EST术中出血及其内镜下止血治疗的临床研究  

Endoscopic management of the hemorrhage in endoscopic sphincterotomy

作　　者：王运东[1] 贾玉良[1] 张国政[1] 何池义[1] 袁鹤鸣[1] 韩真[1] 

机构地区：[1]皖南医学院附属弋矶山医院消化内科,安徽芜湖241001

出　　处：《皖南医学院学报》2015年第2期158-160,共3页Journal of Wannan Medical College

摘　　要：目的：评估十二指肠乳头切开术（endoscopic sphincterotomy，EST）中出血的局部因素，评判不同内镜下止血方式对EST术中出血的止血疗效。方法：回顾性分析皖南医学院附属弋矶山医院2011年9月～2014年9月接受EST手术患者共1336例。回顾资料包括每例患者的十二指肠乳头类型及切开范围和是否出血，每例出血患者的内镜下止血方式及止血效果。评估不同十二指肠乳头类型及切开方式对术中出血发生的影响，评估拉式切开刀电凝止血、针状刀电凝止血、球囊压迫止血、钛夹止血的内镜下止血效果。计量资料采用￡检验、分类资料）（2检验，有序的多组分类资料用秩和检验进行统计分析。结果：十二指肠乳头大切开312例，出血患者22例；十二指肠乳头中切开674例，出血患者37例；十二指肠乳头小切开350例，出血患者9例。三组之间出血发生率有显著差异（P=0．026，X^2=7．298）。正常乳头l063例，出血41例，憩室旁乳头273例，出血27例，两组之间出血率差异有显著差异（P=0．000，X^2=16．366）。拉式切开刀止血34例，成功34例；针状刀止血19例，成功18例，1例转为血管介入手术；球囊压迫止血14例，成功12例，2例转为血管介入手术；钛夹止血1例，成功1例。结论：憩室旁乳头切开出血风险大于正常乳头切开风险，大切开和中切开的出血风险大于小切开风险。对不同的出血方式选择不同的内镜下止血方式可以有效地达到止血效果。Objective：To investigate the local factors associated with hemorrhage in endoscopic sphincterotomy（EST） the endoscopic strategies for man- agement of the bleeding. Methods： The clinical data were reviewed in 1 336 patients undergone EST in our hospital between September 2011 and 2014 concerning the lesion location of the duodenal papilla, level of incision, and presence or absence of hemorrhage in procedure as well as bleeding manage- ment strategy for individual case. All data were measured with t-test and X^2 test for evaluation of the effects on hemostasis. Results ： Hemorrhage occurred in 22 of 312 by large cut ,37 of 674 by medium cut, and 9 of 350 by small cut. Incidence of the hemorrhage was in 43 of 1 063 cases with normal duodenal papilla, and in 27 of 273 with involvement of duodenal papilla by the diverticulum, and the two groups were statistically different （ P = 0. 000, X^2 = 16. 366 ）. Hemostasis achieved in 34 cases by clever knife electrocoagulation therapy, 18 of 19 by needle knife electrocoagulation therapy, 12 of 14 by bal- loon compression therapy and 1 by clip therapy. Conclusion： Cut-through of the duodenal papilla by the diverticulum is associated with greater risk of bleeding in EST compared to cut of normal duodenal papilla, and larger cut has more risks than the small cut. However, appropriate endoscopic strategy can lead to effective hemostasis.

关 键 词：EST 出血 内镜下治疗 

分 类 号：R657.4[医药卫生—外科学]