食管静脉曲张套扎术后早期再出血的急诊内镜止血治疗效果分析

Analysis of the effect of emergency endoscopic hemostasis treatment for early rebleeding after esophageal variceal ligation

目的 评价食管静脉曲张套扎术后早期再出血急诊内镜止血的有效性和安全性。方法 对2011年7月至2022年9月因食管静脉曲张套扎术后早期再出血行急诊内镜治疗的13例患者进行回顾性分析,记录内镜表现、采用的止血措施、操作时长、止血成功率、术后不良反应发生情况,术后随访3月。结果 所有患者均发现原套扎圈部分脱落或完全脱落,创面溃疡形成,其中伴有喷射样出血2例(15.4%),持续渗血5例(38.5%),无活动性出血但溃疡面有裸露血管1例(7.7%)、覆血凝块或血迹5例(38.5%)。13例患者均行硬化剂注射治疗,平均聚桂醇注射量(23.6±10.1)mL,其中3例联合套扎治疗,2例联合胃底组织胶注射治疗。所有患者经内镜治疗后即刻止血,成功率100%,平均操作时长20.3 min。术后出现发热5例(38.5%),胸痛1例(7.7%),腹胀1例(7.7%),经对症治疗后均可缓解,随访3月,均未再次出血。结论 食管静脉曲张套扎术后早期再出血发生后,行急诊内镜治疗安全有效,值得推广。

Objective To assess the effectiveness and safety of emergency endoscopic treatment for early rebleeding after esophageal variceal ligation.Methods A retrospective analysis was performed for 13 patients who underwent emergency endoscopic treatment for early rebleeding after esophageal variceal ligation from July 2011 to September 2022.The endoscopic performance,hemostatic measures used,the duration of the operation,the success rate of hemostasis,and the occurrence of postoperative adverse reactions were recorded.Postoperative follow-up was observed for 3 months.Results All patients showed that the original bandage was partially or completely shed,and ulcers were formed on the wound,including 2 cases(15.4%) with jet-like hemorrhage,5 cases(38.5%) with persistent bleeding,1 case(7.7%) with exposed blood vessels on the ulcer surface without active bleeding,and 5 cases(38.5%) with blood clots or blood stains.All 13 patients were treated with sclerosing injection,and the average sclerosing agent requirement was(23.6±10.1) mL,including 3 cases combined with ligation and 2 cases combined with fundus tissue glue injection.All patients stopped bleeding immediately after endoscopic treatment,with a success rate of 100% and an average operation time of 20.3min.After surgery,5 cases(38.5%) had fever,1 case(7.7%) chest pain,and 1 case(7.7%) of abdominal distention,which could be relieved after symptomatic treatment.At 3 months of follow-up,none of them had any more bleeding.Conclusion When early rebleeding occurs after esophageal variceal ligation,emergency endoscopic treatment is safe and effective and worth promoting.