针形刀点焊式电凝预防内镜下括约肌切开术后出血的临床观察(附102例报道)

Clinical Observation on Spot-Welding Electrocoagulation with Needle-Knife to Prevent Bleeding after Endoscopic Sphincterotomy:Report of 102 Cases

目的探讨内镜下括约肌切开(EST)术后使用针形刀点焊式电凝预防常规创面出血的疗效。方法回顾性分析2009年8月至2009年10月期间187例行EST患者,其中研究组予以针形刀点焊式电凝加1:10 000去甲肾上腺素喷洒(n=102),对照组单纯使用1:10 000去甲肾上腺素喷洒预防出血(n=85),比较2组间的乳头部出血及并发症发生情况。结果 2组患者的性别、年龄、基础疾病、并存疾病、机体营养状况及免疫状况方面比较,差异无统计学意义(P>0.05)。对照组出血4例(4.70%),研究组无一例出血发生,2组间出血率比较差异有统计学意义(P<0.05)。4例出血患者经内镜下点焊式电凝止血成功。187例患者中,继发胆管炎5例,其中研究组和对照组各1例均因病情迅速恶化,多器官功能衰竭而死亡;另外,研究组2例和对照组1例经皮经肝穿刺胆管置管引流和抗感染治疗后胆道感染得以控制。继发胆道内出血2例,对照组1例治疗后痊愈,研究组1例经抢救无效死亡。继发胰腺炎3例,其中研究组1例和对照组2例均经禁食、抑制胰酶分泌等药物保守治疗后痊愈。2组间并发症发生率比较,差异无统计学意义(P>0.05)。结论预防性针形刀点焊式电凝能减少EST术后乳头部出血的发生率,是一种适合基层、安全、有效、简便的方法。

Objective To evaluate the efficiency of the spot-welding electrocoagulation with needle-knife to prevent bleeding after endoscopic sphincterotomy（EST）. Methods The clinical data of 187 patients underwent EST from August 2009 to October 2009 were retrospectively analyzed,study group（n=102） were treated with spot-welding electrocoagulation with needle-knife and 110 000 noradrenaline washing,control group（n=85） were treated with 110 000 noradrenaline washing alone.The bleeding and complications after EST were observed. Results The differences of gender,age,primary diseases,cormorbidities,nutritional status,and immune function were not significant between two groups（P0.05）.The bleeding after EST happened 4 cases（4.70%） in the control group and none in the study group.The bleeding rate of the study group was significantly lower than that of the control group（P0.05）.The bleeding cases in the control group were controlled successfully by spot-welding electrocoagulation with needle-knife under endoscopy.Cholangitis occurred in 5 cases altogether,1 case in each group deteriorated promptly and died of multiple organ failure syndrome,another 3 cases,2 in the study group,1 in the control group,were cured by PTCD and antibiotics.Biliary tract hemorrhage occurred one case in each group,which one died in the study group.Pancreatitis occurred 1 case in the study group and 2 cases in the control group,all of which were salvaged by conservative therapy.The incidences of complications were not significantly different between two groups（P0.05）. Conclusions The spot-welding electrocoagulation with needle-knife can significantly reduce the bleeding rate after EST.It is an effective,safe,and easy technique,especially to rural areas.