吻合口溃疡出血的临床及内镜特点

Bleeding Marginal Ulcer fo Billroth Ⅱ Gastric Resection

目的:探讨吻合口溃疡出血的内镜特点和内科治疗效果。方法:回顾分析59例吻合口溃疡出血(研究组)和243例溃疡病出血(对照组)的内镜下Forrest分级及内科治疗的效果。结果:研究组10例多发溃疡,余为单发,共75个溃疡,位于吻合口、空肠侧及鞍部和胃侧分别是32％、40％和28％。其活动性出血(17％)和有的期出血征象(23.8％)显著多于对照组(8.2％,12.7％)。研究组输血量和住院天数显著高于对照组,而再出血、急诊手术和死亡率等两组间无显著差别。结论:抑酸剂结合内镜下注射可有效治疗吻合口溃疡出血,按照内镜下出血征象进行注射治疗可提高疗效。

Purpose: To investigate the efficacy fo treatment, endoscopic finding and the clinical presentation in bleeding marginal ulcer, Methods: The clinical data, endoscopic finding, epinephrine collected and analyzed in 59 patients with marginal ulcer bleeding and randomly selected 243 patients with peptic ulcer bleeding. Results: Ulcerations were located at the anastomosis(32% ),jejuna! and saddle site(40% ) ,or gastic - anastomotic site(28% ). Ulcer with active bleeding(17% )and stigmata fo recent bleeding(23.8%)were significantly more seen in partial gastrectomy than those without gastrectorny(8. 2%,12.7%) .The amount of blood transfusion and days of hospitalization in marginal ulcer were significantly higher than that in peptic ulcer.No significant difference was found between two groups in rebleeding rates, need of surgey and mortality rates. Conclusion: Marginal ulcer bleeding can be treated as peptic ulcer hemorhage. Endoscopic local injection improves the overall therapeutic efficacy.