经内镜金属夹钳夹术治疗非静脉曲张性上消化道出血

目的 探讨经内镜金属钛夹止血治疗非静脉曲张性上消化道出血的治疗效果。方法2000年7月-2004年3月应用OlympusGIFl30电子胃镜、Olympus钛夹（MD850型）及推进器（HX-5LR-I）止血治疗非静脉曲张性上消化道出血41例。结果 41例非静脉曲张性上消化道出血患者应用经内镜金属钛夹止血治疗，即时止血率达100％。41例患者共用金属夹92枚，平均每例2．24枚。结论 应用经内镜金属钛夹止血是治疗非静脉曲张性上消化道出血的有效方法。     

经内镜金属钛夹治疗消化道急性大出血

目的 探讨经内镜金属钛夹治疗消化道急性出血的适应证、疗效及安全性.方法 使用Olympus HX-600-135型钛夹治疗非静脉曲张性消化道急性大出血患者94例.结果 94例中即时止血率91.5%（86/94）,止血后再发出血率仅2.3%（2/86）.结论 内镜钛夹治疗各种非静脉曲张性消化道急性大出血是一种安全、有效、经济、简便的治疗措施.     

经内镜金属夹钳夹术治疗17例老年人上消化道大出血的疗效分析

目的：探讨经内镜下金属夹钳夹治疗老年人上消化道非静脉曲张性大出血的应用价值。方法：使用Olympus GIF-XQ240电子胃镜及Olympus钛夹(HX-600-090)及推送器(HX-5LR-1型)，观察17例老年性患者治疗效果。结果：即时止血率达100％，无1例出现再发出血和并发症。结论：内镜下钛夹止血治疗老年性上消化道非静脉曲张性出血疗效高，创伤小，适应症广，并发症少，临床已得到肯定。     

胃镜下钛夹、热极凝固及注射治疗急性非静脉曲张上消化道出血的疗效比较

目的 评价胃镜下钛夹、热极凝固及注射治疗急性非静脉曲张上消化道出血的疗效.方法 经胃镜确诊为急性非静脉曲张上消化道出血85例,随机分成钛夹组(n=29)、热极凝固组(n=28)和注射组(n=28)对出血灶进行治疗,评价3种治疗方法的止血率和再出血率的差异.结果 钛夹、热极凝固及注射组首次止血率分别为100.00%、96.43%、92.86%,差异无显著性(P>0.05).钛夹组和热极凝固组各有1例发生再次出血,再出血率分别为3.45%、3.70%,两组再出血率差异无显著性(P>0.05).注射组中有6例发生再出血,再出血率23.08%,高于钛夹组和热极凝固组,差异有显著性(P<0.05).结论 胃镜下钛夹与热极凝固治疗非静脉曲张上消化道出血疗效相当,优于注射治疗.     

内镜下不同方法治疗非静脉曲张性上消化道出血的效果比较

选取在2013年5月~2014年5月我院消化科收治的120例非静脉曲张性上消化道出血症患者,随机分为注射组、钛夹组、微波组和喷洒组各30例。采用电子胃镜进行检查与临床治疗,注射组患者在出血处注射肾上腺素进行止血,钛夹组患者则用金属钛夹进行止血,微波组患者采用微波反复熨烙的方式止血,喷洒组在出血处喷洒去甲肾上腺素止血,观察即时止血效果与1w后的出血情况。结果钛夹组的即时止血效果和治疗有效率都比其他三组要好,差异性显著(P<0.05),注射组的临床疗效也相对较好,微波组和喷洒组则是效果欠佳。在非静脉曲张性上消化道出血的临床治疗上,内镜下钛夹止血与注射止血效果良好,是值得推广的止血方法。     

内镜下金属钛夹治疗非静脉曲张性上消化道出血45例临床护理

目的：探讨内镜下金属钛夹治疗非静脉曲张性上消化道出血的护理方法。方法：对45例非静脉曲张性上消化道出血患者在电子胃镜内镜放置下金属钛夹l～5枚止血，同时对患者进行密切观察和精心护理。结果：本组患者经积极治疗与精心护理，一次止血45例，止血率100％。结论：内镜下金属钛夹治疗急性消化道出血可达到立即止血和预防再出血的目的，放置前、放置中、放置后的精心护理是预防各种并发症的关键。     

胃镜改良法治疗非静脉曲张上消化道出血的临床应用

目的：探讨胃镜改良法治疗非静脉曲张上消化道出血的临床应用价值。方法：57例非静脉曲张上消化道出血患者随机分为改良组。（30例）和对照组（27例）。改良组采用胃镜与双气囊导尿管捆绑，外面套透明无毒聚乙烯塑料管，发现出血病灶后往双气囊导尿管注入气体20～30m1，将气囊压迫在出血点上，阻断血流和减轻水肿，再经胃镜活组织检查道插入夹闭器及安放于前端的金属钛夹，直视下伸出钛夹并张开最大，调整角度，对准病灶，收紧并断离金属钛夹，金属钛夹即将病灶连同附近组织紧箍，彻底截断血流。对照组在胃镜下直接使用金属钛夹止血。计算两组一次性钳夹止血成功率及7d再出血率，6周后复查胃镜观察溃疡愈合情况。结果：改良组一次性止血成功率为100％，7d无再出血病例；对照组一次性止血成功率为89％，7d复查胃镜再出血3例（11％），两组一次性止血成功率、7d再出血率比较差异有统计学意义（P〈0．05）。两组患者总有效率均为100％（P〉0．05）。结论：胃镜改良法先压迫后使用金属钛夹治疗非静脉曲张上消化道出血的一次性止血成功率高，不易发生再出血，值得临床推广。     

内镜下金属钛夹治疗非静脉曲张性上消化道出血45例临床护理

目的:探讨内镜下金属钛夹治疗非静脉曲张性上消化道出血的护理方法. 方法:对45例非静脉曲张性上消化道出血患者在电子胃镜内镜放置下金属钛夹1～5枚止血.同时对患者进行密切观察和精心护理. 结果:本组患者经积极治疗与精心护理,一次止血45例,止血率100%. 结论:内镜下金属钛夹治疗急性消化道出血可达到立即止血和预防再出血的目的,放置前、放置中、放置后的精心护理是预防各种并发症的关键.     

经胃镜金属钛夹治疗非静脉曲张性急性上消化道出血的护理配合

[目的]总结经胃镜金属钛夹治疗非静脉曲张性急性上消化道出血的护理措施.[方法]回顾性分析38例非静脉曲张性急性上消化道出血病人行经胃镜金属钛夹治疗的临床资料.[结果]本组38例病人经内镜下金属钛夹治疗后均立刻止血.[结论]加强非静脉曲张性急性上消化道出血病人行经胃镜金属钛夹治疗的护理配合是手术成功的保证.     

经内镜金属夹钳夹术治疗非静脉曲张性上消化道出血及护理

目的 探讨经内镜金属钛夹止血治疗非静脉曲张性上消化道出血的治疗效果及护理方法。方法 总结1998年至2004年31例患者应用OlympusGIF130电子胃镜及Olympus钛夹（MD850型）及推送器（HX-5LR-I）治疗非静脉曲张性上消化道出血并配合相应护理措施。结果 31例患者共用金属夹72枚,平均每例2．3枚,即时止血率达100％,未发生并发症。结论 应用经内镜金属夹止血是治疗非静脉曲张性上消化道出血的有效方法,积极的护理措施是保证治疗效果的重要条件。     

胃镜下硬化剂注射联合药物治疗食管静脉曲张出血

目的：观察比较胃镜下硬化剂注射联合药物治疗和单纯硬化剂注射治疗、药物治疗食管静脉曲张出血的疗效。方法：95例肝硬化并食管静脉曲张出血患者,分成三组。32例患者给予硬化剂注射联合药物治疗,31例患者给予硬化剂治疗,32例患者给予药物治疗。观察三组患者急诊止血率,近期出血率、远期再出血率、曲张静脉消失率、曲张静脉复发率。结果：联合组、硬化剂组、药物组急诊止血率分别为93.8%、90.3%、68.8%;联合组、硬化剂组、药物组近期出血率分别为6.3%、9.7%、46.9%;联合组、硬化剂组、药物组曲张静脉消失率分别为90.6%、83.9%、1.9%;联合组、硬化组与药物组急诊止血率、近期出血率、曲张静脉消失率有显著差异。联合组、硬化剂组、药物组远期出血率分别为9.4%、59.4%、31.3%;联合组、硬化剂组、药物组曲张静脉复发率分别为18.8%、45.2%、87.5%;联合组与硬化组、药物组远期出血率、曲张静脉复发率有显著差异。结论：胃镜下硬化剂注射联合药物治疗食管静脉曲张出血可显著提高疗效。     

Injection of nonvariceal bleeding lesions of the upper gastrointestinal tract

In a prospective series 102 non-variceal upper GI bleeders were studied. An indication for endoscopic injection therapy was seen in 63 patients. In accordance with bleeding intensity, 27 patients were grouped as Forrest Ia, 37 as Forrest Ib, 8 as Forrest II with a "visible vessel" and 13 as Forrest II without one. Definitive hemostasis was achieved in almost 100% of the cases. Within the Forrest Ia group mortality was lowered to 11% as compared with 20% within the emergency surgery group. More than 80% of patients had at least one severe coexistent illness. The aim of endoscopic injection is to avoid surgery in high-risk patients.     

肝动脉化疗栓塞治疗原发性肝癌自发性破裂出血

目的：分析急诊肝动脉化疗栓塞（TACE）治疗原发性肝癌破裂出血的疗效。方法：2001年3月—2008年3月对40例原发性肝癌急诊破裂出血患者,急诊行TACE治疗,观察治疗后的止血率及肿瘤的切除率,并比较急诊TACE治疗后肝切除组与非切除组的疗效。结果：肝癌自发性破裂出血急诊TACE止血率为82.5%（33/40）。患者TACE治疗后的肿瘤切除率为30%（12/40）。按是否接受肝切除手术分成手术组及非手术组,随访两组患者1、3年生存率分别为75.0%、42.9%及50.1%、0.0%,两者有显著差异（P〈0.05）。结论：急诊TACE是控制原发性肝癌自发性破裂出血的有效手段。部分患者能获得手术切除的机会并有较好的远期疗效。     

The effect of endoscopic hemostasis with alcohol on the mortality rate of nonvariceal upper gastrointestinal hemorrhage. A randomized prospective study

One hundred and forty-five patients with nonvariceal upper GI hemorrhage, active or with stigmata (Forrest I and II) were divided into two groups according to the day of the week on which emergency endoscopy was performed: group A (78 patients) in which conventional treatment was applied (blood transfusions, antacids, cimetidine, pirenzepine), and group B (65 patients) in which endoscopic hemostasis with absolute alcohol (Asaki's method) was performed. The two groups were comparable as regards age, sex distribution and type of hemorrhage (after Forrest). Emergency surgery was performed in both groups if the bleeding did not stop or if it recurred. Twenty patients (11 in group A and 9 in group B) were operated on some time after the bleeding episode (5-18 days) to prevent new episodes. Absolute alcohol injection achieved hemostasis in all the cases of active hemorrhage (Forrest I) and prevented recurrence in 24 out of 25 cases with a clot or visible vessels (Forrest II), so that emergency surgery was not necessary in any of the patients of group B. Mortality rate was significantly lower in group B than in group A (10 deaths in group A, 2 in group B, p less than 0.05) being explained mainly by the reduced post-operative mortality (18% in group B), due to the small number of the operated patients (28 in groups A, 10 in B; p less than 0.02), especially of those operated on as an emergency (one in the endoscopic hemostasis group as compared with 17 in the conventional treatment group; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

内镜套扎术联合组织胶注射治疗食管胃底静脉曲张破裂出血疗效观察

目的观察内镜套扎术联合组织胶注射治疗食管胃底静脉曲张破裂出血的疗效。方法选择73例食管胃底静脉曲张破裂出血的患者,药物+内镜(生长抑素+内镜套扎术联合组织胶注射)治疗组34例,内科保守治疗(生长抑素+普洛奈尔)组39例,观察两组止血有效率和再出血率。结果药物+内镜治疗组止血有效率94.12%,再出血率5.88%;内科保守治疗止血有效率74.36%,再出血率27.27%。两组止血有效率差异无统计学意义(P>0.05),药物+内镜治疗组再出血率发生率明显低于内科保守治疗组,差异有统计学意义(P<0.05)。结论内镜下套扎术联合组织胶注射治疗食管胃底静脉曲张破裂出血安全有效。     

超声造影引导下915MHz微波经皮消融活体犬肾动脉活动性出血的止血研究

目的：比较915 MHz经皮微波消融与药物注射对肾动脉活动性出血的止血效果。方法制造肾动脉活动性出血模型并分组：A：d＜1 mm（被膜下动脉）;B：1 mm＜d＜2 mm（叶间动脉）,C：2 mm＜d＜3 mm（段动脉）,分别行超声造影引导下915 MHz微波治疗与药物注射治疗,比较两者的止血成功率、止血作用时间及静脉补液量,并比较其病理结果。结果 A组两种方法均可有效止血,B组和C组915 MHz微波止血的成功率明显高于药物注射疗法（P＜0.05）。915 MHz微波各组止血时间均显著短于药物注射组[A组（125±18.2）s,B组（187±33.4）s,C组（309±39.1）s vs. A组（187±23.9）s,B组（266±26.7）s,C组（413±31.4）s]（P均〈0.05）;静脉补液量也显著小于药物注射组[A组（34±14.3）ml,B组（104±3.8）ml, C组（421±8.2）ml vs. A组（89±26.4）ml,B组（157±5.7）ml,C组（607±8.6）ml]（P均＜0.05）。结论超声造影引导下915 MHz微波与药物注射相比具有更好的止血作用。     

Esophageal visible vessel as a cause of massive upper gastrointestinal hemorrhage

Besides peptic ulcers, erosions, esophageal varices, tumors and non-variceal esophageal lesions, vascular abnormalities lead to an upper gastrointestinal hemorrhage in 1-5% of cases. Among 581 emergency esophagogastro-duodenoscopies for acute gastrointestinal bleeding performed in our institution between 1987 and 1989, an esophageal visible vessel was found to be the source of massive hemorrhage in five patients. All patients were males with ages ranging from 37 to 84 years. Esophageal visible vessel was localized in one patient in the middle third and in four patients in the distal portion of the esophagus. Using the Forrest classification, endoscopy revealed an oozing hemorrhage (Ib) in two patients and a protruding vessel (IIa) in three patients. Definitive hemostasis could be achieved in all patients by local injection of adrenaline combined with heater probe thermocoagulation. In some patients with recurrent upper gastrointestinal bleeding, visible esophageal vessel is a rare source of bleeding that has not yet been described.     

急诊内镜下治疗内镜下逆行胰胆管造影术后十二指肠乳头出血27例临床分析

目的探讨内镜下逆行胰胆管造影(ERCP)术后十二指肠乳头出血相关因素及急诊内镜治疗的止血措施,总结预防和治疗十二指肠乳头出血的临床经验。方法对该院行急诊内镜下止血治疗的十二指肠乳头出血患者的临床资料进行回顾分析。结果 26例内镜下止血成功,成功率达96.30%。结论治疗性ERCP术后乳头出血重在预防,术后一旦出血,急诊内镜下止血是最直观、简便且有效的措施。     

Endoscopic injection of autologous blood for bleeding gastroduodenal ulcers

Endoscopic injection of diluted epinephrine and the application of endoclips or thermal probes are established endoscopic therapies for peptic ulcer bleeding (PUB). However, autologous blood may offer advantages at least over diluted epinephrine due to its specific properties: corpuscular components may provide prolonged persistence and procoagulatory constituents may additionally prevent recurrent bleeding. We performed successful endoscopic injection of autologous blood for acute spurting (Forrest Ia) or oozing (Ib) bleeding from duodenal or gastric ulcers. The injection of autologous blood was simple to apply and achieved hemostasis in bleeding Forrest I peptic ulcers. This technique can be considered as an adjunct or an alternative to other methods for endoscopic control of PUB.     

49例急诊内镜诊治Dieulafoy病的护理配合

目的：探讨急诊内镜下诊治Dieulafoy病的护理配合方法。方法：在内镜下对49例Dieulafoy病病人进行诊治护理,内容主要包括内镜检查前常规准备,活动性出血伴休克的抢救及术中止血治疗的护理配合等。结果：本组病人均在消化道出血12 h内行急诊诊治,其中4例诊断后直接转外科治疗,其余45例经内镜成功止血。49例Dieulafoy病病人均成功获救。结论：急诊内镜诊治应争取在消化道出血后24 h内进行,生命体征不平稳的病人,可在内科抗休克的同时进行内镜下治疗。护士熟练掌握配合内镜止血治疗的护理措施至关重要。