急诊内镜止血与外科手术治疗上消化道溃疡反复出血的疗效比较  

Comparison of emergent endoscopic hemostasis with surgical treatment for recurrent bleeding of gastroduodenal ulcer

作　　者：胡维杰[1] 王利娜[1] 汪晓峻[1] 

机构地区：[1]解放军第81医院内镜室,江苏南京210002

出　　处：《东南国防医药》2006年第2期95-96,共2页Military Medical Journal of Southeast China

摘　　要：目的 比较急诊内镜和手术治疗对上消化道溃疡反复出血患者的治疗效果。方法64例患者治疗前经内镜证实上消化道溃疡出血，均有两次以上出血史。内镜治疗组（32例）采用10％孟氏液20-40ml对溃疡面进行喷洒或用热探头电凝止血；外科手术组（32例）行胃大部分切除术或溃疡单纯切除术。结果 内镜治疗组：长期治愈25例（78．1％）；治疗半年内再次出血5例；治疗失败1例；治疗时发生穿孔1例，临床消化道症状缓解者21例（65．6％）。外科手术组：出血长期治愈27例（84．4％），半年内再次出血2例，60天内死亡3例，手术后并发症6例（18．8％），长期有消化道症状者18例（56．3％）。结论 与外科手术治疗相比，急诊内镜治疗上消化道溃疡反复出血的疗效相当，但在缓解症状和减少并发症等方面优于外科手术。Objective To evaluate the outcome of emergent endoscopic and surgical hemostasis for recurrent hemorrhage of gastroduodenal ulcer. Methods A series of 64 patients with bleeding gastroduodenal ulcer were divided into endoscopic （n=32） and surgical （n=32） hemostasis groups. Injection of Monsell＇s solution （10%, 20-40ml） or electric diathermy was applied for endoscopic hemostasis. Partial gastrectomy or simple resection of ulcer was performed in surgical group. Results Among patients with endoscopic treatment, 25 （78.1%） cases achieved long term healing, 5 rebleeded in half a year, one failed to treatment, one,had perforation during manipulation and 21 （65.6% ） were free of gastrointestinal symptoms. Among patients with surgical treatment, 27 （84.4%） achieved long term healing, 2 rebleeded in half a year, 3 died in 60 days after operation, 6 had surgical complications and 18 （56. 3%） complained of gastrointestinal symptoms. Conclusion Compared with the surgical treatment, endoscopic hemostasis is an effective treatment of bleeding gastroduodenal ulcer with more alleviation of symptoms and less complications.

关 键 词：胃十二指肠溃疡 反复出血 内窥镜 手术 治疗 

分 类 号：R573.2[医药卫生—消化系统]