新型金属止血夹用于内镜下结肠息肉电切术中出血的治疗效果观察  

Application of a new type of metal clip hemostat in bleeding under endoscopic colonic polypectomy

作　　者：朱伟琴[1] 李华铭[1] Zhu Weiqin;Li Huaming(Department of Digestive Medicine,the Third People's Hospital of Hangzhou,Hangzhou,Zhejiang 310009,China)

机构地区：[1]杭州市第三人民医院消化内科,310009

出　　处：《中国基层医药》2019年第11期1285-1288,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察新型金属止血夹在内镜下结肠息肉电切术中出血的治疗效果。方法选择2016年1月至2017年12月杭州市第三人民医院接诊的结肠息肉电切术中出血患者298例进行研究,采用随机数字表法分为研究组(149例)和对照组(149例)。对照组给予一般止血夹和止血药物,研究组在内镜下给予新型金属夹和止血药物。比较分析两组患者止血率、近远期预后情况和不同治疗时间点(T0:治疗前,T1:治疗后12 h,T2:治疗后24 h,T3:治疗后48 h)的临床症状严重程度积分。结果对照组即时止血率(86.58%)、有效止血率(73.15%)和彻底止血率(66.44%)均明显低于研究组(100.00%、93.29%和89.93%)(χ^2=21.439、21.629、24.104,均P<0.05)。研究组患者的大便潜血试验转阴时间(3.54±0.18)d、肠鸣音复常时间(5.21±0.45)d和住院时间(8.42±0.75)d,均明显短于对照组的(4.16±0.27)d、(7.18±0.26)d和(9.65±1.27)d(t=23.322、46.270、10.180,均P<0.05)。研究组患者的再出血率(6.71%)(10/149)、外科手术率(3.36%)(5/149)、并发症发生率(3.36%)(5/149)和病死率(0.00%)(0/149)均低于对照组[26.85%(40/149)、8.05%(12/149)、6.71%(10/149)和2.01%(4/149)](χ^2=21.629、3.057、1.755、3.031,均P<0.05)。两组患者T0时间点的临床症状严重程度积分差异无统计学意义(P>0.05);两组患者T1、T2、T3时间点的临床症状严重程度积分均依次下降,且研究组患者积分均低于对照组(t=77.562、54.816,均P<0.05)。结论结肠息肉电切术中出血患者运用内镜下新型金属夹止血后,止血率显著提高,治疗效果稳定,出血复发率低。Objective To analyze the effect of a new type of metal clip hemostat in bleeding under endoscopic colonic polypectomy.Methods From January 2016 to December 2017,298 cases of colonic polypectomy hemorrhage patients in the Third People's Hospital of Hangzhou were studied,and they were randomly divided into study group(149 cases)and control group(149 cases)according to the digital table.The control group was given general hemostat and hemostatics,and the study group was given new metal clips and hemostatic drugs under endoscopy.The hemostasis rate,the prognosis in the near and long term and the score of the severity of clinical symptoms at different treatment time points(T0-before treatment,T1-12h after treatment,T2-24h after treatment and T3-48h after treatment)were compared and analyzed in the two groups.Results The immediate hemostasis rate(86.58%),effective hemostasis rate(73.15%)and complete hemostasis rate(66.44%)in the control group were significantly lower than those in the study group(100.00%,93.29%and 89.93%),and there were statistically significant differences in bleeding rates between the two groups(χ^2=21.439,21.629,24.104,all P<0.05).The fecal occult blood clearance time[(3.54±0.18)d],bowel sound recovery time[(5.21±0.45)d]and hospitalization time[(8.42±0.75)d]of the study group were significantly shorter than those of the control group[(4.16±0.27)d,(7.18±0.26)d and(9.65±1.27)d],the differences were statistically significant between the two groups(t=23.322,46.270,10.180,all P<0.05).The rebleeding rate[(6.71%)(10/149)],complication rate[(3.36%)(5/149)]and mortality[(0.00%)(0/149)]in the study group were all lower than those in the control group[26.85%(40/149),8.05%(12/149),6.71%(10/149),2.01%(4/149)],the differences were statistically significant between the two groups(χ^2=21.629,3.057,1.755,3.031,all P<0.05).The difference of clinical symptom severity score of the two groups at T0 was not obvious(P>0.05).The scores of clinical symptoms of the two groups at T1,T2 and T3 were decreased in turn,an

关 键 词：结肠息肉 结肠镜检查 内镜下黏膜切除术 出血 金属夹 止血 

分 类 号：R574.62[医药卫生—消化系统]