内镜下金属夹治疗上消化道出血的临床应用

Clinical Application of Metal Clips in Gastrointestinal Bleeding Under Endoscope

【目的】探讨内镜下金属夹治疗上消化道出血的有效性及安全性。【方法】将72例上消化道出血的患者随机分为内镜下金属夹止血组(金属夹组)和内镜下局部肾上腺素注射止血组(局部注射组)。对两组患者的止血时间、急症手术率、再出血率和止血疗效等情况进行综合比较。【结果】两组患者治疗中均无死亡;金属夹组的止血时间、急症手术率、再出血率均少于局部注射组,差异有显著性(P<0.05);金属夹组36例患者,共放金属夹85枚,平均2.4枚,总有效率为94.4%,明显高于局部注射组(75.0%),差异有显著性(χ2=4.18,P=0.041)。【结论】内镜下金属夹止血创伤小、速度快、成功率高、并发症少,对上消化道出血是一种有效的止血方法,值得临床使用。

[Objective] To explore the efficacy and safety of metal clips in endoscopic treatment of gastrointestinal bleeding. [Methods] Seventy two cases with upper gastrointestinal bleeding in patients were randomly divided into metallic endoscopic hemostasis group （metal clip group） and local epinephrine injection group （local injection group）. The average time to stop bleeding, the rate of emergency surgery, the rate of rebleeding and hemostatic efficacy were compared between two groups. [Results] No patient died in two groups during therapy. The average time to stop bleeding, the rate of emergency surgery and rebleeding in metal clip group were less than those in local injection group, and the difference was statistically significant（ P〈0.05）. Thirty six cases in metal clip group were placed with 85 metal clips（ an average of 2.4）, and total efficiency was 94.4% which was significantly higher than that in local injection group（75.0%）, and the difference was sta- tistically significant（x^2 =4.18, P = 0. 041）. [Conclusion] Endoscopic metal clip for hemostasis has advantages of minimal trauma, rapid effect, high achievement ratio and less complications. It is an effective method for upper gastrointestinal bleeding and should be applied into clinic.