非静脉曲张上消化道出血379例病因分析及内镜诊疗体会

Analysis of causes of non-variceal upper gastrointestinal bleeding of 379 cases and the therapy through the endoscopies

目的对379例非静脉曲张上消化道出血的病因进行分析,探讨不同原因的内镜治疗方法。方法回顾性分析我院1996-2005年379例非静脉曲张良性上消化道出血内镜诊断和治疗。结果消化性溃疡出血是非静脉曲张良性上消化道出血的主要病因,其次为急性胃黏膜病变。胃黏膜下血管病变、食管病变及上消化道癌也是引起该类出血的原因之一。早期内镜检查提高出血责任病灶检出的阳性率,绝大多数良性上消化道小量渗血均可以通过内镜下局部注射及局部电凝法止血,确认为小动脉或小静脉出血时,止血是主要的治疗方法。结论(1)非静脉曲张上消化道出血仍以消化性溃疡为首,急性胃黏膜病变次之,胃黏膜下血管病变、上消化道癌、食管病变的上消化出血均可表现为大量呕血。(2)无内镜诊疗禁忌症者,应及时内镜探查以明确出血原因,确定引起出血的责任病灶;(3)对于不同情况的上消化道出血应区别对待,使用不同的内镜止血方法,才能达到满意的治疗效果。(4)内镜止血后复发出血选择性内镜复查效果好。

Objective To analysis the causes of 379 non- variceal upper gastrointestinal bleeding, and thetherapy through the endoscopies. Methods All cases did endoseopies within 24 hours after uppergastrointestmal hemomiage. After definite the causes of the bleeding, we study the theiapy of these illnessthrough the endoscopies. Results The chief cause was peptic ulcer in non - variceal upper gastrointestmal bleeding（46.8 % ）, the next one was acute hemorrhagic gastritis （15.9 % ）. Gastric auhmaeonsal vessel lesion, esophagusLesion, upper gastrointestmal cancer was one of the causes of upper gastrointestmal bleeding. At the mean while, we found the early to do the endoscopies, the higher positive to find the causes of non- variceal uppergastrointestmal bleeding. The different therapy of non- variceal upper gastrointestinal bleeding through theendoscopies is very efficient. Conclusions The peptic ulcer is the chief cause in non - variceal uppergastrointestmal bleeding. The upper gastrointestrmal bleeding is caused by acute hemorrhagic gastritis, gastriesubmuscosal vessel lesion, all kinds of accompany pyloristenosis, esophagus lesion may show hematensis heavily. Clinical physical must pay attention to about it. k is necessary to do endoscopies within 24 hours with the cases ofhematemesis.The different treatment should be chosen with the different causes of the non-variceal uppergastrointestmal bleeding.