内镜氩等离子体凝固术充分烧灼联合钛夹夹闭治疗结肠憩室出血的疗效和安全性初步分析

Study on the efficacy and safety of combination of sufficient argon plasma coagulation cauterization and clipping in the treatment of colonic diverticular bleeding

目的评估内镜氩等离子体凝固术(APC)充分烧灼联合钛夹夹闭治疗结肠憩室出血的疗效和安全性。方法回顾性分析2018年6月至2022年4月因显性消化道出血就诊于空军特色医学中心消化内科,确诊或疑诊为结肠憩室出血并接受内镜APC充分烧灼联合钛夹夹闭治疗住院患者的临床资料。随访截止日期为2022年9月30日。统计末次随访与治疗前血红蛋白差值、随访期患者再出血和术中、术后并发症发生情况。统计学方法采用描述性分析。结果共15例患者纳入研究,男13例,女2例,年龄为(60.8±14.8)岁,病程为1 d~13年。15例患者共行内镜下治疗结肠憩室145个。术后随访14.5个月(5.3~49.5个月)。15例患者中有12例患者接受单次内镜治疗,至随访期结束均未发生出血;有3例疑诊结肠憩室出血患者分别在第1次治疗后12 d、3个月和8个月出现出血症状遂进行第2次内镜治疗,第2次内镜治疗后至随访结束未再出血。单次治疗的再出血率为3/15,再次治疗的再出血率为0,末次随访血红蛋白比治疗前升高(35.9±26.3)g/L。2例患者出现术中穿孔,给予多枚钛夹夹闭,术后无腹痛等症状,分别于术后3、4 d出院。2例患者出现术后创面短期出血,给予内镜下止血治疗后症状消失。1例患者出现术后感染,给予抗感染治疗后症状消失。结论内镜APC充分烧灼联合钛夹夹闭治疗结肠憩室出血安全、有效。对于明确结肠憩室出血患者,或反复消化道出血,除外其他病因并高度怀疑结肠憩室出血的患者,可行内镜APC充分烧灼联合钛夹夹闭治疗。

Objective To evaluate the efficacy and safety of combination of sufficient argon plasma coagulation(APC)cauterization and clipping in the treatment of colonic diverticular bleeding.Methods From June 2018 to April 2022,the clinical data of patients were retrospectively analyzed,who visited Department of Gastroenterology of Air Force Medical Center due to overt gastrointestinal bleeding,and were confirmed or suspected to have colonic diverticular bleeding and received combination of sufficient APC cauterization and clipping treatment.The deadline for follow-up was September 30,2022.During the follow-up after endoscopic treatment,the re-bleeding rate,hemoglobin level difference between the last follow-up and before treatment,wound healing under colonoscopy as well as the intraoperative and postoperative complications of patients were statistically analyzed.Descriptive analysis was used for statistical analysis.Results A total of 15 patients were enrolled,including 13 males and 2 females,aged(60.8±14.8)years old.The course of the disease was 1 day to 13 years.A total of 145 colonic diverticula of 15 patients were treated under endoscopy.The median follow-up time was 14.5 months(5.3 to 49.5 months)months.Among the 15 patients,12 patients received endoscopic therapy once and no bleeding occurred till the end of follow-up.Three patients suspected with diverticular bleeding received a second endoscopic treatment because of bleeding at the 12 days,3 months and 8 months after the first treatment,respectively.No rebleeding occurred after the second endoscopic therapy till the end of follow-up.The re-bleeding rate of the first treatment was 3/15 and the re-bleeding rate of re-treatment was 0.At the end of follow-up,the hemoglobin concentration increased(35.9±26.3)g/L compared with that before the treatment.Two patients had perforation during operation and were closed with multiple titanium clips.There was no abdominal pain or other symptoms after operation.And the patients were discharged 3 and 4 days after treatment,respectively.Two patients suffered short-term postoperative wound bleeding and successful hemostasis was achieved after endoscopic treatment.One patient developed postoperative infection and the symptoms disappeared after anti-infection treatment.Conclusions Combination of sufficient APC cauterization and titanium clipping is safe and effective in the treatment of colonic diverticular bleeding.For patients with dominant diverticular hemorrhage,or patients with recurrent gastrointestinal bleeding,if other etiology are excluded and colonic diverticular bleeding is highly suspected,the combination of sufficient APC cauterization and titanium clipping under endoscopy is feasible.