胃十二指肠溃疡出血患者内镜下闭合穿孔缝合术治疗价值探究

The value of endoscopic closed perforation suture in the treatment of patients with gastroduodenal ulcer hemorrhage

目的探讨胃十二指肠溃疡出血患者行内镜下闭合穿孔缝合术的手术效果。方法回顾性选取2018年1月至2019年12月山西省文水县人民医院收治的胃十二指肠溃疡出血患者85例,其中30例行单钳道内镜下闭合穿孔缝合术(观察组),55例行传统开腹修补术(对照组)。比较两组术后临床疗效、围手术期指标、术后并发症及手术前后应激指标血清肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)和焦亡指标NOD样受体蛋白3(NLRP3)、半胱氨酸蛋白酶-1(caspase-1)、白细胞介素18(IL-18)、可溶性血管细胞黏附因子-1(sVCAM-1)水平;随访18个月,比较两组Visick分级。结果观察组总有效率高于对照组[96.67%(29/30)比80.00%(44/55)],差异有统计学意义(χ^(2)=4.45,P<0.05)。观察组术中出血量、下床活动时间、进食时间、住院时间均少于对照组[(20.38±5.39)ml比(63.98±10.35)ml、(20.88±4.27)h比(39.98±5.81)h、(58.03±10.34)h比(76.02±14.27)h、(6.04±1.21)d比(8.74±2.05)d],差异有统计学意义(P<0.05)。观察组术后血清Cor、E、NE、NLRP3、caspase-1、IL-18和sVCAM-1水平均低于对照组[(54.73±8.57)μg/L比(87.46±10.53)μg/L、(25.15±4.21)μg/L比(37.08±5.17)μg/L、(29.38±4.09)μg/L比(46.85±6.26)μg/L、(6.53±1.17)μg/L比(7.86±1.23)μg/L、(15.35±2.23)μg/L比(18.73±2.54)μg/L、(239.32±31.19)ng/L比(275.68±36.07)ng/L、(24.97±5.61)nmol/L比(33.61±7.19)nmol/L],差异有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组[3.33%(1/30)比20.00%(11/55)],差异有统计学意义(χ^(2)=4.45,P<0.05)。随访18个月,两组患者Visick分级比较差异有统计学意义(P<0.05)。结论单钳道内镜下闭合穿孔缝合术治疗胃十二指肠溃疡出血患者疗效显著,对患者机体影响较小,术后恢复较快,可有效缩短住院时间,远期疗效更佳,再出血复发率较低,术后并发症少。

Objective To investigate the clinical value of endoscopic closed perforation suture in the treatment of patients with gastroduodenal ulcer hemorrhage.Methods Eighty-five patients with gastroduodenal ulcer hemorrhage admitted to Wenshui County People′s Hospital of Shanxi Province from January 2018 to December 2019 were enrolled,and 30 patients received single forceps endoscopic closed perforation suture(observation group),and 55 patients received traditional open repair(control group).The clinical efficacy,perioperative indexes,postoperative complications,and the levels of stress reactive index serum epinephrine(E),norepinephrine(NE),cortisol(Cor)and the pyroptosis index NOD-like receptor pyrin domain 3(NLRP3),caspase-1,interleukin-18(IL-18)and soluble vascular cell adhesion factor-1(sVCAM-1)before and after the operation were compared between the two groups.The patients were followed up for 18 months to compare the differences in Visick grading between the two groups.Results The total effective rate in the observation group was higher than that in the control group:96.67%(29/30)vs.80.00%(44/55),there was statistical difference(χ^(2)=4.45,P<0.05).The amount of intraoperative blood loss,time of getting out of bed,time of eating and hospitalization in the observation group were less than those in the control group:(20.38±5.39)ml vs.(63.98±10.35)ml,(20.88±4.27)h vs.(39.98±5.81)h,(58.03±10.34)h vs.(76.02±14.27)h,(6.04±1.21)d vs.(8.74±2.05)d,there were statistical differences(P<0.05).The levels of Cor,E,NE,NLRP3,caspase-1,IL-18 and sVCAM in the observation group after operation were lower than those in the control group:(54.73±8.57)μg/L vs.(87.46±10.53)μg/L,(25.15±4.21)μg/L vs.(37.08±5.17)μg/L,(29.38±4.09)μg/L vs.(46.85±6.26)μg/L,(6.53±1.17)μg/L vs.(7.86±1.23)μg/L,(15.35±2.23)μg/L vs.(18.73±2.54)μg/L,(239.32±31.19)ng/L vs.(275.68±36.07)ng/L,(24.97±5.61)nmol/L vs.(33.61±7.19)nmol/L,there were statistical differences(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group:3.33%(1/30)vs.20.00%(11/55),there was statistical difference(χ^(2)=4.45,P<0.05).After 18 months of follow-up,there was significant difference in Visick grading between the two groups(P<0.05).Conclusions The single forceps endoscopic closed perforation suture has significant efficacy in the treatment of patients with gastroduodenal ulcer hemorrhage,with little influence on the patient′s body,faster postoperative recovery,reduction of hospitalization time,better long-term efficacy,shorten recurrence rate of re-bleeding and postoperative complications,it is safe and efficiency.