内镜下OTSC吻合夹止血在急诊难治性急性非静脉曲张性上消化道出血中的应用价值  

The application value of endoscopic OTSC anastomosis clip hemostasis in emergency refractory acute non-variceal upper gastrointestinal bleeding

作　　者：徐鹏 于德洋 郝建玲 董茹婷 王磊[5] XU Peng;YU Deyang;HAO Jianling;DONG Ruting;WANG Lei(Department of Emergency Trauma Surgery,Qingdao Central Hospital,Qingdao Shandong 266000,China)

机构地区：[1]青岛市中心医院急诊创伤外科,山东青岛266000 [2]青岛市中心医院急救中心,山东青岛266000 [3]青岛市胸科医院门诊部,山东青岛266000 [4]青岛市胸科医院急诊,科山东青岛266000 [5]承德医学院附属医院消化科,河北承德067000

出　　处：《中国急救复苏与灾害医学杂志》2024年第5期653-656,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省医学科学研究课题计划项目(编号:20220424)。

摘　　要：目的评估内镜吻合夹系统(OTSC)吻合夹止血对急诊难治性急性非静脉曲张性上消化道出血(ANVUGIB)患者的止血效果、炎症状态的影响。方法选取125例急诊难治性(ANVUGIB)急性非静脉曲张性上消化道出血患者(来自青岛市中心医院),依据止血夹的不同分为观察组66例和对照组59例,分别应用内镜下OTSC吻合夹、内镜下金属钛夹止血治疗。对比两组患者的临床疗效、术后恢复情况、止血效果、炎症状态以及短期随访结果。结果与对照组相比,观察组患者的有效止血率、即时止血率、转外科或介入手术治疗率、1周内再次出血率等止血效果指标均更优(均P<0.05),潜血转阴时间、住院时间、呕血消失时间等止血效果指标均更短(均P<0.05),以及治疗有效率、住院费用更高(P<0.05)。治疗后两组患者炎症指标均下降,且观察组患者的血清CRP、TNF-α、IL-6水平均低于对照组(P<0.05)。术后2个月随访,金属钛夹自行脱落6例,OTSC吻合夹均在原位,差异有显著性(P<0.05),而两组均未出现消化道穿孔、消化道瘘等并发症。结论ANVUGIB患者应用内镜下OTSC吻合夹止血较内镜下金属钛夹止血的效果更佳,可快速康复,减少了外科手术率,提高止血效果,减轻炎症状态,安全可靠;但从经济费用层面来看,费用仍较高。Objective To investigate the application value of endoscopic anastomotic clip system(OTSC)in emergency treatment of refractory acute non-variceal upper gastrointestinal bleeding(ANVUGIB).Methods A total of 125 patients with refractory ANVUGIB were admitted to the Department of Emergency Trauma Surgery,Qingdao Central Hospital.According to the different hemostatic clips,they were divided into observation group(66 cases)and control group(59 cases).They were treated with endoscopic OTSC anastomosis clip and endoscopic metal titanium clip respectively.The clinical efficacy,postoperative recovery(occult blood clearance time,hematemesis disappearance time,hospitalization time),hemostatic effect(immediate hemostasis rate,effective hemostasis rate,rebleeding rate within 1 week,surgical or interventional treatment rate),inflammatory state(CRP,TNF-α,IL-6)and short-term follow-up results were compared between the two groups.Results Compared with the control group,the effective hemostasis rate,immediate hemostasis rate,surgical or interventional treatment rate,and rebleeding rate within 1 week in the observation group were better(all P<0.05).The hemostatic effect indexes such as occult blood negative conversion time,hospitalization time,and hematemesis disappearance time were shorter(all P<0.05),and the treatment efficiency and hospitalization cost were higher(P<0.05).After treatment,the inflammatory indexes of the two groups decreased,the observation group of the levels of serum CRP,TNF-α,IL-6 were lower than those in the control group(P<0.05).After 2 months of follow-up,6 cases of metal titanium clips fell off by themselves,and OTSC anastomosis clips were in situ,the difference was significant(P<0.05),while no complications such as gastrointestinal perforation and gastrointestinal fistula occurred in the two groups.Conclusion Endoscopic OTSC anastomosis clip is effective in the treatment of ANVUGIB patients.It can quickly recover,reduce the surgical rate,improve the hemostatic effect,reduce the inflammatory state,and is

关 键 词：难治性急性非静脉曲张性上消化道出血 内镜治疗 金属钛夹止血术 内镜吻合夹系统止血术 

分 类 号：R573.2[医药卫生—消化系统]