回顾性分析内镜吻合夹系统治疗活动期难治性消化道溃疡出血临床疗效及影响因素研究  

Retrospective analysis of clinical efficacy and influencing factors of over-the-scope-clip system in the treatment of refractory peptic ulcer bleeding in active stage

作　　者：毛旭燕 王文海[1] 孙秀静[1] 褚芮 李鹏[1] MAO Xu-yan;WANG Wen-hai;SUN Xiu-jing;CHU Rui;LI Peng(Department of Gastroenterology,Bejing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100052,China)

机构地区：[1]首都医科大学附属北京友谊医院消化内科国家消化疾病临床研究中心,北京100052

出　　处：《中国实用内科杂志》2025年第1期62-66,共5页Chinese Journal of Practical Internal Medicine

基　　金：北京市医院管理局临床医学发展专项经费资助(XMLX202131)。

摘　　要：目的回顾性分析内镜吻合夹(OTSC)系统治疗急性活动期难治性消化性溃疡出血的临床疗效及影响因素。方法收集首都医科大学附属北京友谊医院2016年1月至2024年1月收治的急性活动期难治性上消化道溃疡出血患者应用OTSC系统及常规组织夹进行止血的资料,共82例,分析指标为术中及时止血成功率、止血时间、7 d内再发出血率;采用单因素及多因素logistic回归分析OTSC系统止血失败的影响因素。结果OTSC组40例,其中39例均内镜下术中即时止血成功,平均止血时间(11.25±4.28)min;常规组织夹组42例,34例术中即时止血成功,平均止血时间(15.07±6.79)min;术中即时止血成功率OTSC组高于组织夹组,OTSC组术中止血时间低于组织夹组(P<0.05);OTSC组术后7 d内再发出血6例,常规组织夹组术后7 d内再发出血7例,7 d内再发出血率OTSC组与组织夹组比较无明显统计学差异(P>0.05)。OTSC组止血失败的logistic回归分析结果显示Forrest分级Ⅰa、溃疡大小≥1.5 cm可能是导致OTSC系统治疗失败的影响因素(P<0.05),危险程度依次是Forrest分级Ⅰa(OR 24.097)、溃疡大小≥1.5 cm(OR17.036)。结论OTSC系统治疗难治性活动性消化道溃疡出血即时止血成功率高,止血时间短,是快速有效的止血方法,但是OTSC系统并未明显降低7 d内再出血率,溃疡大小≥1.5 cm、溃疡出血Forrest分级Ⅰa可能是影响OTSC系统止血失败的影响因素,临床应根据患者具体情况,制定科学合理的止血措施。Objective To retrospectively analyze the clinical efficacy and influencing factors of OTSC system in the treatment of acute active refractory peptic ulcer bleeding.Methods The data of patients with acute active refractory upper gastrointestinal ulcer bleeding admitted to Beijing Friendship Hospital January 2016 to January 2024 were collected for hemostasis using OTSC system and routine tissue clips,and the analysis indicators were the success rate of timely hemostasis during surgery,the time of hemostasis,and the rate of re-bleeding within 7 days.According to the postoperative recurrence of bleeding,and univariate and multivariate logistic regression were used to analyze the influencing factors of the failure of OTSC anastomosis clip hemostasis.Results In the OTSC group,39 cases had successful intraoperative hemostasis under endoscopy,with an average hemostasis time of(11.25±4.28)min,and 42 cases in the conventional tissue clipping group,34 cases had successful intraoperative hemostasis,with an average hemostasis time of(15.07±6.79)min.The success rate of intraoperative immediate hemostasis in the OTSC group was significantly higher than that in the tissue clip group,and the intraoperative hemostasis time in the OTSC group was significantly lower than that in the tissue clip group,P<0.05,the difference was statistically significant,and there was no significant difference in the blood rate in the OTSC group within 7 days after surgery,7 cases in the conventional tissue clip group within 7 days after surgery,and the blood rate in the OTSC group and the tissue clip group within 7 days,P>0.05.The results of logistic regression analysis of hemostasis failure in the OTSC group showed that Forrest gradeⅠa and ulcer size≥1.5 cm were the influencing factors for OTSC treatment failure(P<0.05),and the risk degree was Forrest gradeⅠa(OR=24.097)and ulcer size≥1.5 cm(OR=17.036).Conclusion OTSC is a rapid and effective method of hemostasis in the treatment of refractory active peptic ulcer bleeding with high success r

关 键 词：难治性 上消化道溃疡出血 内镜吻合夹系统 影响因素 

分 类 号：R57[医药卫生—消化系统]