老年人上消化道出血1101例急诊胃镜检查结果分析及胃镜下止血价值评价

THE CAUSE OF ACUTE UPPER GASTROINTESTINAL BLEEDING IN 1101 ELDERLY PATIENTS AND THE VALUE OF EMERGENCY GASTROSCOPIC HEMOSTASIS

目的 探讨老年人上消化道出血病因分布特点及急诊胃镜检查和治疗的价值。方法 对１９８８～１９９７年１１０１例以呕血和（或）黑便为表现的老年人急诊胃镜检查资料及９８例胃镜止血资料进行分析。结果 老年人上消化道出血病因主要为消化性溃疡７８３例（７１．１％），胃癌１１４例（１０．２％），门脉高压症５０例（４．５％）等。９８例患者施行了内镜下止血，其即刻止血率前三位如下：消化性溃疡伴活动性出血为９１．９％，食管静脉曲张破裂出血９２．３％，胃癌伴活动性出血８３．３％。３例贲门粘膜撕裂症及１例胃多发性息肉伴活动性出血即刻止血均成功。为预防再出血，１３例消化性溃疡伴新近出血的患者也施行了胃镜下止血治疗。急诊胃镜检查和胃镜下止血治疗未引起心、肺、脑等系统的并发症。结论消化性溃疡和胃癌是老年人上消化道出血的主要原因，急诊胃镜检查有利于早期诊断、合理治疗。急诊胃镜止血疗效可靠，二者均安全可行。消化性溃疡和胃癌伴活动性出血急诊胃镜止血率分别为９１．９％及８３．３％。

Objective: To investigate the causes of acute upper gastrointestinal bleeding (AUGB) in the elderly and the value of emergency gastroscopy (EG) in diagnosis and treatment. Methods An analysis was made from the clinical records of elderly patients with hematemesis and (or) melena as 1101 cases diagnosed by EG and 98 cases treated by EG in 1988 - 1997. Results The chief causes of AUGB in the elderly were: peptic ulcer (783 cases, 71.1%), gastric cancer (114 cases, 10.2%), portal hypertension (50 cases, 4. 5 % ), etc. The relative instant hemostasis was achieved in 91. 9 % (57/62) of bleeding peptic ulcer cases, 92. 3 % (12/13) esophageal varices cases and 83. 3 % (5/6) bleeding gastric cancer cases. Emergency hemostasis to three cases of Mollory Weiss tears and one case of bleeding gastric polyps were successful. To prevent from rebleeding, 13 cases of recently bleeding peptic ulcer were also performed emergency hemostasis by EG, No major complication was observed in this series. Conclutions Peptic ulcer and gastric cancer are the major causes of AUGB in the elderly. EG is helpful to early diagnosis and suitable treatment, and EG is an effective means for hemostasis. Both measures are safe.