医学英语必读 | 消化内镜的过程和并发症 Endoscopy's Process and Complications
摘要： 内镜检查（Endoscopy）是一种通过内镜经自然腔道或小切口进入体内，用于诊断或治疗消化道及其他器官疾病的微创医疗操作。大多数内镜检查无需全身麻醉，过程通常持续15至60分钟，并发症发生率低于1%。
- 内镜检查通常经肛门、咽喉、尿道或皮肤小切口进行，多数情况下无需住院。
- 患者在检查前可能需要禁食、停用抗凝药物或服用泻药，但必须遵医嘱。
- 并发症罕见（<1%），主要包括感染、器官穿孔、异常出血或麻醉过敏。
- 局部麻醉（如利多卡因棒棒糖）可有效替代镇静剂，减少镇静相关不良事件。
- 术后出现红肿、发热、脓液或持续疼痛等感染征象时应及时就医。
Written by Christian Nordqvist
What happens during an endoscopy?
The patient may be asked to fast (not eat) or drink for a period before the endoscopy if the instrument is going to go in through the anus. In some cases the patient may be given a laxative. Some patients are given antibiotics to prevent infection.
Patients on blood-thinning medications, such as warfarin, may be asked to stop taking them for a number of days before their endoscopy. There is a risk the blood thinner may cause excessive bleeding during the procedure. It is important the patient only does so if the doctor tells him/her. A study concluded that anti-inflammatory drugs, such as aspirin, do not increase the patient’s risk of bleeding during an endoscopy.
In the UK most endoscopies are done in hospital, or some large GP (general practice) clinics.
The vast majority of endoscopies do not require a general anesthetic. Some patients may receive a local anesthetic. A study found that administering a lidocaine lollipop as a single-agent anesthetic to patients undergoing an upper gastrointestinal endoscopy procedure eliminated the need for sedation in the majority of patients. Patients describe the procedure as possibly ‘uncomfortable’, but hardly ever ‘painful’. This study explains that the use of an evidence-based sedation protocol for endoscopic procedures improves the quality of practice and reduces the incidence of sedation-related adverse events.
Most endoscopes will enter the patient via the:
- Anus
- Throat
- Urethra (urine exits the body through the urethra)
- A small incision made in the skin.
In most cases endoscopies will last from 15 to 60 minutes. The patient rarely has to spend the night in hospital. Some patients may notice some blood in their urine after a cystoscopy (bladder examination) or when they pass a stool after a prostate biopsy, for example - this is normal for a few days.
Most patients can get up within an hour of their endoscopy. It is advisable that the patient does not drive out of the hospital after an endoscopy.
What are the complications of an endoscopy?
According to the National Health Service (NHS), UK, less than 1% of endoscopies have complications. When they do occur, they may include:
- An infection, possibly somewhere along the path of the endoscope.
- Piercing or tearing of an organ. This may require subsequent surgery. This isarticle explains how tears and perforations caused by endoscopy can be fixed without invasive surgery.
- Bleeding more than normally expected. This may require subsequent surgery.
- An allergy to the anesthetic. Antihistamines may be used to treat this.
The following signs may indicate an infection has developed after the endoscopy:
- Redness
- Swelling
- Fluid or pus discharge
- Pain
- Temperature (fever).
Any patient who experiences these signs after an endoscopy should contact their doctor. A course of antibiotics should clear up the infection.
常见问题
内镜检查会很痛吗？
大多数患者描述内镜检查为“不适”但极少感到“疼痛”；使用局部麻醉（如利多卡因棒棒糖）可有效减轻不适，多数人无需镇静。
做内镜前需要停用阿司匹林或华法林吗？
华法林等抗凝药可能需在医生指导下暂停数日以降低出血风险，但阿司匹林等非甾体抗炎药通常不会增加内镜出血风险，无需常规停用。
内镜检查后多久能恢复正常活动？
多数患者可在检查后一小时内起身活动，但建议当天不要驾车；若无并发症，通常无需住院。
内镜检查后出现血尿或便血正常吗？
在膀胱镜检查后出现少量血尿，或前列腺活检后短暂便血，属于正常现象，通常持续数天。
参考资料
NHS (National Health Service) - Endoscopy
英国国家医疗服务体系关于内镜检查的官方信息，提及并发症发生率低于1%及术后注意事项。
Evidence-based sedation protocol for endoscopic procedures
研究指出基于证据的镇静方案可提升内镜操作质量并减少不良事件。
Lidocaine lollipop as single-agent anesthetic in upper GI endoscopy
研究显示利多卡因棒棒糖作为单一麻醉剂可使多数上消化道内镜患者无需额外镇静。