食管胃静脉曲张破裂出血胃镜检查时机选择研究

Study on the Timing of Gastroscopy for Esophageal and Gastric Variceal Bleeding

目的探讨有利于食管胃底静脉曲张破裂出血患者诊治的首次胃镜检查时机。方法回顾性分析2014年1月至2017年6月在南方医科大学附属小榄医院接受胃镜诊疗的54例食管胃底静脉曲张出血患者的临床资料,按胃镜诊疗时机选择不同分为A组和B组,每组各27例。A组于入院后24小时内有活动性出血期间行急诊胃镜检查,B组经治疗后无活动性出血时行胃镜检查。对比两种方法对胃镜诊断和治疗效果的影响。结果 A组胃镜检查时间窗为入院后(12. 26±9. 95) h,B组为(21. 55±18. 37) h,两组比较差异有统计学意义(P<0. 05)。A组病灶检出率低于B组(74. 07%vs. 100%,P<0. 05),A组首次内镜下治疗成功率与B组比较两组比较差异无统计学意义(75%vs. 100%,P>0. 05)。A组内镜检查并发症显著高于B组(22. 22 vs. 0%,P<0. 05)。两组患者的输血量、住院时间和死亡率比较差异无统计学意义(P>0. 05)。结论在活动性食管胃底静脉曲张出血的首次胃镜诊疗中,过早胃镜干预有较高的内镜诊疗并发症和漏诊风险,以病情为胃镜检查的时机选择靶点是一种安全、有效的选择。

Objective To explore the opportunity of the first gastroscopy for diagnosis and treatment of esophageal varices bleeding.Methods The clinical data of 54 patients with esophageal and gastric variceal bleeding who received gastroscopy from January 2014 to June 2017 in Siu Lam affiliated to Southern Medical University were analyzed retrospectively.The patients were divided into group A and group B according to the timing of gastroscopy,27 cases in each group.Group A underwent emergency gastroscopy during active bleeding within 24 hours after admission,and group B received gastroscopy when there was no active bleeding after treatment.The effects of the two methods on the diagnosis and treatment of gastroscopy were compared.Results The time window of gastroscopy in group A was(12.26±9.95)hours after admission,(21.55±18.37)hours in group B,and there was a significant difference between the two groups( P <0.05).The detection rate of lesions in group A was lower than that in group B(74.07% vs.100% P <0.05).There was no significant difference in the success rate of first endoscopic treatment between group A and group B(75% vs.100%,P >0.05).The complications of endoscopic examination in group A were significantly higher than those in group B(22.22%vs.0)( P <0.05).There was no significant difference in blood transfusion,hospitalization time and mortality between the two groups( P >0.05).Conclusion In the first gastroscopy diagnosis and treatment of active esophageal variceal bleeding,early gastroscopy intervention has a high risk of endoscopic diagnosis and treatment complications and missed diagnosis.It is a safe and effective choice to choose the target of gastroscopy examination with the condition of the disease.