Dieulafoy病引起急性上消化道出血的内镜下治疗  

Endoscopic treatment of acute upper gastrointestinal bleeding caused by Dieulafoy′s disease

作　　者：李晨光 邓彩虹 蒋煜[1] 何玲玲[1] 周玉玲[1] 梁秀霞[1] 胡居龙[1] 马佳丽[1] 陈旭 魏红山[1] 李坪[1] LI Chenguang;DENG Caihong;JIANG Yu;HE Lingling;ZHOU Yuling;LIANG Xiuxia;HU Julong;MA Jiali;CHENXu;WEI Hongshan;LI Ping(Department of Gastroenterology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院消化内科,北京100015

出　　处：《胃肠病学和肝病学杂志》2022年第3期266-268,274,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：北京市医院管理中心消化内科学科协同发展中心专项(XXZ04)。

摘　　要：目的分析电子胃镜下医用组织胶注射治疗Dieulafoy病引起急性上消化道出血的临床应用价值。方法回顾性分析首都医科大学附属北京地坛医院2011年1月至2020年12月38例经内镜治疗的Dieulafoy病引起急性上消化道出血的患者资料,分为医用组织胶治疗组和金属夹治疗组,观察分析患者的即时止血率、再出血率及不良事件发生率等临床指标。结果应用医用组织胶注射法即时止血成功率高于金属夹(100%vs 68.75%,P<0.01)。38例患者中,电子胃镜下医用组织胶治疗组共22例,即时止血治疗成功22例(胃部5例,十二指肠17例),成功率100%,1例患者24 h内再发出血,经医用组织胶联合金属夹再次行内镜下止血后,出血停止。电子胃镜下金属夹治疗组共16例,即时止血治疗成功11例(胃部7例,十二指肠4例),5例患者金属夹治疗失败后,采用医用组织胶补救止血成功,首次止血成功率68.75%。电子胃镜下医用组织胶治疗即时止血率高于金属夹治疗组(P<0.01)。两组患者均无死亡病例且未发生不良事件。结论电子胃镜下医用组织胶注射止血可应用于治疗Dieulafoy病引起的急性上消化道出血,并且止血效果较为显著,可有效避免金属夹术后脱落引起再发出血的风险。Objective To study the endoscopic injection of fibrin tissue adhesive in the treatment of acute upper gastrointestinal bleeding caused by Dieulafoy′s disease.Methods The clinical data of 38 patients diagnosed with acute upper gastrointestinal bleeding caused by Dieulafoy′s disease were retrospectively analyzed from Jan.2011 to Dec.2020.They were divided into the endoscopic injection of fibrin tissue adhesive hemostasis group and endoscopic hemoclipping hemostasis group,and clinical indicators such as immediate hemostasis rate,rebleeding rate and incidence of adverse events were observed and analyzed.Results The success rate of immediate hemostasis with the endoscopic injection of fibrin tissue adhesive was higher than that of endoscopic hemoclipping(100%vs 68.75%,P<0.01).Among the 38 patients,a total of 22 patients were treated by the endoscopic injection of fibrin tissue adhesive,and instant hemostasis was successful in 22 cases(5 cases in the stomach and 17 cases in the duodenum),with a success rate of 100%.In the endoscopic hemoclipping hemostasis group,there were 16 cases,11 cases(7 cases in the stomach,4 cases in the duodenum)were successfully treated.However,5 cases failured to the treatment by endoscopic hemoclipping as successfully treated with injection of fibrin tissue adhesive,and the success rate of the instant hemostasis was 68.75%.The instant hemostasis rate of the endoscopic injection of fibrin tissue adhesive under electronic gastroscopy was statistically significant compared with that of endoscopic hemoclipping(P<0.01).There were no deaths or adverse events in both groups.Conclusion The endoscopic injection of fibrin tissue adhesive is an effective hemostasis scheme for acute upper gastrointestinal bleeding caused by Dieulafoy′s disease,which can effectively avoid the risk of rebleeding caused by the endoscopic hemoclipping falling off after surgery.

关 键 词：DIEULAFOY病 急性上消化道出血 消化内镜 医用组织胶 金属夹 

分 类 号：R57[医药卫生—消化系统]