内镜下钛夹治疗十二指肠乳头括约肌切开并发中重度迟发性出血的临床应用价值  

Clinical practice and value of endoscopic titanium clip in treatment of duodenal sphincterotomy complicated with moderate and severe delayed hemorrhage

作　　者：马文聪 楼奇峰 张筱凤 杨建锋 沈绚丽 余爱玉 Wen-cong Ma;Qi-feng Lou;Xiao-feng Zhang;Jian-feng Yang;Xuan-li Shen;Ai-yu Yu(Department of Gastroenterology,the First People’s Hospital of Hangzhou,Zhejiang University School of Medicine,Hangzhou,Zhejiang 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院消化内科

出　　处：《中国内镜杂志》2019年第8期47-52,共6页China Journal of Endoscopy

摘　　要：目的在改良内镜负压装置下,探讨钛夹治疗十二指肠乳头括约肌切开并发中重度迟发性出血的临床价值。方法选择10例十二指肠乳头括约肌切开并发中重度迟发性出血的患者,采取在全麻气管插管下行胃镜探查,确定出血部位为十二指肠乳头切口处,更换十二指肠镜予以钛夹夹闭止血。结果10例患者均一次止血成功,胃镜下探查平均耗时(48.93±3.24)min,钛夹夹闭平均耗时(14.55±2.21)min,使用钛夹数量平均(2.70±1.22)个。10例患者内镜下止血前与止血后12和24 h血清淀粉酶、总胆红素和直接胆红素比较,差异均无统计学意义(P>0.05),内镜下止血前与止血后12和24 h血红蛋白比较,差异有统计学意义(P<0.01)。结论在保证内镜视野的前提下,内镜下钛夹治疗十二指肠乳头括约肌切开并发中重度迟发性出血安全、有效,具有十分重要临床意义。Objective To investigate the clinical practice and application value of titanium clip in treatment of moderate and severe delayed hemorrhage of duodenal papillary sphincterotomy based on modified endoscopic negative pressure device.Methods 10 cases of duodenal papillary sphincterotomy complicated with moderate and severe delayed hemorrhage were examined by gastroscopy under general anesthesia and tracheal intubation,and the location of bleeding was determined as duodenal papillary incision.Replace duodenoscope with titanium clip to stop bleeding.Results All the 10 patients were successful in hemostasis at one time.The average time of exploration under gastroscopy was(48.93±3.24)min,the average time of titanium clip clamping was(14.55±2.21)min,and the average number of titanium clips was(2.70±1.22).10 patients were treated with amylase before and after endoscope hemostasis 12 h and 24 h after hemostasis.The laboratory results of total bilirubin and direct bilirubin had no significant difference(P>0.05),but there was significant difference in the laboratory results of hemoglobin before endoscopy and 12 h and 24 h after hemostasis(P<0.01).Conclusion Under the premise of ensuring endoscopic visual field,endoscopic titanium clip is safe and effective in the treatment of duodenal sphincterotomy complicated with moderate and severe delayed hemorrhage,which is of great clinical significance.

关 键 词：十二指肠乳头括约肌切开 中重度迟发性出血 内镜 钛夹 

分 类 号：R65[医药卫生—外科学]