急诊胃镜对肝硬化合并上消化道出血的诊断及治疗价值

目的:比较肝硬化合并上消化道出血的患者进行不同时机的胃镜检查及治疗结果,探讨急诊胃镜对肝硬化合并上消化道出血的诊断及治疗价值.方法:选择94例在我院进行诊治的肝硬化合并上消化道出血患者的临床资料进行回顾性分析和随访,其中27例患者进行急诊胃镜诊治(A组),23例患者进行普通胃镜诊治(B组),20例患者为活动性出血急诊胃镜组(C组),24例患者选择保守药物治疗.比较胃镜检查和治疗结果.结果:70例患者接受胃镜检查,食管胃静脉曲张破裂出血(64.29%)是肝硬化合并上消化道出血的主要原因.43例(61.43%)患者经胃镜检出出血部位,C组出血部位检出率(80.0%)明显高于A组(66.67%)和B组(39.13%),有统计学差异.61例患者进行胃镜辅助止血治疗,止血成功率达到53.19%.A组(66.67%)、B组(60.87%)和C组(50.0%)患者的止血成功率高于D组(33.33%),有统计学差异.另外A(7.41%)、B(4.35%)、C(10.0%)组患者早期再出血率明显低于D组(37.5%),有显著地统计学差异.而四组患者迟发性再出血的几率没有统计学差异.结论:肝硬化合并上消化道出血的患者进行急诊胃镜诊治可尽早明确出血部位以及出血原因,选择合理的治疗方案,有效地提高患者止血部位检出率和止血成功率,降低早期再出血率以及患者1年内死亡率.

The Diagnostic and Therapeutic Values of Emergency Endoscopyin Liver Cirrhotic Patients with Upper Gastrointestinal Bleeding

Objective To compare the inspection and treatment outcomes between liver cirrhotic patients with upper gas-trointestinal bleeding endoscopically examined at different time, in order to explore the diagnostic and therapeutic values of emergency endoscopy in liver cirrhotic patients with upper gastrointestinal bleeding. Methods 94 cases of liver cirrhotic pa-tients with upper gastrointestinal bleeding hospitalized in our hospital were selected and divided into four groups based on the endoscopy timing, including 27 patients in Group A with the emergency endoscopy within 48h; 23 patients in Group B with selective endoscopy; 20 patients with active hemorrhage in Group C with emergency endoscopy; 24 patients in Group D with traditional treatment. The different inspection and treatment outcomes were made a comparison between the four groups. Results 70 patients were examined by endoscopy. The main reason of liver cirrhotic with upper gastrointestinal bleeding was gastroesophageal varices (64.29%). The bleeding rate at endoscopy (80.0%) in Group C was higher than Group A (66.67%) and B (39.13%). And there was statistical difference. Among 61 patients treated with endoscopy, the bleeding of 50 patients (53.19%) was successfully controlled. And the rates of successful hemostasis of patients in Group A (66.67%), B (60.87%) and C (50.0%) were higher than that of Group D (33.33%). And there was statistical difference. Besides, the rates of early rebleeding of patients in Group A (7.14%), B (4.35%) and C (10.0%) were lower than that of Group D (37.5%). Andthe difference was statistically sig-nifican. However, there was no significant difference in the delayed rebleeding between the four groups. Conclusion The liver cirrhotic patients with upper gastrointestinal bleeding examined and treated with emergency endoscopy could be conducive to making sure the location and cause of hemorrhage, choosing the reasonable treatment plan, enhancing the discovery rate of he-morrhage location and the successful rate of hemostasis, and reducing the rate of early bleeding and mortality within 1 year.