内镜下治疗结直肠出血的临床疗效  

Efficacy of endoscopy for the treatment of colorectal hemorrhage

作　　者：刘靖正[1] 周平红[1] 姚礼庆[1] 徐美东[1] 马丽黎[1] 胡健卫[1] 秦文政[1] 任重[1] 

机构地区：[1]复旦大学附属中山医院内镜中心、内镜诊疗研究所、上海医学院外科学系,上海200032

出　　处：《中华消化外科杂志》2013年第12期952-955,共4页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（11071046）

摘　　要：目的探讨内镜下治疗结直肠出血的临床疗效。方法回顾性分析2008年6月至2011年6月复旦大学附属中山医院收治的104例结直肠出血患者的临床资料。内镜下治疗结直肠疾病术后出血，内镜下即可见出血部位；无内镜治疗史者，必须在内镜下迅速找到出血部位，了解其性质。内镜下首先应用1：1000冰去甲肾上腺素生理盐水充分冲洗肠腔，尽量吸引病灶周围血块，使镜下视野清晰，辨认出血部位；必要时可使用连续注水泵，以保证内镜下治疗视野的清晰。主要止血方法：（1）局部喷洒止血药物。（2）金属夹止血。（3）氩气离子凝固术。（4）硬化剂注射。（5）多技术联合止血。术后随访1～6个月。结果104例结直肠出血患者中内镜治疗术后出血84例、外科手术后出血16例、结直肠原发疾病出血4例。初次成功止血97例，24h内再出血7例（再次内镜下成功止血6例、止血失败转腹腔镜治疗1例），内镜下止血总有效率为99．04％（103／104）。内镜治疗术后平均随访4．2个月，患者复查肠镜均无再出血发生。结论内镜下治疗结直肠出血是一种安全、有效的治疗方法。Objective To investigate the clinical efficacy of endoscopic treatment for colorectal hemor- rhage. Methods The clinical data of 104 patients with coloreetal hemorrhage who were admitted to the Zhongsban Hospital of Fudan University from June 2008 to June 2011 were retrospectively analyzed. The conditions of the lesions of hemorrhage were identified directly under the endoscope. The enteric cavity was completely irrigated by 0.1% norepinephrine saline to remove the blood clots around the lesions for providing a better vision. The main hemostatic methods included hemostatic drugs, metallic hemostatic clip, argon plasma coagulation, sclerosing agent injection, and various techniques combination. Patients were followed up for 1-6 months after the treatment. Results Eighty-four patients were diagnosed as with colorectal hemorrhage after endoscopy, 16 patients were with colorectal hemorrhage after surgery, and 4 patients were with eolorectal hemorrhage caused by primary colorectal diseases. Hemostasia was successfully completed in 97 patients. Seven patients had colorectal hemorrhage recur- rence within 24 hours, and hemostasia was successfully completed in 6 patients, 1 patient was converted to open surgery. The total successful rate of endoscopic hemostasis was 99.04% （103/104）. The mean time of follow-up was 4.2 months, and no colorectal hemorrhage recurrence was observed during the follow-up. Conclusion Endo- scopic hemostasis is safe and effective for the treatment of eolorectal hemorrhage.

关 键 词：结肠疾病 直肠疾病 出血 内窥镜检查 

分 类 号：R574[医药卫生—消化系统]