术前使用质子泵抑制剂对胃部内镜黏膜下剥离术相关性出血作用的初步研究

Effects of preoperative administration of proton pump inhibitor on bleeding related to endoscopic submucosal dissection of gastric diseases

目的探讨术前使用质子泵抑制剂对胃部内镜黏膜下剥离术相关性出血的预防作用。方法 148例患者按病灶大小(2 cm)随机分为术前用药组(n=76)和对照组(n=72)进行内镜黏膜下剥离术(ESD),术前用药组术前1 d口服泮托拉唑片40 mg,手术当天上午静滴泮托拉唑40 mg,下午行ESD,两组术后当天静滴泮托拉唑40 mg,第1至第3天早晚各静滴泮托拉唑40 mg,术后第4天改泮托拉唑口服40 mg/d,术后d1、d7、d28复查胃镜,并将溃疡进行Forrest分级,ESD术前、术后检测胃液pH值,并统计两组术中及术后延迟性出血的比例。结果术前用药组ESD时胃液pH值明显高于对照组(P<0.05),而术后无差异;两组均未出现术中大量出血,术中少量出血术前用药组1例,对照组10例(P<0.05);在术后迟发性出血术前用药组4例,对照组3例(P>0.05);术后第1天复查胃镜ForrestⅡa级溃疡术前用药组3例,对照组9例(P<0.05),ForrestⅡb级溃疡术前用药组5例,对照组14例(P<0.05)。结论术前使用质子泵抑制剂能减少胃部ESD术中出血,但并不能减少术后迟发性出血的发生。

Objective To evaluate the effect of starting proton pump inhibitor （PPI） treatment 1 day before endoscopic submucosal dissection （ESD） of gastric diseases to prevent bleeding related to the procedure. Methods After stratification by lesion size （i.e.≤2 cm or 〉2 cm）, a total of 148 patients who underwent ESD were randomly assigned to the preoperative administration group（n=76） and control group （n=72）. All patients received standard ESD. Patients in the preoperative group were administered lansoprazole from the day before ESD, and patients in the control group received lansoprazole after ESD. Follow-up endoscopy was performed on day 1, day 7, and day 28. Intragastric pH was measured from samples of gastric juice. The incidence of bleeding during and after ESD were counted. Results 75 of 76 patients in preoperative group and 71 of 72 in control group were analyzed. Intragastric pH at ESD in the control group was lower than that in the preoperative group （P〈0.05）. Bleeding during ESD occurred in one patient in preoperative group and 10 in the control group （P〈0.05）. Bleeding after ESD occurred in 4 in preoperative group and 3 in the control group（P〉0.05）. The frequency of typeⅡa andⅡb lesions on day 1 were significantly higher in the control group compared with the preoperative group（P〈0.05）. Conclusion Preoperative administration of PPI could prevent bleeding during ESD, but could not offer additional benefit over postoperative administration alone in the prevention of delayed bleeding after ESD.