老年患者结肠血管畸形急性出血的临床特点及内镜治疗

Clinical features and endoscopic treatment for aged patients with acute hemorrhage arising from vascular malformation of colon

目的 探讨老年患者结肠血管畸形急性出血的临床特点及内镜下钛夹止血效果.方法 经内镜诊断为结肠血管畸形急性出血共56例,将31例年龄≥60岁者列为老年组,25例〈60岁者列为对照组,比较两组患者的临床特点及急诊内镜钛夹止血疗效.结果 老年组并发高血压、冠状动脉性心脏病及糖尿病者占80.6%（25/31）,显著高于对照组E40.0%（10/25）,P〈0.01].内镜下,老年组急性出血表现为涌血者占45.2%（14/31）,而对照组仅为16.0%（4/25）,两组间差异有统计学意义（P〈0.05）.老年组和对照组分别有18例和6例采用钛夹治疗,即时止血成功率分别为17/18和6/6,止血后再发出血率为2/17和0,两组问差异均无统计学意义（P值均〉0.05）.但老年组每例平均使用钛夹（5.35±2.4）枚.显著高于对照组[（3.1±1.3）枚,P〈0.05].结论 老年血管畸形急性出血患者多合并心血管疾病及糖尿病,出血率较高.用药物或电凝止血反应差,结肠镜对出血病灶能明确定位及判断出血程度,及时采用钛夹止血具有很好疗效.

Objective To investigate the clinical features of aged patients with acute hemorrhage arising from vascular malformation of colon and the efficacy of endoscopic placement of hemoclip in treatment of hemorrhage. Methods Fifty-six patients were diagnosed with acute bleeding arising from vascular malformation of colon by colonoscopy. Patients were assigned to aged group （n = 31,≧60 years of age） and control group （n = 25, 〈60 years of age）. The clinical manifestations and the efficacy of emergent endoscopic treatment with hemoclip application were compared between two groups. Results The complications including hypertension, coronary heart disease and diabetes were higher in aged group [80. 6% （25/31）] than in control group [40. 0% （10/25） ] with significant difference （P〈0. 01）. The effusive bleeding accounted for 45. 2% （14/31） in aged group and 16. 0% （4/25） in control group （P〈0. 05）. Endoscopic treatment with hemoclip was performed in 18 and 6 patients in aged group and control group, respectively. Initial hemostasis was achieved in 17 and 6 patients in the aged group and control group, respectively （P〈0. 05）. Recurrent hemorrhage occurred in 2 patients in the aged group and none in the control group （P〉0. 05）. The mean number of hemoclips application was 5. 3 ± 2. 4 in aged group and 3. 1 ± 1. 3 in control group （P〈0. 05）. Conclusions The hemorrhage is more serious in aged patients with acute hemorrhage, because they often complicate with cardiovascular diseases and diabetes. The lesion of hemorrhage can be found and precisely localized using colonoscopy. Promptly endoscopic placement of hemoclip is quite effective in treatment of acute hemorrhage.