内镜黏膜下剥离术后短期内胃镜检查对防治迟发性出血的价值评价  

Post-ESD endoscopy for prevention of delayed bleeding

作　　者：钟芸诗[1] 时强[1] 姚礼庆[1] 周平红[1] 徐美东[1] 任重[1] 陈涛[1] 

机构地区：[1]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中华消化内镜杂志》2012年第5期247-250,共4页Chinese Journal of Digestive Endoscopy

基　　金：上海市科委重大项目（09DZ1950102,10411962300,11411950502）;国家自然科学青年基金（81101566）;上海市卫生局新优青计划（XYQ2011017）

摘　　要：目的探讨胃黏膜病变内镜黏膜下剥离术（ESD）后短期内再行胃镜检查在防治迟发性出血中的临床价值。方法回顾性分析2011年5月至11月间，行ESD治疗的67例胃黏膜病变患者的临床资料，患者年龄31～84岁，中位年龄63岁。所有患者术后第1天、第3天常规胃镜复查，观察有无创面迟发性出血，并给予适当处理及随访。结果67例患者中，病变位于贲门5例、胃体6例、胃底3例、胃窦35例、胃角16例、残胃2例。病变最大直径2．0～7．0cm，平均（3．73±1．24）cm。ESD术中无大量出血和穿孔等并发症，术后9．0％（6／67）的患者发生迟发性出血，5例发生在术后第3天，1例在术后第4天。迟发性出血者中Forrest分级Ib2例，Ⅱb4例，均经内镜下成功止血。本组中迟发性出血的发生率远高于既往仅根据患者的临床表现判断迟发性出血所得的出血发生率，但从随访结果看，两者治疗效果及安全性相当。结论ESD术后迟发性出血的实际发生率较高，但大多无临床症状，无严重不良后果，故可以不常规行ESD术后短期内胃镜检查，以减轻患者的痛苦和精神负担。Objective To evaluate a second endoscopy for prevention of delayed bleeding after ESD. Methods Data of 67 patients with gastric epithelial neoplasms undergoing ESD from May to November 2011 were reviewed. The median age was 63 （31 ± 84） years. All patients were followed up by endoscopy on the first and the third day after ESD. Results Of 67 lesions, 5 were located at eardia, 6 at gastric body, 3 at fundus, 35 at antrum, 16 at gastric angle, and 2 at residual stomach. The mean maximum diameter of the lesions was 3.73 ±1.24 （2.0 ± 7.0 ）em. There were no intraoperative complications. Post-ESD de- layed bleeding was detected by endoscopy in 6 （9.0%） patients, with 5 on the third day and 1 on the fourth day. Forrest grading showed 2 cases of ] b, and 4 of 11 b. All 6 cases were cured by endoscopy. The inci- dence of postoperative bleeding was far more than that evaluated based on the patients＇ clinical manifestations only. But therapeutic effect and safety were the same according to the follow-up results. Conclusion Incidence of post-ESD bleeding is high, but there are no symptoms or severe consequences, so a second endoscopy after gastric ESD may contribute little to the prevention of delayed bleeding.

关 键 词：内镜黏膜下剥离术 手术后并发症 手术后出血 

分 类 号：R573[医药卫生—消化系统]