急诊胃镜在上消化道急症的临床应用

Clinical application of emergency gastroscopy in emergent upper digestive tract diseases

目的 评估急诊胃镜在上消化道急症中的临床应用。方法 对 5 87例上消化道急症分 4组进行急诊胃镜检查 ,并用相应的器械及方法进行镜下治疗。结果 上消化道异物组 15 5例全部病例诊断明确 ,镜下一次去除成功 14 8例 ,成功率为 95 5 %。食管静脉曲张出血 (EVB) 6 9例 ,其中并胃底静脉曲张 11例 ,急诊止血率为 10 0 % ,2例再出血死亡。非静脉曲张性上消化道出血组 (NVB) 2 5 6例 ,诊断明确 2 4 1例(94 1% ) ,无结论者 15例 (5 9% ) ,镜下治疗 197例 ,止血成功率为 94 9% ,术后 7天内再出血 14例 ,近期再出血率 7 1%。 2 4例胆道蛔虫 ,2 3例成功取出虫体 ,1例断裂。结论 急诊胃镜在上消化道急症的应用安全有效。

Objective To evaluate the efficacy and safety of emergency gastroscopy in emergent upper digestive tract diseases.Methods 587 patients with emergent upper digestive tract disease received emergency gastroscopy and therapy. They were divided into 4 groups: foreign body, esophagus or stomach fundus varixes bleeding, non-varix bleeding and biliary ascariasis. Foreign bodies were taken out with different eyewinker grip, net basket and mesh ware. Esophagus or stomach fundus varixes bleeding were treated with mesh ware and histoacryl. Non-varix bleeding were treated with titanium nips, injection, sclerosis, electric coagulation and spraying thrombin. Biliary ascariasis was taken out with eyewinker grip.Results 155 foreign body patients were all verified and the removal rate was 95.5%. 36 patients with esophagus varixes bleeding and 8 patients of stomach fundus varixes bleeding were verified during endoscopy in 69 esophagus varixes bleeding patients who involved 11 stomach fundus varixes patients. The emergency hemostasia rate was 100% and 2 patients died of rebleeding. Among 256 patients of non-varix bleeding, 241 patients were verified. 197 non-varix bleeding patients accepted endoscopy therapy. 95 patients, 57 patients and 45 patients received injection, electric coagulation-injection and received injection-titanium nips therapy, respectively. 187 patients were successfully treated and 14 patients (out of 7.1%) rebleeded within 7 days. The emergency hemostasia rate of endoscopy treatment for the non-varix bleeding was 94.9%. Among 24 patients of biliary ascariasis, 23 ascarids were taken out but one ascarid body was ruptured.Conclusion It is concluded that emergent gastroscopy is safe and effective in upper digestive tract emergency diseases.