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&wxfrom=5&wx_lazy=1&wx_co=1&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&tp=webp&wxfrom=5&wx_lazy=1&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&wxfrom=5&wx_lazy=1&tp=webp" style="width: 50%; margin-bottom: 20px;">
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