组织黏合剂对内镜黏膜下剥离术难治性出血的临床疗效

Clinical efficacy of tissue adhesive on intractable bleeding during endoscopic submucosal dissection

目的研究组织黏合剂对治疗内镜下黏膜剥离术（ESD）中难治性出血及预防迟发性出血的疗效。方法上海复旦大学附属中山医院内镜中心自2006年9月至2013年8月在对9874例胃肠道黏膜或黏膜下肿瘤的患者行ESD治疗中，发生5例难治性出血（0．05％），在其他止血方法无效的情况下，运用注射和喷洒组织黏合剂的方法进行止血，观察其疗效及其并发症。结果5例患者运用组织黏合剂后均止血成功，且未发生迟发性出血及穿孔。内镜随访2个月后，见创面愈合并瘢痕形成。结论组织黏合剂对治疗ESD难治性出血快速、有效并安全。

Objective To investigate the efficacy of tissue adhesive on intractable bleeding during endoscopic submucosal dissection （ESD） and delayed bleeding. Methods A total of 9874 patients with gastrointestinal mucosal or submucosal tumors underwent ESD in our center from September 2006 to August 2013 and intractable bleeding occurred during ESD in 5 cases. Under the condition of no effective hemostasis methods, the tissue adhesive injection or spray were used to stop the bleeding. The efficacy and safety were evaluated. Results All the 5 cases were successfully managed by the hemostasis method with tissue adhesive without any adverse event. In follow-up of two months after operation, wound healing and scar formation were observed under endoscopy. Conclusion Tissue adhesive is safe, effective and fast for intractable bleeding during ESD and delayed bleeding.