内镜下乳头括约肌切开术中出血的治疗  

Treatments for bleeding during endoscopic sphincterotomy

作　　者：王闯 周晓华[2] 姚金科 刘建平[3] Wang Chuang;Zhou Xiaohua;Yao Jinke;Liu Jianping(Department of General Surgery,Zengcheng District People's Hospital of Guangzhou,Guangzhou 511300,China;Department of Ultrasound,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China;Department of Biliary-pancreatic Surgery,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]广州市增城区人民医院普通外科,511300 [2]广州医科大学附属第二医院超声科,510260 [3]中山大学孙逸仙纪念医院胆胰外科,广州510120

出　　处：《中华肝脏外科手术学电子杂志》2018年第2期123-126,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨内镜下乳头括约肌切开术(EST)术中出血的原因及止血方法。方法回顾性分析2013年1月至2016年10月在广州医科大学附属第二医院行EST并发生术中出血的90例患者临床资料。其中男48例,女42例,平均年龄(51±2)岁。患者均签署知情同意书,符合医学伦理学规定。观察EST患者的出血部位、出血原因及不同止血方法的疗效。率的比较采用χ2检验。结果出血点明确者共72例,其中出血部位于乳头10~2点钟方向51例,位于乳头2~6点钟方向10例,位于乳头6~10点钟方向11例;出血呈弥漫性者18例。出血原因包括方向不准、刀丝过深、刀弓过高、切口过大。所有患者均治愈,采用钛夹止血40例,成功率97%(39/40);电凝止血31例,成功率81%(25/31);热探头止血14例,成功率71%(10/14);注射纤维蛋白胶10例,成功率7/10;1∶10 000肾上腺素黏膜下注射10例,成功率5/10;球状球囊局部压迫6例,成功率3/6;手术止血1例。内镜下钛夹止血、电凝止血、热探头止血效果确切,其中钛夹止血成功率明显高于电凝止血成功率(χ~2=11.813,P=0.008)。钛夹止血尤其适用于出血血管裸露者,电凝和热探头止血适用于渗血患者。结论十二指肠乳头出血作为EST术后常见并发症,内镜下钛夹止血、电凝止血、热探头止血效果比较确切。Objective To explore the cause and hemostasia for bleeding during endoscopic sphincterotomy(EST).Methods Clinical data of 90 patients undergoing EST and suffering from intraoperative bleeding in the Second Affiliated Hospital of Guangzhou Medical University between January 2013 and October 2016 were analyzed retrospectively.There were 48 males and 42 females with a mean age of(51±2)years.The informed consents of all patients were obtained and the local ethical committee approval was received.The bleeding part,bleeding cause and efficacy of different hemostasia in EST patients were obsesrved.Comparison of rates was conducted by Chi-square test.Results 72 cases were observed with definite bleeding points,including 51 cases'bleeding part was at the papilla 10-2 o'clock direction,10 cases at 2-6 o'clock direction,and 11 cases 6-10 o’clock direction.18 cases were observed with diffuse bleeding.The bleeding causes included inaccurate direction,excessively deep knife cut,excessively high knife bow,and excessively large incision.All patients were cured,including 40 cases of titanium clip hemostasis with a success rate 97%(39/40),31 cases of electric coagulation hemostasis with a success rate 81%(25/31),14 cases of thermal probe hemostasis with a success rate 71%(10/14),10 cases of fibrin glue infusion with a success rate 7/10,10 cases of 1:10 000 epinephrine sub-mucosal injection with a success rate 5/10,6 cases of local compression with spherical sacculus,with a success rate 3/6,and 1 case receiving operative hemostatis.Endoscopic titanium clip hemostatis,electric coagulation hemostatis and thermal probe hemostatis had definite effects.The success rate of titanium clip hemostatis was obviously higher than electric coagulation hemostatis(χ2=11.813,P=0.008).Titanium clip hemostatis was particularly applicable to patients with exposed bleeding vessel,while electric coagulation and thermal probe hemostatis were applicable to patients with errhysis.Conclusion Duodenal papilla bleeding,as a common postoperative complicati

关 键 词：括约肌切开术 内窥镜 止血 治疗结果 

分 类 号：R656[医药卫生—外科学]