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КАЧЕСТВЕННАЯ ПОДГОТОВКА К КОЛОНОСКОПИИ – ЗАЛОГ ТОЧНОЙ ДИАГНОСТИКИ

https://doi.org/10.21518/2079-701X-2017-15-82-88

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Аннотация

Колоноскопия – «золотой стандарт» визуализации толстой кишки. К предраковым изменениям толстой кишки относятся аденоматозные полипы, серратные образования и изменения слизистой, ассоциированные с дисплазией (у больных с воспалительными заболеваниями кишечника). Из-за уплощенного характера выявление серратных образований представляет сложности, а локализация в правых отделах требует особенно тщательной подготовки кишечника. По-видимому, нераспознанные плоские серратные аденомы служат преимущественным источником развития «интервального рака». Одними из важнейших показателей качественной колоноскопии служат хорошее и отличное качество подготовки кишки, полнота осмотра, время извлечения эндоскопа не менее 6–10 мин, частота выявления аденом, которая составляет порядка 15–30%. Недостаточное качество подготовки к колоноскопии напрямую связано с высокой частотой пропущенных аденом и вероятностью развития «интервального рака». Среди предикторов недостаточной подготовки выделены применение наркотических препаратов и трициклических антидепрессантов, наличие сахарного диабета, ожирения, артериальной гипертензии, цирроза печени, запора, неполное следование пациента инструкциям. Степень очистки различных сегментов толстой кишки нередко оценивалась с применением 9-балльной Бостонской шкалы (Boston Bowel Preparation Scale, BBPS). Стандартом подготовки первой линии сегодня является применение раствора полиэтиленгликоля (ПЭГ). Также широкое применение имеет альтернативный препарат на основе фосфата натрия. Однако в настоящее время российские и международные эксперты рекомендуют использовать двухэтапный («сплит») режим раствора ПЭГ 2 л + 2 л. ПЭГ не вмешивается в процессы пищеварения, не абсорбируется в кишечнике. А сплит- режим ПЭГ 2 л + 2 л показывает высокую эффективность и существенно лучшую переносимость пациентами, благодаря чему является стандартом подготовки к колоноскопии, рекомендуемым профессиональными сообществами.

 

Об авторе

Ю. О. Шульпекова
Первый Московский государственный медицинский университет им. И.М. Сеченова
Россия

к.м.н.



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ISSN 2079-701X (Print)
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