两种不同内镜下钛夹止血法治疗消化性溃疡出血的回顾性对比研究

Retrospective comparative study on the treatment of peptic ulcer bleeding with two different endoscopic titanium clips hemostasis

目的对比分析两种不同内镜下钛夹止血法治疗消化性溃疡出血的疗效及再出血原因。方法选取2012年3月~2017年7月消化性溃疡出血患者152例,按时间顺序分为单用OLYMPUS钛夹组(A组)84例和内镜下肾上腺素注射联合新型可回收旋转组织钛夹组(B组)68例。对比分析两组间初次止血成功率、近期出血率、延迟出血率、再次止血成功率、钛夹使用数量、止血时视野清晰情况、再出血时血清白蛋白水平及钛夹开始脱落时间。结果 B组初次止血成功率高于A组(P<0.001);A组近期出血率及延迟出血率均高于B组(P<0.05);两组间再次止血成功率比较差异无统计学意义(P>0.05);A组钛夹使用数量少于B组(P<0.001);B组视野清晰情况优于A组(P=0.002);再出血时血清白蛋白水平两组间差异无统计学意义(P=0.635);B组钛夹开始脱落时间晚于A组(P<0.001)。结论内镜下肾上腺素注射联合新型可回收旋转组织钛夹治疗消化性溃疡出血比单纯金属钛夹更有效,可保持治疗时视野清晰、精准而又充分地夹闭血管及重视患者术后处理,能提高患者内镜下止血成功率。

Objective To compare and analyze the curative effect and re-bleeding reasons of peptic ulcer hemorrhage treated by two different endoscopic titanium clips hemostasis. Methods A total of 152 patients with peptic ulcer bleeding from March 2012 to July 2017 were divided into OLYMPUS alone group（group A） with 84 cases and group B with 68 cases who were treated with endoscopic injection of epinephrine combined with new recyclable rotary tissue titanium clips. The success rate of initial hemostasis, rate of recent hemorrhage, rate of delayed hemorrhage, success rate of re- hemostasis, the number of titanium clips used, the clear visual field during hemostasis, the level of serum albumin when bleeding again and the time for titanium clip to begin to fall were compared and analyzed between the two groups. Re- suits The success rate of initial hemostasis in group B was higher than that in group A（P〈0.001）. The rates of recent hemorrhage and delayed hemorrhage in group A were significantly higher than those in group B（P〈0.05）. There was no significant difference between the two groups in the success rate of re-hemostasis（P〉0.05）. There was no significant dif- ference in serum albumin level when bleeding again （P=0.635）. The time for titanium clip to begin to fall in group B was later than that in group A （P〈0.001）. Conclusion The combination of endoscopic injection of epinephrine and new recyclable rotary tissue titanium clip in the treatment of peptic ulcer bleeding is more effective than the simple titanium clip, can maintain a clear field of vision when treatment, accurate and adequate vascular occlusion and attention to patients with postoperative treatment can increase the endoscopic success rate of hemostasis.