">非常</span>钟，完事后回头看了一眼马桶，天啊，出事了。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">流血</span>了，大便<span style="color: black;">流血</span>了。</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">徐女士很少便血，以前<span style="color: black;">亦</span>有过痔疮，但从来<span style="color: black;">无</span>这次拉了这么多血，<span style="color: black;">全部</span>马桶水都染红了，<span style="color: black;">况且</span>纸巾<span style="color: black;">亦</span>都是红色的，肯定是肛门<span style="color: black;">周边</span>某个血管破了，否则不会拉这么多血。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">徐女士请了假，找了丈夫，直奔县医院急诊科。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">急诊科<span style="color: black;">大夫</span>问完<span style="color: black;">状况</span>后，<span style="color: black;">测绘</span>了<span style="color: black;">病人</span>生命体征，血压、心率、血氧饱和度什么的都是稳定的，<strong style="color: blue;">不紧急</strong>。起码不是<span style="color: black;">海量</span><span style="color: black;">流血</span>，<span style="color: black;">倘若</span>是<span style="color: black;">海量</span><span style="color: black;">流血</span><span style="color: black;">导致</span>的失血性休克，<span style="color: black;">病人</span>的血压会降低、心率会<span style="color: black;">火速</span>的。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">先抽血，查血常规等。</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">结果出来了，血红蛋白还有120g/L，<strong style="color: blue;"><span style="color: black;">无</span>贫血啊</strong>，虽然拉了点血，<span style="color: black;">然则</span>不影响大局，正<span style="color: black;">一般人</span>的血红蛋白<span style="color: black;">亦</span><span style="color: black;">便是</span>120-150g/L。<span style="color: black;">大夫</span>说。密切关注，<span style="color: black;">倘若</span><span style="color: black;">无</span>再<span style="color: black;">流血</span>就不着急，晚点看消化内科<span style="color: black;">或</span>肛肠科<span style="color: black;">大夫</span>，<span style="color: black;">检测</span>一下痔疮<span style="color: black;">状况</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">大夫</span>，我这段时间老拉肚子，吃了<span style="color: black;">非常多</span>药效果都<span style="color: black;">欠好</span>。徐女士跟急诊科<span style="color: black;">大夫</span>抱怨。要不要换点<span style="color: black;">药品</span>再试试。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">没什么好试的，<strong style="color: blue;">你这个肯定不是急性肠胃炎</strong>。急诊科<span style="color: black;">大夫</span>大手一挥，我还没见过拉差不多10天的肠胃炎呢。你这个可能有其他肠道病变，<span style="color: black;">必要</span>进一步<span style="color: black;">检测</span>，住院吧。</span></p><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;">还有其他肠道病变？</span></strong></strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">徐女士对住院早有心理准备。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">那就住院。</span><span style="color: black;">住入了消化内科。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">先留了大便，大便结果出来，说看到有红细胞，这是肯定的，肉眼都看到有血了。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">而后</span>准备做肠镜。</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">大夫</span>说这种<span style="color: black;">状况</span><span style="color: black;">必要</span>要做肠镜，<span style="color: black;">瞧瞧</span>结肠是不是有炎症<span style="color: black;">或</span>溃疡<span style="color: black;">或</span>肿瘤等到，<span style="color: black;">此刻</span>肿瘤<span style="color: black;">青年</span>化趋势提前，别说30几岁，即便是20几岁都可能有<strong style="color: blue;">直肠癌</strong>了。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">直肠癌<span style="color: black;">病人</span><span style="color: black;">亦</span>会有便意频繁啊，<span style="color: black;">好似</span>大便怎么拉<span style="color: black;">亦</span>拉不干净<span style="color: black;">同样</span>，以前一天拉1次，<span style="color: black;">此刻</span>可能一天拉七八次<span style="color: black;">乃至</span><span style="color: black;">更加多</span>，拉完又想拉，这叫里急后重。部分<span style="color: black;">病人</span>还会有腹痛呢。<span style="color: black;">倘若</span>癌肿有破溃了，血管破了，那就会<span style="color: black;">流血</span>，大便表面会带着血，<span style="color: black;">乃至</span>有脓血便。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">大夫</span>的话，让徐女士更加心惊胆战。这说的<span style="color: black;">便是</span>她啊。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">倘若</span>直肠癌有转移，<span style="color: black;">例如</span>转移到膀胱，可能会<span style="color: black;">显现</span>尿频、尿痛、血尿等。<span style="color: black;">倘若</span>侵犯了阴道，还会<span style="color: black;">显现</span><span style="color: black;">反常</span>的阴道分泌物。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">徐女士闭上了眼睛，不敢再去想。<span style="color: black;">大夫</span>说的话，字字扎心。<strong style="color: blue;">她这段时间就有尿频、尿急表现啊，<span style="color: black;">况且</span>阴道经常会有味道<span style="color: black;">欠好</span>闻的白带。</strong>她以前只是觉得这可能是妇科炎症。但<span style="color: black;">基本</span>没想到，这可能是直肠癌转移到阴道的表现。</span></p><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;">会是直肠癌吗？</span></strong></strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">当天<span style="color: black;">夜晚</span>喝了泻药，清理肠道，<span style="color: black;">并不</span><span style="color: black;">必须</span>怎么喝泻药，徐女士本来就还在拉肚子，拉出来的都是清水了，基本上不影响肠镜的视野。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">次日</span>如期做了肠镜。</span><span style="color: black;">结果<span style="color: black;">火速</span>就出来了。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">大夫</span>拿着报告找到徐女士，说结肠里面<span style="color: black;">非常多</span>粘膜都糜烂、溃疡、<span style="color: black;">流血</span>了，不像结肠癌，倒像是......</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这，不是癌症吧？</span><span style="color: black;">这是天大的好<span style="color: black;">信息</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">但接下来<span style="color: black;">大夫</span>说的一句话，又让徐女士从天堂下到地狱。</span></strong></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这是个麻烦病啊，虽然短期内死不了人，<span style="color: black;">然则</span>这辈子恐怕都得吃药咯，有人说这是“不死的癌症”，病情容易反复，<strong style="color: blue;">可能会经常性拉肚子、腹痛、便血，有些病人会瘦的不成人样</strong>。管床<span style="color: black;">大夫</span>说。</span></p><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">大夫</span>说的“不死的癌症”是什么呢？后续治疗又<span style="color: black;">显现</span>了变故，是咋回事？</span></strong></span></strong></span></strong><span style="color: black;">-</span><span style="color: black;">--答案</span><span style="color: black;">分割线---</span><img src="https://mmbiz.qpic.cn/sz_mmbiz_gif/KlUicAjuHNrXg6GskwaMW4NJKYibcQNliaxbeQAYAs55T9SS3f7RXrK16micICLWTBgh0QiaOAw2JwEsPIAnbc5s6Xg/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;">或点击文末</span><span style="color: black;"><strong style="color: blue;">阅读原文</strong></span><span style="color: black;">，<span style="color: black;">亦</span>可进入“<span style="color: black;">大夫</span>站网页版”<span style="color: black;">得到</span>答案～</span><span style="color: black;"><span style="color: black;">为<span style="color: black;">认识</span>各频道粉丝用户的阅读习惯和兴趣</span></span><span style="color: black;"><span style="color: black;"><span style="color: black;">供给</span>更<span style="color: black;">靠谱</span>、实用、免费的内容</span></span><span style="color: black;"><span style="color: black;">医学界消化肝病</span><span style="color: black;">频道欢迎<span style="color: black;">大众</span>动动手指完成调研</span></span><span style="color: black;"><span style="color: black;">责任编辑：网友投稿</span>肖潇</span><span style="color: black;">*"医学界"力求所<span style="color: black;">发布</span>内容专业、<span style="color: black;">靠谱</span>，但不对内容的准确性做出承诺；</span><span style="color: black;">请<span style="color: black;">关联</span>各方在采用或以此<span style="color: black;">做为</span>决策依据时另行核查。</span><span style="color: black;"><strong style="color: blue;">戳“阅读原文”，学习<span style="color: black;">更加多</span>临床技能</strong></span><img src="https://mmbiz.qpic.cn/mmbiz_gif/fgnkxfGnnkTMNtGy7KWfCrdJibAYY6HtIGhhtVOFQXzkE5GcmZIhTLgxggMlCe3oMwqKNesBDoU7kfgzFHuxyeA/640?wx_fmt=gif&amp;wxfrom=5&amp;wx_lazy=1&amp;tp=webp" style="width: 50%; margin-bottom: 20px;">

流星的美 发表于 2024-9-4 03:48:14

楼主果然英明！不得不赞美你一下！

m5k1umn 发表于 2024-10-10 14:04:01

论坛的成功是建立在我们诚恳、务实、高效、创新和团结合作基础上，我们要把这种精神传递下去。

qzmjef 发表于 2024-10-12 03:24:45

在遇到你之前，我对人世间是否有真正的圣人是怀疑的。

qzmjef 发表于 昨天 16:13

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