[肠癌康复期复查篇3] — 复查报告医生看什么?患者、家属看什么?

术后前两年里复查腹部B超和腹部增强ct轮流做?影像报告医生主要看什么?

结直肠癌术后患者,复查时应行胸部增强ct,腹部增强ct,盆腔增强ct检查,结直肠癌术后患者,肿瘤容易通过血液,淋巴结转移到,肺部,肝脏,盆腔等部位,如果发现这些部位异常,应及时做进一步检查,结合其它的检查结果,做出大概率的综合判断,以指导医生下续的诊疗措施。

腹部B超(肝胆脾胰)检查

结直肠癌术后患者,肝脏和肺脏的检查非常重要,和术区是每次影像复查的重中之重。肠癌肿瘤容易往肝脏转移,肝功能,彩超,ct等应定期穿插复查,这也是肠癌患者术后前两年腹部B超(肝胆脾胰)和腹部增强ct穿插轮流做的原因,保证每半年患者都做过一次腹部B超和腹部增强ct各一次,利用各种检查设备的优点,互补各种检查设备的缺点,发挥各种检查设备的功能优势,每半年给予患者一套最科学的影像检查;而肺脏的转移主要以每次检查都有安排的胸部正位片和ct平扫为主,每次复查都安排的胸部正位片有助于发现肺部结节及纵隔转移灶及周边淋巴结肿大。一般大于5mm的肺结节,检查报告就开始跟踪描述其结节的性质和形态,对于怀疑有肺部转移者需要进一步做胸部增强CT检查,以进一步排除或确诊肺部转移。

腹部增强CT检查

结肠癌术后患者一般每半年做腹部增强CT检查一次,直肠癌建议做下腹部ct检查,以了解局部是否有复发和腹膜后淋巴结是否有转移。根据原结直肠癌所在的部位决定是行上腹部CT增强还是下腹部CT增强,有不能够判断的怀疑复发结节时,医生一般还会建议患者做核磁检查甚至派特CT检查,用派特CT的异常摄取LUV值去帮助医生判断怀疑结节是否原位复发。结直肠癌术后患者,怀疑有骨转移的病人,应行核素骨扫描检查,以判断转移的部位,必要时可以局部核磁共振成像能明确骨质破坏情况,确诊骨转移之后要及时作出治疗处理,如对骨转移非常敏感、有效的放疗治疗。

为在每个复查期,更好更全面的了解患者术后复查期内的各种器官的变化情况,或者发现复发转移的征兆,及时做更进一步的检查以排除或确诊患者在某个器官的怀疑病灶,及时作出必要的判断和诊治措施,对某些怀疑病灶结合其它如肿瘤标志物指标、生化指标对高度怀疑的肝肺病灶和复查期怀疑异时转移病灶进行高概率的判断,医嘱随诊或者做进一步通过化疗观察怀疑病灶的变化,(不变、缩小、长大)去判断患者某个器官(如肝、肺、术区)高度怀疑结节是否确诊转移、复发,或者继续观察、或者排除怀疑。

结直肠癌术后患者,经济条件好的话每年可以进行一次PETCT检查,能较早发现患者的复发转移病灶,经济条件一般的患者一般要有高度怀疑的复发转移病灶,或者无法解释的癌胚抗原急速升高的情况时,医生才会建议患者和家属去做PETCT检查。

术后前两年里复查腹部B超和腹部增强ct轮流做,影像报告患者和家属主要看什么?

一般患者术后每次复查影像检查时,影像检查医生都会将患者的上一次同类型设备做的检查结果做对比,去发现患者某个器官、某个身体部位在复查期内有什么明显或微小的变化或没有变化;并在检查报告中描述各个器官(主要以肝肺和术区)上次检查发现的异常的低密度影、低密度结节影、高密度结节、实性结节、不均衡强化结节、环形强化结节、囊肿、疤痕、条索影、钙化灶、形状等的变化、周边淋巴结影或淋巴结长大,并描述这些异常结节和淋巴结的尺寸,并在报告的依次写出检查所见和最后的诊断意见,对某些高度怀疑的结节或者首次超过要报告的肝肺5mm以上结节,该影像设备不能够很准确判别的结节,而建议外科医生医嘱患者做增强核磁乃至PETCT检查,或结合临床和其它检查结果,以进一步判断患者是否有复发转移的迹象。

患者和家属拿到报告之后要详细的看看各种报告检查所见和诊断意见描述病情的每一句话,特别是跟上次检查报告里检查所见中描述有发生变化的地方,如:上次报告描述是低密度影,现在是高密度影,上次是低密度结节,这次是高密度结节、或者实性结节,上次的实性结节现在变成不均匀强化结节,上次是不均匀强化,这次是环形强化结节;上次是淋巴结影,这次是小淋巴结、或肿大的淋巴结,并描述其尺寸,检查所见术区吻合口是不是增厚、是否强化?肠外是不是有肿块?术区周边是否有淋巴结影或者淋巴结肿大,并描述其最大者的尺寸,结合肠镜检查吻合口是否有新生的肿物等等,和在检查所见中新增描述的新的结节,达到5mm医生开始描述跟踪观察的结节,变大、变小、与上次相仿等检查所见描述和最后的诊断意见总结。

根据上述的综合检查结果去初步综合判断患者,在这个复查期内有没有高度怀疑的复发转移迹象;在给手术医生或胸外科医生、肝胆外科医生,或者心肺科医生看片或看报告之前,自己对报告有个基本的变化判断和了解变化的基础跟医生对话,询问看片、看报告的医生各种变化与没有变化的意义,特别是新增结节和新增肿大淋巴结,结节变实性和强化的结节,变大或者化疗之后变小的结节,吻合口增厚程度和周边是否有不正常的包块,和这种包块的形状及意义。在跟看片、看报告医生有限的交流时间里,略过一些没有变化或与前相仿等问题,一些囊肿问题,一些未见异常的常规表述问题,其它跟肠癌关系不大的器官的常规表述问题,重点跟医生讨论肝肺和术区的敏感变化问题和新增加新发现的结节问题,变大变小或变强化的重点问题。

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[肠癌康复期复查篇3] — 复查报告医生看什么?患者、家属看什么?》有223个想法

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