内镜下止血夹治疗高危消化性溃疡出血的临床价值

Hemostatic efficacy for hemoclip therapy in treating high-risk bleeding ulcers

目的探讨Forrest分级为Ⅰ级、Ⅱa和Ⅱb的高危消化性溃疡出血患者采用内镜下金属止血夹治疗的疗效,评估高危消化性溃疡出血患者内镜止血夹治疗的必要性。方法选取2002年2月～2007年12月因呕血和(或)黑便入院,急诊内镜检查确诊为消化性溃疡出血且Forrest分级为Ⅰ级、Ⅱa和Ⅱb患者89例,止血夹组48例,对ForrestⅠ级、Ⅱa级和Ⅱb级患者均予止血夹钳夹治疗。对照组41例,对ForrestⅠ级和Ⅱa级患者粘膜下生理盐水注射止血,Ⅱb级患者不予镜下处理。结果两组内镜下即刻止血率均为100%,止血夹组再出血率6.26%,对照组再出血率22.0%,两组差异有显著性(P<0.05)。止血夹组手术率4.17%,对照组手术率9.8%,两组差异无显著性(P>0.05)。结论内镜下止血夹治疗安全有效,优于粘膜下生理盐水注射治疗。对于镜下表现为ForrestⅠ级、Ⅱa和Ⅱb级的消化性溃疡出血患者,内镜下止血夹治疗是有效和必要的。

ObjectiveTo study the therapeutic effect of hemoclip therapy in treating high-risk peptic ulcer bleeding and evaluate its significance. MethodsFrom February 2002 to December 2007, 89 patients with hae-matemesis and/or hematochezia diagnosed as peptic ulcer by immediate endoscopy were divided into two groups. Based on Forrest grading, 48 patients were treated with hemoclip therapy （hemoclip group） and other 41 were control group. In the control group, the patients of grade Ⅰ and Ⅱa ulcer were given normal saline solution injection thera-py and the patients of grade Ⅱb without any endoscopic therapy. ResultsInitial hemostasis was all achieved in 89 patients. Bleeding recurred in 3 patients in the hemoclip group and 9 patients in the control group （6.25% vs 22.0%, P 〈0.05）. 2 patients in the hemoclip group and 4 patients in the control group underwent emergency surgery to arrest bleeding （4.17% vs 9.76%, P 〉0.05）.ConclusionEndoscopic hemoclip therapy is an effective and safe measure for bleeding peptic ulcer with Forrest grade Ⅰ and Ⅱa and Ⅱb, and is superior to the normal saline solu-tion injection therapy.