OTSC吻合夹与传统TTSC内镜夹治疗消化性溃疡出血的对比研究

Comparison of over-the-scope clip and traditional through-the-scope clip in the treatment of peptic ulcer bleeding

目的比较OTSC吻合夹止血术与TTSC内镜夹止血术治疗消化性溃疡出血(PUB)的差异,探讨OTSC吻合夹治疗PUB的临床疗效。方法采用回顾性研究方法,选择22例完成OTSC吻合夹止血术和应用OTSC吻合夹止血术前近期完成TTSC内镜夹止血术的24例PUB患者为研究对象,通过对比两种术式的即时止血成功率、夹子总数、首次止血成功率、术后复发率、止血成功率、再出血率、二次内镜治疗率、永久止血率、并发症率、术后住院时间和死亡率来评价OTSC吻合夹止血术的安全性和有效性。结果 OTSC吻合夹止血术治疗PUB的即时止血成功率为90.9%(20/22),夹子总数为22枚,首次止血成功率为90.9%(20/22),术后复发率为5.0%(1/20),止血成功率为86.4%(19/22),再出血率为5.0%(1/20),二次内镜治疗率为13.6%(3/22),永久止血率为81.8%(18/22),并发症率为0.0%(0/22),术后住院时间为(8.95±0.96)d,死亡率为0.0%(0/22);TTSC内镜夹止血术治疗PUB的即时止血成功率为54.2%(13/24),夹子总数为56枚,首次止血成功率为54.2%(13/24),术后复发率为0.0%(0/13),止血成功率为54.2%(13/24),再出血率为0.0%(0/13),二次内镜治疗率为45.8%(11/24),永久止血率为54.2%(13/24),并发症率为0.0%(0/24),术后住院时间为(8.54±0.53)d,死亡率为4.2%(1/24)。OTSC组即时止血成功率、首次止血成功率、止血成功率、永久止血率均高于TTSC组,二次内镜治疗率低于TTSC组,差异有统计学意义(P<0.05)。结论 OTSC吻合夹止血术治疗PUB安全有效,对较大管径血管破裂出血或其他原因引起的复杂性难治性PUB可作为首选治疗。

Objective To compare the difference between endoscopic hemostasis with over-thescope clip and conventional endoscopic hemostasis with through-the-scope clip for treatment of peptic ulcer bleeding. Methods Using the method of retrospective study, 22 cases of peptic ulcer bleeding patients treated by endoscopic hemostasis with over-the-scope clip and 24 cases recently completed by endoscopic hemostasis with through-the-scope clip before the application of endoscopic hemostasis with over-the-scope clip as the research object, then evaluate the efficacy and safety of endoscopic hemostasis with over-the-scope clip by comparing immediate hemostasis success（rate）, the total number of clips used for operation, first successful hemostasis（rate）, postoperative recurrence（rate）, hemostasis success（rate）, rebleeding（rate）, two endoscopic treatment（rate）, permanent hemostasis（rate）, complication（rate）, postoperative hospital stay（d）, mortality（rate）. Results Immediate hemostasis success（rate） of peptic ulcer bleeding patients treated by endoscopic hemostasis with over-the-scope clip was 20/22（90.9%） and the total number of clips used for operation was 22, the first successful hemostasis（rate） was 20/22（90.9%）, postoperative recurrence（rate） was 1/20（5.0%）, successful hemostasis（rate） was19/22（86.4%）, rebleeding（rate） was 1/20（5.0%）, two endoscopic treatment（rate） was 3/22（13.6%）, permanent hemostasis（rate） was 18/22（81.8%）, complications（rate） was 0/22（0.0%）, postoperative hospital stay time（d） was（8.95 ± 0.96） d, death（rate） was 0/22（0.0%）. Immediate hemostasis success（rate） of peptic ulcer bleeding patients treated by hemostasis therapy with through-the-scope clip was 13/24（54.2%） and the total number of clips used for operation was 56, the first successful hemostasis（rate） was 13/24（54.2%）, postoperative recurrence（rate） was 0/13（0.0%）, successful hemostasis（rate） was 13/24（54.2%）, rebleeding（rate） was 0/13（0.0%）, two endoscopic treatment（rate） was 11/24（45.8%）, permanent hemostasis（rate） was 13/24（54.2%）, complications（rate） was 0/24（0.0%）, hospitalization time after operation（d） was（8.54 ± 0.53） d, death（rate） was 1/24（4.2%）. Immediate hemostasis success（rate）, first successful hemostasis（rate）, hemostasis success（rate）, and permanent hemostasis（rate） were higher in the OTSC group than in the TTSC group. However, two endoscopic treatment（rate） was lower in the OTSC group than in the TTSC group（P〈0.05）. Conclusion Endoscopic hemostasis with over-the-scope clip is safe and effective on the treatment of peptic ulcer bleeding,it can be used as the first choice for the treatment of complicated and refractory peptic ulcer bleeding due to rupture of blood vessel with the larger diameter or other causes.