Kolonoskopiya

Description:

The first attempts of endoscopic visualization of all large intestine and terminal department of an ileal gut belong to 1967. For last years the technique of carrying out this research is well developed and allows to examine all departments of a large intestine in most cases. Preparation for a research consists in appointment to the patient within 3 days before a research of a besshlakovy diet. In 1 day prior to a kolonoskopiya to the patient laxative is appointed, for 12 h and for 2 h before survey — 3 or 4 cleansing enemas are meant. On the workmanship the kolonoskopiya belongs to difficult methods of an endoscopic research. In spite of the fact that its technique is well developed, nevertheless specific features of a large intestine and in particular pathological processes in it sometimes create almost insuperable difficulties in implementation of a research in full. Carrying out a colonoscope on a large intestine can be followed by painful feelings. Them gut stretching a colonoscope or air which is entered into a gut for the purpose of disclosure of its gleam can be the cause. Anesthetics and antispasmodics should be entered parenterally into time of carrying out the tool at the raised pain reaction or an excessive spazmirovaniye of a gut. Kolonoskopiya is carried out in position of the patient on the left side with the lower extremities bent in knee and hip joints. The distal end of a colonoscope greased with a layer of a liquid paraffin is entered into a rectum directly or through a proctal dilator. At this time the distal end is not fixed and passes in a rectum usually freely. If the gleam of a gut drops out of sight, it is necessary to delay a colonoscope before emergence of a gleam back and again to enter it on the gut course. The entrance to a sigmoid gut (14 — 16 cm from an anus) is found turns of the distal end of the device. Having found an entrance to a sigmoid gut (that quite often should be made use of insufflation), the distal end is fixed. After carrying out the device in a sigmoid gut it is necessary to execute the repeated manipulations directed to its nasazhivaniye on the fiberscope. The sigmoid gut collected in the form of a corrugated tube considerably facilitates and does painless for the patient further carrying out the device on the descending gut. The last is easily recognized by a characteristic triangular gleam, and a splenic corner — by a big livor along big curvature of a gut (a shadow of the lower pole of a spleen). It is easier to carry out carrying out the device through this bend, having turned the patient on a back. A cross part of a large intestine also has wider gleam, also in a form approaching to triangular. In cases when it is strongly displaced to a small pelvis, it is also necessary to get a gut on a plait by repeated forward and return movements. The hepatic bend also has an accurate reference point in the form of the dark "hepatic" stain which is located at vertex of angle. Overcoming a hepatic bend and survey of a caecum usually does not present considerable difficulties in process of acquisition of practical skills. Bauginiyeva the gate represents a labelloid fold which form and the sizes in many respects depend on amount of air in the right department of a large intestine. In process of removal of air the gate takes a form of a double-wing fold with quite thick walls and the wide gleam which is easily passing a plait. The terminal department of an ileal gut usually works well an osmotreyona an extent from 5 to 25 — 30 cm. The mucous membrane of a large intestine at healthy people at survey through a colonoscope looks pale: its color in many respects depends on intensity of lighting. Small blood vessels of mucous and submucosal covers are well traced. Walls are covered with a thin layer of transparent slime and look brilliant. Circular folds high, gaustra deep. The size and a form of folds depends on a tone of circular muscle fibers. In places of physiological sphincters a tone especially high, the long spastic reductions connected rather with reaction of a gut to the conducted research, than with dysfunctions can be observed. Nevertheless, at patients with an irritable colon of disturbance of motor function are rather a rule, than an exception. Along a gut throughout it is possible to see edge along which the mesentery is attached. In a caecum as approaching a dome of a shadow meet to its center. In this place it is usually possible also a look an entrance to a worm-shaped shoot. Normal it represents the oval opening the sizes no more than 0,5 x 1,0 cm which is periodically closed and opening. A mucous membrane of terminal department of an ileal gut Krasnov that color, a velvety look, with the rare circular folds which are easily finishing in the course of survey. Walls are elastic, periodic peristaltic waves are traced. Many patients have a gut wall relief uneven due to semi-spherical educations by the sizes from 0,2 to 0, 5 cm formed by submucosal lymphoid follicles. Separate elements of a nodal lymphoid hyperplasia can occur also at almost healthy people, but much more often they appear at the patients with intestinal infectious diseases or who transferred in the recent past yersinia or other infections. The nodal lymphoid hyperplasia at patients with the general variable hypogammaglobulinemia is especially expressed.
How often there are diagnosis errors at a kolonoskopiya? Miller B.J. and юавт. (1998) report that the colorectal cancer is passed at a kolonoskoskiya at 1% of patients with the revealed colon cancer. Why it occurs? Kolonoskopiya can be considered full when the device is entered into a caecum zone, the ileocecal valve, inlet opening of an appendix and a banner of a caecum at the level of an entrance to terminal department of an ileal gut is identified. Such survey is possible to carry out from 79% of kolonoskopiya. If it is not possible to conduct the device in a caecum, then a research it is considered incomplete. Mistakes can be connected also with insufficient survey of a rectum and an anus. Jerome D. and Waye. M.D. (1999) consider that at a kolonoskopiya it is necessary to use method of a retroflexion for more careful survey of distal department of a rectum. Reception of a retroflexion it is necessary to carry out every time if there are no contraindications. Narrowing of an ampoule of a rectum concerns to them, for example, at a radiation proctitis and ulcer colitis. The future of a kolonoskopiya is connected with use of scanners (a virtual kolonoskopiya). Virtual and standard kolonoskopiya have similar efficiency for polyps> 5 mm, polyps of the smaller size can be found at a virtual kolonoskopiya more often. From kolonoskopiya complications the most dangerous is perforation of a gut and bleeding. These complications happen less, than in 0,1% of cases of the endoscopies which are carried out by experienced endoscopists.