The removal of gastrointestinal polyps under gastrointestinal endoscopy, although it is a minimally invasive small operation, but the surgical safety and quality requirements can not be sloppy at all, and the preoperative preparation can not be taken lightly, please read carefully.
Endoscopic minimally invasive resection of gastrointestinal polyps should know five common senses
(1) Gastrointestinal endoscopic polypotomy is based on different parts, sizes and forms of polyps, using biopsy removal, electrocoagulation snare removal, mucosal excision (emr), mucosal detachment (esd) and other techniques, auxiliary nylon rope ligation, injection, titanium clip, argon and electrocautery and other minimally invasive excision of polyps.
(2) Compared with traditional laparotomy, gastrointestinal endoscopic polyps are less invasive, easy to operate, short in time and less risky; postoperative recovery is fast, the patient's hospital stay time is short, and the hospitalization can be discharged within a few days, and generally can choose to stay in the day surgery ward; the treatment cost is relatively reduced.
(3) Mostly for elective surgery, patients can choose the treatment time, because the wound may not be completely healed within one month after the operation, bleeding will occur after excessive activity, such as business trips, examination competitions, overtime, decoration and moving, children getting married and having children within the past month, etc., it is not appropriate to remove polyps for the time being.
(4) Surgery needs to be performed under painless anesthesia, most of which use intravenous anesthesia, a few anesthetize in the trachea, and polyp treatment is limited by the indications of anesthesia. Therefore, when painless anesthesia cannot be obtained, only small individual polyps are treated under general gastrointestinal endoscopy.
(5) Due to the large number of patients and the rapid turnover of inpatient patients, it is particularly important to understand and master the relevant preoperative common sense, assist in preparation, and standardize each preparation link in order to ensure the safety and quality of minimally invasive treatment of gastrointestinal polyps endoscopy.
Sixteen preparation details should be known prior to gastrointestinal polyp cutting
(1) Diet management: Eat less residue and easy to digest in the days before surgery, avoid gastrointestinal infection caused by unclean diet; fast to fried, meat and other protein fatty solid foods for 8 hours before surgery; fast to rice noodles, milk and other carbohydrated solid foods for 6 hours before surgery; prohibit drinking water 2 hours before surgery, but you can brush your teeth and drink a small amount of water because of medication. 30 minutes before gastroscopy, the total amount of mucosal cleansers such as local anesthetic lidocaine paste, antifoamer dimethicone, and antimucus deyou can be taken does not exceed 50-100 milos.
(2) Rest management: within a few days near the operation, you should rest well, avoid strenuous exercise, work overtime, fall asleep early, recuperate, relax your mood, and benefit postoperative rehabilitation. Avoid being under anesthesia from colds and respiratory infections.
(3) Smoking and drinking: quit smoking for at least 2-4 weeks, coughing up sputum should take cough and sputum reduction drugs to reduce cough after anesthesia; at least one week after abstinence from alcohol, drinking alcohol will affect the amount of surgical anesthesia, postoperative awakening, and the choice of postoperative antibiotic application.
(4) Dress up: do not wear makeup such as lipstick, apply nail polish, so as not to affect the anesthesia observation of hypoxia; do not wear tight underwear to facilitate the operation will be placed skin electrode plates. Before the operation, you can change into a patient's uniform, and pay attention to the buttons of the jacket to wear backwards to facilitate the wearing and taking off during the operation.
(5) Personal hygiene: trim nails to prevent scratching the skin when the anesthesia is not awake; take a bath on the day before the operation, and generally should not be active and bathed for 2-3 days after the operation. If the surgery day of female patients is during menstruation, the operation is generally postponed.
(6) Urination: The appointment time is not the actual time, the waiting time for the pick-up table may be long, and the defecation should be removed again before the operation. People with constipation should take laxatives such as lactulose (dubuque) several days in advance to ensure that they have a bowel movement at least once a day.
(7) Oral dentures: If there are movable dentures, braces and dental trays, they should be removed before surgery to prevent them from falling out of the trachea during anesthesia muscle loosening examination. Loose teeth should be informed in advance to the doctor, as intraoperative placement of the mouth pad or endotracheal tube may cause a loss.
(8) Valuables: mobile phones, watches, necklaces, bracelets, earrings, glasses, stealth glasses, wallets, ID cards, bank cards and various documents, please do not bring them into the operating room, and are properly kept by relatives and friends in advance to prevent loss.
(9) Data preparation: Please bring the information of various examination reports such as the gastrointestinal endoscopy report and the pathology report for the formulation of surgical plans and anesthesia assessment. Bring a good examination report of the hospital at the same level in the near future, if the examination results are normal, you can recognize each other and do not repeat the examination.
(10) Intestinal preparation: Oral intestinal lavage is best performed 6-8 hours before surgery, such as around 8:00 a.m. for treatment at 2:00 p.m. and around 3:00 a.m. for 9:00 a.m. treatment. The method is to mix the appropriate amount of polyethylene glycol electrolyte powder (such as Hengkang Zhengqing 3 hehe 9 packs) into a container of warm boiled water of 3000 ml (about two water bottles of ordinary hot water bottles) and stir evenly, cool to 45-50 ° C after a balanced and slow oral administration within 1-2 hours, and gradually appear diarrhea after oral administration for about 5-10 times until it is dissolved to yellow water-like dilute water.
(11) Gastric preparation: general gastric polyp resection before the operation of fasting and drinking for 6-8 hours; the fasting time of the esophagus and proximal gastrectomy should be extended, and Coca-Cola can be drunk three times a day for several days before the operation 50-75ml, which is conducive to emptying the gastric contents. For patients with vomiting symptoms of gastroesophageal emptying and gastric retention, in order to prevent anesthesia vomiting from choking into the trachea, if necessary, the gastrointestinal tube is first placed for gastrointestinal decompression, and before anesthesia, the gastroscope can be used to enter the gastric cavity to suck the gastric contents clean and then anesthetize.
(12) Oral drugs: drugs that affect blood clotting such as aspirin stop for 7 days, clopidogrel stop for 5 days, low molecular weight heparin stop for 3 days, warfarin stop for 3 days, heparin stop for 6-12 hours; anesthetic drugs such as compound antihypertensive tablets, antihypertensive No. 0 and other reserpine need to be stopped for 7 days; stop taking Puly, sartan hypertension drugs on the same day, now think that it may have an impact on anesthetic drugs; stop taking diabetes drugs on the same day, blood glucose fluctuations are replaced by insulin; stop taking traditional Chinese medicine, proprietary Chinese medicine and available Western medicines, health care products, etc. Please follow your doctor's advice for special medications.
(13) Identity confirmation: Please wear the inpatient wrist strap and outpatient identification code on the right wrist, and the medical staff will confirm your identity at any time during the diagnosis and treatment and transfer process. Strictly implement the real-name system in accordance with medical insurance regulations, and do not use the status of relatives and friends to be hospitalized for diagnosis and treatment.
(14) Informed consent: Usually minimally invasive treatment of polyps is safe, but there are still possible risks, the surgical and anesthesiologist will inform you and your family of possible complications before treatment, and sign an informed consent form for endoscopic treatment and anesthesia by yourself or your client. Gastroscopy may appear upper abdominal distention pain, biopsy bleeding, airway aspiration, sore throat, mandibular dislocation, etc.; colonoscopy may appear abdominal pain and bloating, biopsy bleeding, intraoperative perforation, delayed hair perforation, etc.; painless anesthesia may appear dizziness, headache, fatigue and weakness, nausea and vomiting, airway aspiration, drug allergy, etc.; endoscopic treatment may include intraoperative bleeding, delayed hemorrhage, intraoperative perforation, delayed perforation, stenosis, lesion residual recurrence, pathological abnormalities, etc., and in severe cases, emergency or elective surgical laparotomy, etc. There may also be cardiovascular and cerebrovascular accidents, local or systemic infections, unpredictable complications, and failure of diagnosis and treatment to achieve the expected goals. Once complications arise, the doctor will actively deal with them, and the cost of hospitalization will increase accordingly.
(15) Escort: After the operation, it is necessary to arrange for family members or relatives and friends to accompany them, assist in transport, living, diet and care, and the doctor will communicate with the family before and after the operation, explain the condition, and watch the excision of specimens. Full-time caregivers may be employed if there is no accompanying person.
(16) Expense settlement: Prepare referral slips, bank cards, Alipay, medical insurance cards, insurance policies, etc. in advance, prepare for the settlement of discharge expenses, and do not carry cash in the ward during hospitalization to prevent accidents.
What routine tests should be done before surgery?
(1) Blood routine, urine routine, stool routine, occult blood test;
(2) Blood biochemistry, liver and kidney function, blood glucose lipids, electrolytes;
(3) Coagulation routine;
(4) Infectious markers:
(5) tumor markers;
(6) Electrocardiogram;
(7) abdominal ultrasound or ct;
(8) Full chest x-ray;
(9) People over 65-70 years old or with a history of cardiovascular and cerebrovascular diseases and lung diseases should be added to echocardiography, carotid artery ultrasound, lung function and other examinations. There are other underlying diseases and concomitant diseases to complete the relevant tests.
Under what circumstances can gastrointestinal polyps be treated temporarily?
Preoperative doctors will conduct a comprehensive assessment of whether polypsection can be made, the appointment date is not equal to the actual surgical day, when the following conditions occur in the preoperative related examinations and evaluations, the doctor will recommend suspending the operation, further diagnosis and treatment or transfer to the relevant specialist for diagnosis and treatment, and then perform endoscopic polypectomy after the indicators are normally met.
(1) There is stomach retention and repeated vomiting, there is no diarrhea after intestinal cleansing, and intestinal cleaning is not up to standard;
(2) The female patient is during the menstrual period;
(3) Hemoglobin in blood routine is less than 70 g/L, and platelets are less than 70x109/l
(4) The conventional prothrombin time of coagulation is extended by >3 seconds;
(5) Hypertension cannot be controlled, and blood pressure is above 160/100mmhg;
(6) Coronary heart disease has symptoms and cannot stop anticoagulants, myocardial infarction within 6 months;
(7) Atrial fibrillation resting heart rate greater than 80 beats / min, clearly with epistaxial thrombosis;
(8) Within 1 month of the onset of heart failure; the ejection fraction is less than 53%,
(9) Expiratory insufficiency, blood oxygen saturation below 93%;
(10) Within 1-2 weeks after the symptoms of asthma, cough and sputum production improve;
(10) Within 6 weeks after transient cerebral ischemia, cerebral infarction and cerebral hemorrhage;
(11) Various liver diseases with hepatic insufficiency graded below grade b;
(12) Various nephropathy renal insufficiency creatinine > 170mmol/l;
(13) Electrolytes, blood sodium< 130mmol/l blood potassium< 2.5mmol/l;
(14) Blood glucose, fasting> 10mmol/l random or postprandial > 12mmol/l
(15) Excessive obesity bmi> more than 28, such as height 170cm weight>85 kg;
(16) Difficulty in opening the mouth in diseases of the oral and jaw joints;
(17) Neck lump, goiter enlargement compresses the trachea to affect exhalation;
(18) Blood tests with serious infectious diseases;
(19) Anxiety and depression symptoms are not effectively controlled, and there are greater concerns about polyps treatment;
(20) Other patients with various acute chronic diseases in the active period of severe illness and advanced tumor.
I wish you a successful completion of endoscopic treatment of gastrointestinal polyps and an early recovery!
This article is reproduced from the WeChat public account: "Navigation Digestion".