经内镜注射肾上腺素联合钛夹治疗非静脉曲张性上消化道出血的体会

目的：探讨内镜下注射肾上腺素联合钛夹治疗上消化道出血36例患者的方法和疗效。方法：内镜下用1：10000肾上腺素高渗盐水局部注射并联合钛夹止血。结果：36例患者止血成功,无任何并发症。结论：肾上腺素联合钛夹治疗非静脉曲张性上消化道出血疗效显著。     

内镜下三种不同方法治疗Dieulafoy病出血效果观察

目的观察内镜下三种不同方法治疗Dieulafoy病出血的疗效。方法将72例经内镜诊断为Dieulafoy病出血患者随机分为金属钛夹组、注射组、金属钛夹联合治疗组（联合组）3组,各24例,分别行内镜下钛夹、注射、钛夹联合注射治疗。结果联合组全部止血成功率,高于另外两组;且无再次出血及转手术治疗,明显少于另两组。结论内镜下钛夹联合注射是治疗Dieulafoy病出血安全、有效的方法,值得临床推广应用。     

止血夹与注射疗法治疗Dieulafoy病出血的疗效比较

目的观察内镜下放置止血夹与注射疗法在治疗Dieulafoy病出血中的疗效。方法回顾分析自2001年至2009年我院诊治的Dieulafoy病内镜下特点及治疗结局,比较内镜下止血夹与注射疗法的止血的疗效差异,分析治疗失败的原因。结果①21例Dieulafoy病中男16例,女5例,平均年龄56.6岁,分别有11例行内镜下止血夹治疗,10例行注射治疗止血,两组间患者年龄、病变Forrest分级、平均输血量均有可比性;②采用止血夹治疗组止血成功率、再发出血率、转手术治疗比例分别为72.7%、27.3%、18.2%,注射治疗组分别为60.0%、40.0%、20.0%,两组间止血疗效比较差异无统计学意义(P>0.05);无内镜治疗相关的并发症发生;③内镜治疗后再次出血的时间均在48h内。注射治疗组有2例再出血患者死亡。结论内镜下放置止血夹及注射治疗均是治疗Dieulafoy病的有效方法再出血多见于内镜治疗后48h内;死亡的患者存在高龄、合并慢性病等因素。     

急诊胃镜金属钛夹治疗Dieulafoy病35例疗效观察

目的 观察Dieulafoy病急诊胃镜下金属钛夹止血的临床效果.方法 对35 例Dieulafoy 病患者在急诊胃镜下确诊后即行钛夹止血.结果 所有病例在急诊胃镜下钛夹止血均一次成功.平均随访180 d,无一例发生再出血.结论 急诊胃镜下钛夹止血治疗Dieulafoy病疗效确切,止血迅速、创伤小、再出血率低、操作简便、...     

胃镜下注射肾上腺素联合钛夹治疗急性非静脉曲张上消化道出血

目的：观察胃镜下钛夹和注射肾上腺素联合钛夹治疗急性非静脉曲张上消化道出血的疗效。方法将经胃镜检查确诊为急性非静脉曲张上消化道出血患者58例,随机均分为钛夹组对照组和注射肾上腺素联合钛夹组治疗组,在胃镜下,对照组钛夹对准出血并夹闭出血部位,治疗组先用含1：10000肾上腺素注射液局部注射,然后再用钛夹对准并夹闭出血部位。术后7d比较两种治疗方法的止血率和再出血率的差异。结果两组首次止血成功率均为100％,但对照组有5例发生再次出血,再出血率17．24％,治疗组无再出血发生。两种止血方法比较,注射联合钛夹组的止血效果较好,差异有统计学意义（P〈0．05）。结论胃镜下注射肾上腺素联合钛夹治疗非静脉曲张上消化道出血疗效可靠,优于单纯钛夹治疗。     

内镜下金属钛夹联合去甲肾上腺素喷洒治疗急性消化道出血疗效分析

目的分析内镜下金属钛夹联合去甲肾上腺素冰盐水喷洒治疗急性消化道出血的疗效及安全性。方法 56例急性消化道出血患者,内镜下先予8%去甲肾上腺素冰盐水喷洒,继以金属钛夹夹闭出血部位,达到止血目的。结果 56例患者中,54例一次性止血成功,一次性止血成功率96.4%,1例24 h内再出血,再出血率1.9%,再出血病例经再次内镜下金属钛夹治疗,未再出血。结论内镜下金属钛夹联合去甲肾上腺素冰盐水喷洒治疗急性消化道出血疗效确切、再出血率低且安全快捷,值得推广。     

胃镜下注射肾上腺素联合钛夹治疗急性非静脉曲张上消化道出血

目的 评价胃镜下钛夹和注射肾上腺素联合钛夹的方法治疗急性非静脉曲张上消化道出血的疗效.方法 经胃镜检查确诊为急性非静脉曲张上消化道出血患者65例,随机分为钛夹组（31例）、注射肾上腺素联合钛夹组（注射联合钛夹组,34例）,对出血灶进行治疗,评价两种治疗方法的止血率和再出血率的差异.结果 注射联合钛夹组和钛夹组的所有患者均首次止血成功,止血率均为l00%;钛夹组有6例发生再次出血,再出血率19.4%,注射联合钛夹组中有1例发生再出血,再出血率2.9%,两组差异有统计学意义（P＜0.05）.结论 胃镜下注射肾上腺素联合钛夹治疗非静脉曲张上消化道出血疗效可靠,优于单纯钛夹治疗.     

注射联合钛夹止血治疗消化道大出血疗效观察

消化道大出血是消化内科常见急危重症.治疗除了常规内科用药外,最有效、疗效最快、最直接的方法是胃镜下止血.常用的有:局部喷洒止血、注射止血、电凝止血、生物蛋白胶止血、微波止血、金属夹止血等.对于出血量小的可能单纯应用其中一种就能达到止血效果,对于出血量较大患者,可采用多种止血方法联合止血.本文就注射联合钛夹止血治疗消化道大出血做一经验总结.     

内镜诊治Dieulafoy病急性上消化道大出血11例分析

目的探讨内镜下对Dieulafoy病的诊断治疗方法,提高对Dieulafoy病的诊治水平。方法回顾分析本院11例Dieulafoy病的临床资料,并复习文献,提出诊疗方法。结果11例患者临床表现均为大量呕血、黑便,病变位于贲门部4例,胃体上部前壁3例、胃窦小弯2例、十二指肠球部1例、胃空肠吻合口后壁1例。11例内镜确诊Dieulafoy病后,立即进行镜下局部硬化栓塞止血及金属钛夹钳止血,除1例镜下止血失败而改外科手术外(手术证实为Dieulafoy病),余10例均一次止血成功。结论该病临床特点为突发性、难治性出血。因此,紧急内镜下检查不仅可确诊Dieulafoy病,更重要的是直接进行镜下止血,达到暂时或永久性止血,提高对危及生命大出血的抢救成功率,使部分患者避免不必要的外科手术治疗。     

消化内镜下注射肾上腺素联合钛夹对非静脉曲张上消化道出血患者止血有效率及机体应激因子水平的影响

目的:分析消化内镜下注射肾上腺素联合钛夹对非静脉曲张上消化道出血患者止血有效率及机体应激因子水平的影响。方法:选取某院2017年3月～2019年6月85例非静脉曲张上消化道出血患者,接受消化内镜下钛夹治疗的42例为对照组,接受消化内镜下注射肾上腺素联合钛夹治疗的43例为观察组,比较两组止血有效率、治疗前后机体应激因子水平[抗利尿激素(ADH)、皮质醇(Cor)]。结果:观察组止血有效率较对照组高(P0.05);治疗后,观察组ADH、Cor水平较对照组低(P0.05)。结论:非静脉曲张上消化道出血患者接受消化内镜下注射肾上腺素联合钛夹治疗,能提高止血有效率,降低机体应激因子水平。     

金属夹在胃肠道疾病中应用价值的探讨

目的观察金属夹在诊治胃肠道疾病中的有效性和安全性。方法收集我院内镜中心放置金属夹病例。经内镜活检孔反复置放金属夹,直到达到了诊治的目的。观察放置的成功率、并发症,随访放置的有效性。结果26例患者平均使用金属夹3.2枚,成功率100%;止血治疗16例,即时止血率100%。1例胃Dieulafoy病患者,在金属夹治疗24 h后,因再次出血转外科手术治疗,其余15例随访4周,未再出血;4例粗蒂和广基息肉电切前后分别用金属夹进行了预防性治疗,无出血和穿孔;6例金属夹定位的病灶和手术切除病灶位置完全一致。治疗后均无发热、腹痛等症状。结论金属夹能有效治疗胃肠道出血、预防电切息肉后出血和穿孔并能对病灶进行准确定位,值得推广应用。     

Endoscopic band ligation could decrease recurrent bleeding in Mallory–Weiss syndrome as compared to haemostasis by hemoclips plus epinephrine

Background  Mallory–Weiss syndrome (MWS) with active bleeding at endoscopy may require endoscopic haemostasis the modalities of which are not well-defined.
Aim  To compare the efficacy of endoscopic band ligation vs. hemoclip plus epinephrine (adrenaline) in bleeding MWS.
Methods  From 2001 to 2008, 218 consecutive patients with a MWS at endoscopy were hospitalized in our Gastrointestinal Bleeding Unit. In 56 patients (26%), an endoscopic haemostasis was required because of active bleeding. Band ligation was performed in 29 patients (Banding group), while hemoclip application plus epinephrine injection was performed in 27 patients (H&E group). Treatment efficacy and early recurrent bleeding were retrospectively compared between the two groups.
Results  Primary endoscopic haemostasis was achieved in all patients. Recurrent bleeding occurred in 0% in Banding group vs. 18% in H&E group ( P  = 0.02). The use of hemoclips plus epinephrine (OR = 3; 95% CI = 1.15–15.8) and active bleeding at endoscopy (OR = 1.9; 95% CI = 1.04–5.2) were independent predictive factors of early recurrent bleeding.
Conclusions  Haemostasis by hemoclips plus epinephrine was an independent predictive factor of rebleeding. This result suggests that band ligation could be the first choice endoscopic treatment for bleeding MWS, but requires further prospective assessment.     

Dieulafoy病12例临床分析

目的提高对胃肠道Dieulafoy病临床特点的认识。方法对12例Dieulafoy病进行回顾性分析。结果胃肠道Dieulafoy病是黏膜下恒径动脉畸形，主要表现为无痛性消化道大出血，术前、术中纤维内窥镜检查即可诊断，手术治疗效果好。结论胃肠道Dieulafoy病非常罕见，无痛性消化道大出血为其特点。纤维内窥镜可协助诊断，手术治疗最佳。     

内镜下金属钛夹治疗上消化道Dieulafoy病的临床分析

目的探讨经内镜金属止血夹治疗Dieulafoy病的疗效。方法回顾性分析本院2010年2月至2011年2月收治的20例Dieulafoy病患者的临床资料。结果本组患者再出血率为5%,早期止血率为100%。平均住院天数(4±0.75)d,无1例需转外科手术治疗,无穿孔及其他并发症发生。结论经内镜下金属止血夹治疗Dieu-lafoy病是一种积极有效的方法,方法简单、可靠,值得临床推广使用。     

金属钛夹与氩离子凝固术治疗上消化道Dieulafoy病出血的临床对比研究

目的比较内镜下金属夹(EHP)与氩离子凝固术(APC)治疗上消化道Dieulafoy病出血的疗效。方法 2005年3月至2010年8月共收治72例Dieulafoy病所致上消化道出血患者,随机分为EHP组(n=40)和APC组(n=32),对两组治疗结果进行比较。结果 EHP组与APC组早期止血率均为100%;再出血率:EHP组为2.5%,APC组为12.5%,对比两组之间的差异(P>0.05)无统计学意义。两组均未出现并发症。结论本研究显示,EHP和APC治疗上消化道Dieulafoy病出血的疗效与安全性方面无明显差异。     

阿替卡因肾上腺素注射液在老年患者口腔治疗中的麻醉效果观察

目的 观察阿替卡因肾上腺素注射液在老年患者口腔治疗中的麻醉效果.方法 随机选择无明显血压异常及心脏病的60岁以上患者56例66颗牙编号分组,观察阿替卡因肾上腺素注射液在牙体牙髓病、牙周病、牙槽外科及修复治疗中的应用效果,采用VAS标尺法评价患者疼痛程度,评价麻醉效果,并监测患者在麻醉剂注射前、注射即刻、注射后5 min的心率和血压.结果:阿替卡因肾上腺素注射液进行局部浸润麻醉时,注射、治疗疼痛程度轻(总有效率95%～100%),麻醉起效快,无明显不良反应.结论 阿替卡因肾上腺素注射液局部渗透力强,麻醉安全、有效,在老年患者口腔治疗中具有良好的应用前景.     

Photodynamic therapy in gastrointestinal cancer: a realistic option?

Photodynamic therapy is now a useful and practical option of the local treatment of gastrointestinal cancers. There is increasing screening and surveillance of patients at risk of oesophageal and gastric cancers. The early detection of disease is often unhelpful if an elderly or frail patient needs to be subjected to radical resectional surgery. Photodynamic therapy can eradicate and cure early mucosal disease following a single endoscopic treatment. If the disease is more advanced good local control and palliation is often possible. Overall, palliation can often be achieved using simpler methods which are highly effective and not associated with the problems of prolonged photosensitisation. It is rapidly becoming clear that the ideal indication is for the treatment of dysplastic lesions in the oesophagus associated with columnar-lined oesophagus (Barrett's oesophagus). In these circumstances a heterogeneous field change often with multifocal dysplasia or cancer can be widely eradicated. Similar areas of squamous dysplasia in the upper oesophagus can be treated. At present a major complication of stricture formation is associated with the use of some photosensitisers. The treatment of cancer at the ampulla of Vater and choriocarcinoma is also proving very effective. The treatment can be performed at endoscopy and is well tolerated and safe.     

组织胶栓塞对胃静脉曲张出血的疗效分析

目的探讨人体组织胶镜下栓塞在胃静脉曲张出血的治疗和预防中的应用价值。方法回顾性分析肝硬化胃静脉曲张病例72例,分药物组（44例）和药物加栓塞组（28例）,统计分析其止血率、2周出血率、复发出血时间、出血相关死亡率及不良反应。结果平均随访23月,栓塞组较药物组止血率高,复发出血时间长,不良反应多;2周内出血率和复发出血相关死亡率无统计学差异。结论胃静脉曲张出血的治疗,药物联合镜下组织胶栓塞效果更优。     

Cisplatin/epinephrine injectable gel.

1. Cisplatin/epinephrine injectable gel is a preparation for intratumoural injection containing cisplatin 4 mg/ml, epinephrine (adrenaline) 0.1 mg/ml and bovine collagen as a protein carrier matrix. It has been evaluated for the palliative treatment of accessible inoperable metastatic or recurrent solid tumours. 2. The vasoconstrictor action of epinephrine limits the diffusion of cisplatin into the systemic circulation. Intratumoural injection of cisplatin/epinephrine injectable gel achieves high concentrations of cisplatin in the tumour with very low concentrations in plasma and other tissues. 3. In double-blind randomised trials, cisplatin/epinephrine injectable gel was more efficacious than placebo in the palliative treatment of recurrent and resistant head and neck squamous cell carcinoma. 4. Cisplatin/epinephrine injectable gel reduced tumour size and improved local symptoms in patients with metastatic breast cancer, metastatic malignant melanoma, oesophageal carcinoma and hepatic tumours in a number of noncomparative clinical trials. 5. Adverse events with the use of cisplatin/epinephrine injectable gel are mainly limited to the local site of injection. No systemic adverse events such as nephrotoxicity, neurotoxicity or ototoxicity have been reported with use of this preparation.