{"id":5278,"date":"2016-10-17T00:00:00","date_gmt":"2016-10-16T16:00:00","guid":{"rendered":"\/\/www.afterroberto.com\/?guid=bd321bbe7c3ae372cb07666cb95272cf"},"modified":"2019-12-09T18:12:31","modified_gmt":"2019-12-09T10:12:31","slug":"%e5%95%8f%e9%86%ab%e7%94%9f%ef%bc%9a%e5%81%9c%e6%9c%8d%e8%96%84%e8%a1%80%e4%b8%b8-%e5%85%88%e8%a1%a1%e9%87%8f%e9%a2%a8%e9%9a%aa","status":"publish","type":"post","link":"\/\/www.afterroberto.com\/%e5%95%8f%e9%86%ab%e7%94%9f%ef%bc%9a%e5%81%9c%e6%9c%8d%e8%96%84%e8%a1%80%e4%b8%b8-%e5%85%88%e8%a1%a1%e9%87%8f%e9%a2%a8%e9%9a%aa\/","title":{"rendered":"\u554f\u91ab\u751f\uff1a\u505c\u670d\u8584\u8840\u4e38 \u5148\u8861\u91cf\u98a8\u96aa"},"content":{"rendered":"

\"\"<\/a>
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* \u9999\u6e2f\u5927\u5b78\u746a\u9e97\u91ab\u9662\u75c5\u7406\u90e8\u5b78\u7cfb\u8f44\u4e0b\u300c\u907a\u50b3\u6027\u8178\u80c3\u764c\u57fa\u56e0\u8a3a\u65b7\u5316\u9a57\u5ba4\u300d\uff0c\u70ba\u907a\u50b3\u6027\u7d50\u76f4\u8178\u764c\u60a3\u8005\u63d0\u4f9b\u57fa\u56e0\u8a3a\u65b7\u670d\u52d9\u3002<\/p>\n

\u7db2\u7ad9\ufe55goo.gl\/F6Rvz5<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】鄭：鄭志文醫生 梁：梁家騮醫生 觀：facebook Live 觀眾<\/p>\n

觀﹕我爸爸70歲，服食薄血丸（華法林Warfarin）5年。近日大便有血，可否做大腸鏡檢查？是否需要停藥？<\/p>\n

梁﹕視乎什麼原因服食華法林（口服抗凝血藥），停藥與否，需平衡風險。若暫停用藥對於本來疾病沒有很大影響，病人可以停藥一段時間，安心進行大腸鏡，減低出血風險。<\/p>\n

若病人不適宜停藥，醫生或會考慮轉用另一隻抗凝血藥（肝素Heparin）；它比華法林易於控制，進行檢查相對安全一點。<\/p>\n

某些極端個案（例如曾經接受更換心瓣手術），病人必須一直服食抗凝血藥，一旦停藥，風險很大；若醫生懷疑腸道出現嚴重疾病，可能在不停藥下照做腸鏡檢查，或者商討其他檢查方法（如：電腦掃描）。<\/p>\n

痔瘡出血 不能做篩查？<\/p>\n

觀﹕患有痔瘡，若接受大便隱血測試篩查，結果會否不準確？<\/p>\n

梁﹕若在痔瘡出血期間採便，就會出現陽性結果。痔瘡病人如要接受大便隱血測試，應該在痔瘡沒有出血時採便。 <\/p>\n

大便隱血測試有其局限性，絕對不是百分百（大約80%） 準確。即使結果呈現陰性，不代表一定沒事。至於結果陽性，也包括不少「假陽性」個案。例如：30萬人接受大便隱血測試篩查，預計1萬人結果呈陽性。這1萬人再做大腸鏡檢查，可能300個有癌症，2000個有瘜肉，餘下7000多個可能是痔瘡患者。29萬呈現陰性結果的人當中，亦可能有癌症或大瘜肉；不過在大便隱血測試期間沒有出血，所以偵測不到。<\/p>\n

另外，大家需要注意，大便出血（不論因為痔瘡與否），其實已經歸納在「出現病徵」群組，不要掉以輕心。<\/p>\n

基因檢查 跟進遺傳性腸病<\/p>\n

觀﹕我的媽媽48歲死於大腸癌。我在24歲進行大腸鏡檢查時，發現瘜肉；我是否要一直定期檢查？<\/p>\n

梁﹕如果患者帶有某些突變基因，屬於遺傳性的腸道疾病，包括：遺傳性非瘜肉結直腸癌綜合症及家族性結直腸瘜肉綜合症。前者特徵是超過一名家庭成員患上超過一種癌症，而且年輕病發；後者則在年輕時候，大腸開始出現大量瘜肉，如果沒有適當的跟進和治療，40歲左右可能演變成為癌症。<\/p>\n

如有懷疑，建議透過基因診斷（*），檢查有沒有突變基因。若帶有突變基因，病人須一直定期跟進。視乎年紀和病變，可能需要採取預防性的切除手術。<\/p>\n

若非帶有突變基因，醫生就會當作高風險人士跟進。不論年齡，若大腸鏡檢查發現瘜肉，視乎瘜肉的數目、大小及病變程度，建議每3至5年定期進行腸鏡檢查。<\/p>\n

大腸鏡檢查 有何風險？<\/p>\n

鄭﹕大腸鏡檢查，出血風險在哪裏？<\/p>\n

梁﹕進行大腸鏡檢查，若沒有發現瘜肉，一般風險很低。若發現瘜肉，需要切除治療，出現併發症和出血的風險增加。大腸鏡有弄損或刺穿腸道的風險，導致出血或腹膜發炎徵狀，可能需要手術修補。<\/p>\n

另外，大腸鏡檢查前需要飲用藥水，清洗腸道。準備過程，也有可能出現罕有併發症。例如：某些洗腸藥水可能令到本來腎功能有問題的病人出現腎衰竭；或腸塞病人洗腸時或會弄穿腸壁。<\/p>\n

* 香港大學瑪麗醫院病理部學系轄下「遺傳性腸胃癌基因診斷化驗室」，為遺傳性結直腸癌患者提供基因診斷服務。<\/p>\n

網站﹕goo.gl\/F6Rvz5<\/a><\/p>\n

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