止血粉与止血夹用于结直肠病变内镜下黏膜切除术中止血及预防再出血的随机对照研究  

Hemostat in comparison with metallic hemoclip for hemostasis and preventing post-procedure bleed- ing after endoscopic mucosal resection： a prospective, randomized trial

作　　者：张林慧[1] 黄蕊[1] 刘志国[1] 潘阳林[1] 张荣春[1] 王向平[1] 罗辉[1] 惠娜[1] 陶芹[1] 马婷[1] 郭学刚[1] 

机构地区：[1]第四军医大学西京消化病医院消化六科,西安710032

出　　处：《中华消化内镜杂志》2013年第12期661-664,共4页Chinese Journal of Digestive Endoscopy

摘　　要：【摘要】目的探讨止血粉用于结直肠病变内镜下黏膜切除术中创面止血及预防术后再出血的临床效果。方法164例结直肠黏膜及黏膜下病变行EMR治疗患者采用随机数字表法随机分成2组，止血粉组和止血夹组各82例，创面分别给予止血粉和止血夹止血处理和预防性治疗，比较2组术中止血治疗时间、止血成功率、术后再出血和出血发生率、不良反应及创面愈合情况。结果止血粉组和止血夹组术中止血治疗时间分别为64（37—114）S和123（82—234）S，差异有统计学意义（P〈0．01）。止血粉组和止血夹组分别有20例和19例出现术中出血，单独使用止血粉或止血夹止血率分别为90．0％（18／20）和89．5％（17／19），差异无统计学意义（P=0．677），两组未能成功止血者分别联合热活检钳或APC均成功止血。术后72h内止血粉组术中出血者术后再出血发生率为25．0％（5／20），止血夹组为15．8％（3／19），两组差异无统计学意义（P=0．695）；术后72h内止血粉组术中预防性止血者出血发生率为4．8％（3／62），止血夹组为9．5％（6／63），两组差异亦无统计学意义（P=0．491）。两组均未发生严重不良反应，术后随访1个月，结肠镜复查见手术创面愈合好，无再出血发生。结论结直肠病变内镜下黏膜切除术应用止血粉可有效进行创面止血并预防术后再出血，并且较止血夹止血具有操作时间短的优点，可选择作为内镜下的止血方法。Objective To compare the clinical effects of hemostat and metallic hemoclip on bleed- ing control and prevention after endoscopic mucosal resection. Methods A total of 164 patients, who re- ceived colorectal EMR in our hospital from April 2009 to July 2011, were randomly divided into hemostat group or hemoclip group, 82 cases in each. The hemostatic time, hemostatic rates, rebleeding rates and treatment-related complications were compared. Results The hemostatic times of hemostat group and hemo- clip group were 64 （ 37-114 ） s and 123 （ 82-234 ） s, respectively （ P 〈 0. O1 ）. Twenty lesions in hemostat group and 19 lesions in hemoclip group showed bleeding immediately after procedure, with hemostatic rates of 90. 0% （18/20） and 89.5% （17/19） , respectively （ P = 0. 677）. Lesions of unsuccessful hemostatis in each group were treated by hot biopsy forceps or argon plasma coagulation, and complete hemostasis was achieved in all cases without referring to surgery. The rebleeding rates within 72 hours in hemostat group and hemoclip group were 25. 0% （5/20） and 15.8% （3/19） （P =0. 695）. In patients without bleeding immedi-ately after procedure, the procedures were performed for prophylaxis, the bleeding rates of whom were 4. 8% （3/62） in hemostat group and 9.5% （6/63）in hemoclip group （P = 0. 491 ） within 72 hours. No major ad- verse events of treatment were reported during 30-day follow-up. Colonoscopy was performed at the 30th day of the follow-up and complete healing of mueosal defect was observed in all cases. Conehtsion Hemostat showed efficacy on post-EMR hemostatsis and bleeding prevention with the advantage of less procedure time, thus might be a useful alternative to control bleeding endoscopically.

关 键 词：【关键词】止血粉 止血粉喷洒系统(EndoClot) 止血夹 内镜下黏膜切除术 

分 类 号：R656[医药卫生—外科学]