金属钛夹与药物注射治疗Dieulafoy溃疡伴活动性出血的疗效观察

Curative Effect Observation of the Treatments with Metal Titanic Clip and Drug Injection on Bleeding Dieulafoy Ulcer

目的观察内镜下金属钛夹与药物注射治疗Dieulafoy溃疡并活动性出血的临床疗效。方法对2009年1月-2013年12月我院内镜明确诊断为Dieulafoy溃疡伴活动性出血,且予以内镜下治疗62例患者的临床资料进行回顾性分析。根据治疗方式不同,分为钛夹组与药物注射组,钛夹组35例于内镜下金属钛夹止血治疗,药物注射组27例于内镜下局部注射肾上腺素止血治疗。对比两组即时止血率、有效止血率、再出血率、外科手术率之间的差异。结果钛夹组即时止血率及有效止血率明显高于药物注射组,再出血率、外科手术率明显低于药物注射组,P﹤0.05,具有统计学意义;药物注射组出现4例心悸、3例血压升高并发症,钛夹组术后无明显并发症,两组均未出现死亡患者。结论与药物注射治疗相比,金属钛夹治疗Dieulafoy溃疡伴活动性出血具有止血迅速、成功率高、复发出血率低、无并发症,可作为内镜下治疗止血首选方式。Dieulafoy溃疡为少见胃肠道出血性疾病,病灶小、隐匿,出血前多无先兆,病情反复,诊断困难,胃镜检查容易漏诊[1],直接威胁生命。本文回顾性分析我院2009年1月-2013年12月收治的62例Dieulafoy溃疡伴出血患者的临床资料,对比分析内镜下金属钛夹治疗与药物注射治疗Dieulafoy溃疡的止血疗效。

Objective To observe the clinical curative effect of the treatments with metal titanic clip and drug injection on bleeding Dieulafoy ulcer. Methods A retrospective analysis was made to the clinical data of 62 cases with confirmed diagnosis of bleeding Dieu- lafoy ulcer by endoscope in my hospital during the period from Jan., 2009 to Dec., 2013;the 62 cases were divided into 2 groups： metal titanic clip group （n=35） and drug injection group （n=27）; hemostatic treatment with mental titanic clip was performed to cases in men- tal titanic clip group while local injection of epinephrine for hemostasis under endoscope was performed to cases in drug injection group; the instant hemostatic rates, effective hemostatic rates, reoccurrences of bleeding and the rates of surgery in the 2 groups were compared. Results The instant hemostatic rate and the effective hemostatic rate of the cases in mental titanic clip group were much high- er than those of the cases in drug injection group; the reoccurrence of bleeding and the rate of surgery of the cases in mental titanic clip group were much lower than those of the cases in drug injection group （P〈0.05）, the difference was of statistical significance; 4 cases in drug injection group had heart palpitations and 3 cases had complications of increased blood pressure; no obvious complications were observed in metal titanic clip group; no death occurred in both groups. Conclusions Compared with drug injection, hemostatic treatment with mental titanic clip is of fast hemostasis, high successful rate, low reoccurrence of bleeding, no complications, it can be the first choice for hemostatic treatment under endoscope.