宝宝腹泻便血 需警惕儿童型肠息肉.doc

4宝宝腹泻便血 需警惕儿童型肠息肉宝宝腹泻出现便血了？听到这样的话，你不是特别的着急呢，专家说，宝宝腹泻便血，需要多加的警惕，因为很可能是儿童型肠息肉哦！琪琪3岁了，长得很是讨人喜欢，半年多以前，妈妈发现她经常腹泻反复，有时可见到血液黏在大便上面，带她去几家三甲医院看过，曾以“肠炎、肠系膜淋 巴结炎”抗菌素治疗几天后似乎有所好转，但半年内间中仍是有腹痛、腹泻、便血，大便常规提示有红细胞、潜血阳性，大便培养2次也没有致病菌，怎么这“肠 炎”就那么顽固呢?后来，妈妈带琪琪来到了广东省妇幼保健院小儿消化专科，经验丰富的刘医生给琪琪完善了肠镜检查后，终于揪出了导致琪琪反复腹泻腹痛便血的元凶了，原来是横结肠大息肉惹的祸。住院后予以行结肠镜下电切治疗后，琪琪终于没有再老是出现腹痛腹泻及大便带血的状况了。息肉是起源于腺上皮组织黏膜上突起的赘生物。上至鼻腔、声带，下至直肠、宫颈等，都有可能会出现息肉，人体的胃肠道黏膜，也是息肉好发的部位。提起息肉，很多人也许会觉得不以为然，完全不当一回事，他们常常心存侥幸地认为，不就是那么一丁点的赘生物嘛，何必大动干戈呢。儿童型肠息肉以直肠、乙状结肠多见，发病年龄在110岁，其中发病高峰年龄在36岁，以男孩多见。息肉通常呈圆形或卵圆形，表面光滑，直径从数 毫米到2cm不等，多数小于1cm。息肉较大的多有蒂柄，少数呈粗糙颗粒状或分叶状，色淡红色或暗红色，切面可见大小不一的囊腔，囊腔内充满灰白色粘液或 灰黄色脓性液体。一般情况下，这类息肉是不会发生恶变的，临床上多以便血为首发症状，表现为间断性大便带血，多为鲜红色。长蒂或息肉接近肛门的，可有息肉 脱出，这个时候造成腹痛的现象比较少见。息肉较大的，有时可引起肠套叠，以致造成肠梗阻而出现腹痛的症状。如果息肉继发感染的话可表现为粘液便或粘液血 便，因而常常被误诊为出血性结肠炎，此类患者往往给予抗菌类治疗症状会好转，给人假象是验证反应导致的而反复使用抗菌素治疗，既延误了病情，又滥用了抗菌 素。部分肠息肉的患儿因长期便血，可发生慢性贫血、营养不良，甚至可影响到生长发育，因此，一旦发现肠息肉，应及早处理。但又由于儿童型息肉临床表现不一定非常典型，而且大多数儿童都不会清楚确切地表述症状，因此仅靠临床症状来诊断还是较为困难的。怎样才能及时发现息 肉并做出处理呢?过去，小儿结肠息肉的诊断主要依靠直肠指诊、X线气钡灌肠等，但直肠指诊只能用于检查近肛门处的直肠息肉，而X线气钡灌肠虽然可以完整地 观察结肠的情况，但检查的时候比较费时，且有辐射损伤，漏诊率也较高，并可出现假阳性。近年来，随着小儿肠镜检查技术的推广与发展，对存在有原因不明的腹 痛、腹泻、便血等消化道症状的患儿，可以通过肠镜检查来进一步了解下消化道的疾病情况，是目前发现小儿肠息肉的较好办法，也是治疗息肉的有效手段。临床上 凡是出现以下情况，都可以考虑使用小儿肠镜：1。不明原因的下消化道出血。2。不明原因的慢性腹泻或便秘。3。疑大肠或回肠末端肿瘤。4。结肠息肉、肿 瘤、出血等病变需做内镜治疗或手术定位。5。药物或手术治疗后复查及随访目前，经肠镜下高频电切除肠息肉已经相当普及了，它相对来说比较安全有效。在肠镜检查前，待完善了相关术前检查后，医生会根据患儿的临床症状和依从性来选择肠道的准备方法，对于不能很好配合的幼儿，会给予全麻肠镜，若大一点的患儿，或者是能够很好地配合检查的患儿，为了减少麻醉意外的发生，则一般会尽量避免麻醉。如果术中发现息肉即于镜下行电凝电切术切除或氩离子凝固术治疗。通过结肠镜的诊治，不仅可以达到诊治的目的，而且又可避免开腹手术的风险和并发症。虽然结肠镜是诊断结肠息肉的金标准，但因它具有一定的侵入性和创伤性，所以术前患儿家长应该积极配合医生，做好患儿的安抚，减轻患儿的恐惧和紧张的心理，使之能更好地配合检查，以增加检查的成功率和安全性，避免出现肠穿孔或出血等并发症。同时在术后也要叮嘱患儿注意卧床休息，避免剧烈活动，并注意观察患儿有无再出现腹痛及便血。腹痛、腹泻是儿童消化道常见的疾病之一，大多数为感染性肠炎或过敏性疾病引起，临床上往往予以完善大便常规、腹片、腹部B超、过敏原等检查后可以明确诊断，予以饮食调理、抗感染、调节肠道等对症治疗后一般可完全治愈。但如果您的孩子反复出现腹泻、腹痛、便血，经过多次抗炎等治疗后都没有好转，或者好转后又容易复发的话，那么，则应该要警惕儿童型肠息肉的发生，这个时候，建议最好让您的孩子去做个结肠镜检查，以便尽早诊断，一旦确诊，则应尽快治疗，以免错过了治疗的最佳时机而损害了孩子的健康。Baby bloody diarrhea occur? To hear that, you are not special worry about it, experts said, the baby bloody diarrhea, need more alert, because is likely to be marketed for intestinal polyps!Girl 3 years old, is very attractive, more than half a year ago, my mother found her often diarrhea over and over again, sometimes visible to blood in stool, take her to read several 3 armour hospital, had enteritis, mesenteric pour into inflammation antimicrobial therapy seems to be better in a few days, but still is in between the half a year have abdominal pain, diarrhea, bloody, move bowels regular reminders have red blood cells, occult blood positive, defecate train 2 times and no pathogenic bacteria, how this intestinal inflammation is so stubborn? Afterwards, mother with kiki come to guangdong province maternity and child care pediatric digestive specialist, experienced doctor liu to kiki improved after endoscopic check, finally find out the cause the kiki repeated abdominal pain bloody diarrhea, turned out to be a large transverse colon polyps. Hospital shall be line after colonoscopy under cutting after treatment, the girl finally didnt always diarrhea abdominal pain and bloody stool condition.Polyps are originated from protrusions on the glandular epithelium mucosa of vegetations. Up to the nasal cavity, the vocal cords, rectum, cervical etc., all possible polyps, gastrointestinal mucosa of the human body, but also the site of polyps good hair. Mention polyps, a lot of people might think, completely ignoring, they often take any chances that is not a bit of vegetations, why the need for fighting?Child-shaped intestinal polyps in the rectum, sigmoid colon, onset age, at the age of 1 10 of which peaks in the ages of 3 and 6 years of age, with the boy. Polyps are usually assumes the circular or ovoid, smooth surface, ranging from a few millimeters to 2 cm in diameter, most less than 1 cm. The much larger polyps, handle, a handful of coarse granular or lobulated, pink or dark red color, the lumen of the visible aspects of different sizes, cystic cavity filled with gray, gray mucus or purulent fluid. In general, this type of polyp is not enough, so that more blood for clinical symptoms start, characterized by intermittent bloody stool, are bright red. Long or polyps near the anus, polyp of emergence, this time cause the phenomenon of abdominal pain are relatively rare. Polyp is bigger, sometimes can cause intussusception, so that cause the symptoms of intestinal obstruction and abdominal pain. If polyp secondary infection can be characterized by mucus or mucous bloody stool, and often misdiagnosed as hemorrhagic colitis, such patients will get better treatment with an antibiotic classes often symptoms, give a person illusion is to validate reaction caused by the repeated use of antibiotic treatment, delay the disease, and the abuse of antibacterial. Part of intestinal polyps with long-term bloody, chronic anemia, malnutrition can occur, even can affect the growth and development, therefore, once found that intestinal polyps, should be dealt with as soon as possible.But due to the clinical manifestation is not necessarily very typical child-shaped polyp, and most children are not clear exactly describe symptoms, so only by clinical symptoms to diagnosis is relatively difficult. How can find meat and make timely treatment? In the past, the diagnosis of pediatric colon polyps relies on, X-ray barium enema on a digital rectal exam, etc., but can only be used on a digital rectal exam to check near the anus rectum polyp, and X-ray gas barium enema while it is possible to fully observe the situation of the colon, but check the more time-consuming, and radiation damage, the missed diagnosis is high, and can produce false positive results. In recent years, with the promotion and development of pediatric colonoscopy examination technology, for there are unexplained abdominal pain, diarrhea, bloody digestive tract symptom such as children, can further understand the digestive tract by endoscopic check disease situation, is a good way to currently found that children with intestinal polyps, and effective means for the treatment of polyps. Clinically, those who develop any of the following can consider using pediatric colonoscopy: 1. The gastrointestinal bleeding of unknown origin. 2. Unexplained chronic diarrhea or constipation. 3. Suspected e. or terminal ileum tumor. 4. Colon polyps and swollen lump, the bleeding lesion location to do endoscopic therapy or surgery. 5. Review and follow-up after drug or surgical treatmentAt present, the colonoscopy under high frequency electric resection is a popularized the intestinal polyps, it is relatively safe and effective. In front of the endoscopic check, to perfect the related preoperative examination, the doctor will choose according to the patients clinical symptoms and adherence to the intestinal preparation method, for young children cannot very good cooperation, will give general anesthesia enteroscope, if older children, or children is able to coordinate well with check, in order to reduce the happening of the accident, is usually as far as possible avoid anesthesia. If intraoperative find polyps in mirror downward electric coagulation electric operation excision or argon ion coagulation treatment. By colonoscopy in the diagnosis and treatment, not only can achieve the purpose of make a diagnosis and give treatment, and can avoid the risk of open operation and complications.Although colonoscopy is the gold standard in the diagnosis of colon polyps, but because it has a certain invasive and traumatic, so preoperative parents should cooperate a doctor actively, make children calm, relieve the patients fear and nervous psychology, making them better able to cooperate to check, check to increase the success rate and safety, avoid complications such as intestinal perforation or bleeding. At the same time should also be told after surgery with attention to bed rest, avoid strenuous activity, and watch with pre