急性消化道出血的内镜下金属钛夹治疗

我院自2001年6月至2002年9月，应用金属钛夹治疗急性消化道出血18例，收到满意止血效果，现报道如下。     

内镜下止血夹治疗在急性非静脉曲张性消化道出血中的应用

目的 观察内镜下金属止血夹治疗急性非静脉曲张消化道出血的治疗效果.方法 收集我院2004年7月至2009年7月收治的急性非静脉曲张消化道出血患者79例,在内镜下明确出血部位,使用止血夹钳夹止血.结果 79例急性非静脉曲张消化道出血患者应用内镜下金属止血夹止血治疗,共用金属夹238枚,平均每例3.01枚,即时止血率97.47%(77/79),20例止血夹止血失败病例中1例Dieulafoy病患者改用内镜下套扎治疗止血成功,另1例转外科手术治疗.1周内再出血率3.80%(3/79),其中2例患者转手术治疗.所有患者内镜术后均未出现内镜治疗相关并发症,全组无死亡病例.结论 内镜下金属止血夹是一种治疗急性非静脉曲张消化道出血的有效方法,具有操作简单,止血效率高及无明显并发症等优点,值得临床推广应用.     

金属钛夹治疗急性非静脉曲张性消化道大出血

消化道大出血为临床常见急症，内镜钛夹在止血方面的作用日益受到重视。为进一步探讨内镜钛夹止血法的适应证、疗效、安令性及临床应用价值等，我们自2002年1月-2004年11月应用金属钛夹治疗52例消化道急性出血患者，现报道如下。     

经内镜金属钛夹治疗消化道急性出血

经内镜金属钛夹治疗消化道急性出血吴云林，钟捷，袁耀宗，程时丹，俞丽芬，王立夫作者单位：２０００２５上海第二医科大学瑞金医院消化道出血为临床常见急症，原因包括溃疡病、息肉、癌肿、静脉曲张、内镜治疗并发症等。本文报道作者应用ＭＤ８５０金属钛夹治疗１２例消...     

內镜下OTSC夹治疗急性非静脉曲张性上消化道出血的临床体会

[目的]探讨OTSC(over-the-scope clip system)金属夹夹闭止血术在治疗常规方法不易控制的急性非静脉曲张性上消化道出血(acute non-variceal upper gastrointestinal bleeding,ANVUGIB)中的作用。[方法]回顾性分析2014-07-01-2017-07-01期间对常规注射法治疗效果差、普通止血夹难以闭合、通过OTSC金属夹夹闭止血治疗的15例ANVUGIB的临床资料。15例包括贲门黏膜撕裂并出血3例,消化性溃疡出血9例,疑似杜氏病(Dieulafoy)2例,胃癌1例。[结果]15例用OTSC均成功的进行了内镜下止血,成功率100.0%,无近期再出血,3个月内复查电子胃镜OTSC自行脱离率26.7%,11例6个月后再次胃镜检查OTSC总的自行脱离率为46.7%。[结论]采用OTSC夹闭治疗药物及常规內镜下止血治疗效果不佳的ANVUGIB止血成功率高,一定程度上可避免外科手术,但远期OTSC夹自行脱离率较低,必要时需內镜下处理。     

上消化道非静脉曲张性急性出血内镜止血夹治疗的护理体会

随着内镜技术及其它相关技术的发展，内镜止血已成为目前消化道出血的首选方法。特别对于急性活动性出血和内镜下可见血管残端裸露的消化道出血，内镜下金属夹止血更具快速而有效的特点，深受广大消化内镜医师的青睐。我们自2001～01／2003～11，共对23例上消化道非静脉曲张性急性出血的病人行胃镜下金属夹止血，疗效确切。现将其治疗和护理体会总结如下。     

金属夹治疗上消化道非静脉曲张性大出血

１９９７年～１９９９年我们对２９例上消化道非静脉曲张急性出血患者应用Olympus内镜金属夹治疗取得了满意的疗效。１．一般资料：２９例患者中男１６例，女１３例；年龄１４～７８岁，平均４０．６岁。均有上消化道急性出血史，２４h内行急诊内镜检查。检查结果：胃溃疡１１例，十二指肠球部溃疡７例，胃癌３例，食管贲门粘膜撕裂症２例，胃息肉３例，Dieu－lafoy病１例，胃息肉内镜切除术后出血２例。出血按Forrest分类法：喷射性活动性出血（Ⅰa）１０例，渗出性活动出血（Ⅰb）１２例，血管显露（Ⅱa）７例。２．器械：Olympus－EVI…     

内镜下金属夹在消化道出血中的治疗作用

消化道出血的治疗除了有电凝、氩气刀、套扎、硬化剂等止血外，内镜下金属夹止血也是较为广泛应用的止血手段之一。我院对35例消化道出血病例进行了金属夹止血治疗，止血迅速，成功率高，现报道如下。     

内镜下钛夹治疗在非静脉曲张上消化道出血中的应用

非静脉曲张上消化道出血是临床较常见的急症和重症，出血量大时可危及患者生命，通过内科保守治疗虽可暂时止血，但难以确定出血部位及性质，且仍有近期再次出血的可能。因此如何迅速、有效、安全地止血已成为治疗的关键。     

内镜下血管夹联合注射治疗非静脉曲张性上消化道出血

1997～2000年我们对36例非静脉曲张性上消化性出血(UGI)患者应用内镜金属血管夹联合注射肾上腺素治疗,并与一组(40例)单独应用内镜下注射肾上腺素治疗者进行对照,现总结报告如下。     

内镜治疗在急性非静脉曲张上消化道出血中的应用

急性非静脉曲张上消化道出血是临床常见的急危重症。内镜技术在急性非静脉曲张上消化道出血的治疗中有重要价值。近年此领域有了持续的新进展。本文即就内镜治疗对急性非静脉曲张上消化道出血的适宜治疗患者、治疗时机以及治疗方法和策略等方面给予简述。     

Second look endoscopy in acute non-variceal upper gastrointestinal bleeding

Bleeding peptic ulcer remained an important cause of hospitalization worldwide. Primary endoscopic hemostasis achieved more than 90% of initial hemostasis for bleeding peptic ulcer. Recurrent bleeding amounted to 15% after therapeutic endoscopy, and rebleeding is an important risk factor to peptic ulcer related mortality. Routine second look endoscopy was one of the strategies targeted at prevention of rebleeding. The objective of second look endoscopy was to treat persistent stigmata of recent hemorrhage before rebleeding. Three meta-analyses showed that performance of routine second look endoscopy significantly reduced ulcer rebleeding especially when the endoscopic therapy was performed with thermal coagulation. Two cost-effectiveness analyses, however, demonstrated that selective instead of routine second look endoscopy is the most cost-effective approach to prevent ulcer rebleeding. While international consensus and guidelines did not recommend routine performance of second look endoscopy for prevention of ulcer rebleeding, further research should focus on identification of patients with high risk of rebleeding and investigate the effect of selective second look endoscopy in prevention of rebleeding among these patients.     

金属夹联合微波治疗带蒂大肠息肉疗效评价

目的对内镜下金属夹联合微波治疗消化道带蒂大息肉的作用进行评价.方法应用OlympusMD-850金属夹联合微波治疗消化道带蒂大息肉10例,胃息肉6例(6颗),结肠息肉4例(4颗),1.5-2cm大小息肉9颗,＞2cm息肉1颗,蒂直径1-1.5cm,治疗后5-10天内及1个月复查内镜,观察息肉治疗和创面愈合情况.结果10例患者均1次治愈,成功率100%,平均放置金属夹2.7枚(2-4枚),无1例发生术中术后出血、穿孔等并发症.结论金属夹联合微波治疗消化道带蒂大息肉,疗效确切,安全性高,且操作简便,设备要求不高,此项技术适宜在各级医院推广应用.     

Risk analysis of 30-day rebleeding in acute non-variceal upper gastrointestinal bleeding

Background and study aimsThis study aimed to compare the prognostic value of ABC, Glasgow-Blatchford, Rockall and AIMS65 scoring systems in predicting rebleeding rate within 30 days after endoscopic treatment of acute non-variceal upper gastrointestinal bleeding (ANVUGIB).Patients and methodsA total of 93 patients with ANVUGIB were selected as the study subjects and they were divided into groups according to whether there was rebleeding in the 30 days’ follow-up period. 7 patients with rebleeding within 30 days were included in the rebleeding group, and the other 86 patients without rebleeding were included in the non-rebleeding group.ResultsBy drawing ROC curve, we found that ABC scoring system had the highest accuracy (area under the receiver operating characteristic (AUROC) curve [95% confidence interval (CI), 0.65]) in predicting rebleeding within 30 days compared with the AIMS65 (0.56; P < 0.001), RS (0.51; P < 0.001), and GBS (0.61; P < 0.001). ABC scoring system showed the highest risk of rebleeding in 30 days. When the 4 scoring standards were judged as medium–high risk patients, the efficacy of the ABC scoring system in predicting the risk of rebleeding at 30 days for ANVUGIB was found to be the best in diagnostic sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy.ConclusionComprehensive evaluation showed that ABC score had the highest prediction accuracy. The negative differential significance of each evaluation method was great, that is, the risk of rebleeding was generally low when judged as low risk patients, while the value of predicting rebleeding was limited when judged as medium and high risk patients.     

急性非静脉曲张上消化道出血临床特征分析

目的分析急性非静脉曲张上消化道出血(acute nonvariceal upper gastrointestinal bleeding,ANNUGIB)病因构成、内镜下表现,探讨影响患者预后的危险因素。方法收集我院2005年1月-2010年12月已确诊因急性非静脉曲张上消化道出血(AN-VUGIB)首次入院且资料完整的患者临床资料,共计858例。出院后随访30 d,并将死亡或出院后30 d为临床研究终点,回顾性分析ANVUGIB临床特征。结果 (1)老年组发病率明显高于青、中年组,急性胃黏膜病变占老年组发病病因首位,而青、中年组中十二指肠球部溃疡占首位。(2)出血后行急诊胃镜(≤48 h)检查内镜下有出血征象明显多于>48 h的胃镜检查。(3)女性在十二指肠球部溃疡比率明显高于男性,复合性溃疡比率较男性高,男性在胃溃疡、胃癌、急性胃黏膜病变以及食管癌和Mallory-Wiess综合征比率高于女性。(4)老年组病死率明显高于青、中年组(6.8%、0、1.9%),老年组再出血发生率高于青、中年组(9.3%、4.4%、4.9%)。结论 ANVUGIB以高龄男性多见,青、中年组发病病因中十二指肠球部溃疡占首位,老年组发病病因以急性胃黏膜病变为首位。ANVUGIB老年患者死亡率和再出血率均高于青、中年组,急诊胃镜有助于ANVUGIB的诊断。     

AIMS65评分在老年急性非静脉曲张上消化道出血中的应用

目的探讨AIMS65评分系统对老年非静脉曲张性上消化道出血患者(ANUGIB)再出血及死亡的预测价值。方法回顾性分析北京老年医院消化内科2011年3月至2016年11月期间ANUGIB住院患者220例,根据AIMS65评分分为低危组(AIMS65评分2分)和高危组(AIMS65评分≥2分),比较两组死亡与存活、再出血与未再出血患者的AIMS65评分情况。采用SPSS 19.0统计软件对数据进行分析。计量资料用均数±标准差(x±s)表示,两组比较采用t检验。计数资料用百分率表示,组间比较用X~2检验,Pearson相关性分析AIMS65评分与再出血和死亡的相关性。应用受试者工作特征(ROC)曲线下面积(AUC)评估AIMS65评分对再出血和死亡的预测价值。结果再出血患者AIMS65评分高于未出血患者,差异有统计学意义[(3.82±1.55)vs(2.25±1.31);t=7.23,P0.05]。死亡患者AIMS65评分高于未死亡患者,差异有统计学意义[(4.65±1.23)vs(2.53±1.02);t=7.41,P0.05]。AIMS65评分与再出血及死亡呈正相关(r=0.620,r=0.863,P0.01)。AIMS65评分≥2分预测老年ANUGIB患者再出血及死亡的敏感度分别为85.71%和100.00%,特异度分别为34.04%和32.69%,AUC分别为0.719(95%CI:0.621~0.817)和0.892(95%CI:0.858~0.952),对再出血和死亡预测价值高(P0.01)。结论 AIMS65评分系统可用于对老年ANUGIB患者再出血和死亡的预测,值得临床推广。     

双抗血小板聚集药物应用后患者急性非静脉曲张性上消化道出血的发生率、临床特点及相关因素分析

目的：探讨双抗血小板聚集药物所致急性非静脉曲张性上消化道出血（ANVUGIB）临床特点及相关因素。方法：以本院2010年3月～2015年12月接受双抗血小板聚集药物治疗的800例患者为研究对象,以6个月内ANVUGIB发生率为终点事件,单因素及Logistic多因素回归分析抗血小板聚集药物所致ANVUGIB发生相关因素。结果：双抗血小板聚集药物所致ANVUGIB发生率6.2%;首发表现为黑便者22例（44.0%）,呕血8例（16.0%）,呕血伴黑便者14例（28.0%）;轻度出血30例,中度出血10例,重度出血10例;胃镜检查者42例（84.0%）,出血位于胃部25例（59.5%）;Logistic多因素回归分析显示ANVUGIB发生独立危险因素包括年龄（＞60岁）、双抗血小板聚集用药时间（＞3个月）、既往上消化道出血史。结论：双抗血小板聚集药物所致ANVUGIB首发症状以黑便为主,好发于胃部,其发生与患者年龄、双抗血小板用药时间、既往上消化道出血史有关。     

Evaluation of metal clips combining with microwave therapy in treatinglarge, pedicellated gastrointestinal polyps

AIM To evluate the curative effect of metal clips combining with microwave in treating large, pedicellatedgastrointestinal polyps by endoscopy.METHODS Ten patients with pedicellated gastrointestinal polyps were treated with metal clips (OlympusMD-850) combining with microwave by endoscopy. Among them, gastric polyps were found in 6 cases (6polyps), colonic polyps in 4 cases(4 polyps), 9 polyps were 1.5 cm - 2 cm in size, the other one was morethan 2 cm, the diameter of pedicel was 1 cm to 1.5 cm. All patients were repeatedly examined withendoscopy to observe the curative effect at 5 to 10 days and one month after treatment.RESULTS All the 10 polyps were eradicated, 2- 4 metal clips were placed in one polyp, the succeedingcurative rate was 100%. No hemorrhage, perforation and other complications occurred.CONCLUSION The curative effect of metal clips combining with microwave in treating large, pedicellatedgastrointestinal polyps by endoscopy is reliable and safe.     

Treatment with proton pump inhibitors in acute non-variceal upper gastrointestinal bleeding: a meta-analysis

Medical therapy is an attractive adjuvant to endoscopic treatment in upper gastrointestinal (UGI) bleeding. This review aims to assess the treatment effects of proton pump inhibitor (PPI) therapy in acute non-variceal UGI bleeding. Outcome measures evaluated were further bleeding, surgery, all-cause deaths, ulcer deaths and non-ulcer deaths. We searched MEDLINE (1966-2002) and EMBASE (1974-2002) using the terms 'gastrointestinal hemorrhage', 'peptic ulcer hemorrhage', 'proton pump inhibitor', 'omeprazole', 'pantoprazole', 'lansoprazole', 'rabeprazole' and 'esomeprazole'. The search was extended to the Cochrane controlled trials registry database, published abstracts from five international gastroenterology conferences, manufacturers of PPI, known contacts and bibliographies from each full-length published report. We included trials published in English and non-English languages. Eligible studies were randomized controlled trials that compared the treatment effects of PPI therapy with placebo or H2 receptor antagonists in patients with acute non-variceal UGI bleeding. Of the 175 articles screened, 26 controlled trials including 4670 subjects (2317 in treatment arm and 2353 in control arm) were analyzed. The methodology, population, intervention, and outcomes of each selected trial were evaluated using duplicate independent review. Disagreements were resolved by consensus. PPI therapy significantly reduced rates of further bleeding (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.40-0.57) and surgery (OR, 0.61; 95% CI, 0.48-0.76). All-cause deaths were unaffected (OR, 1.02; 95% CI, 0.76-1.37). Ulcer deaths showed a significant reduction (OR, 0.58; 95% CI, 0.35-0.96), while non-ulcer deaths showed a significant increase (OR, 1.60; 95% CI, 1.06-2.41) in the PPI therapy group. Sensitivity analysis of 22 trials published in peer-reviewed journals, 10 trials with double-blind design and 19 trials with high quality score and 22 trials using omeprazole in the treatment group showed results similar to those seen in the analysis of all 26 trials, confirming the stability of the conclusions. Subgroup analysis revealed that summary outcome measures were not influenced by control group therapy (placebo vs H2 receptor antagonists) or the use of prior endoscopic treatment to achieve hemostasis (given vs not given). However, the summary treatment effects for further bleeding and need for surgery were significant in only those trials enrolling patients with peptic ulcers having high risk for rebleeding and not in those trials enrolling patients with all causes of UGI bleeding. The summary treatment effects for further bleeding and need for surgery were significant in trials using intravenous as well as oral PPI. However, summary OR for all-cause deaths and non-ulcer deaths in trials using intravenous PPI were higher in the treatment group and not in trials using oral PPI. This raised the possibility of intravenous PPI-therapy-associated non-ulcer deaths in high-risk patients. PPI therapy in acute non-variceal UGI bleeding reduced rates of further bleeding, surgery and deaths caused by ulcer complications. However, non-ulcer deaths were increased. The overall mortality was unaffected. PPI therapy is useful only in a selected group of patients with acute non-variceal UGI bleeding, namely those with peptic ulcers having endoscopic high-risk stigmata for rebleeding.