内镜在肝源性溃疡出血患者中的应用价值

目的探讨内镜在肝源性溃疡出血中的诊断及治疗意义。方法回顾分析31例肝源性溃疡出血患者(溃疡组)和食管胃底静脉曲张破裂出血患者(静脉曲张组)临床表现、内镜下特征和治疗情况。结果两组患者性别、年龄、入院时血色素、肝功能分组无差异;溃疡组临床症状(上腹痛、反酸、嗳气)比静脉曲张组明显(P<0.01),但两组出血方式和程度无差异(P>0.05);溃疡组内镜下阳性出血特征者26例(83.9%):主要为渗血(32.3%)、血凝块或血痂附着(25.8%)和血管显露(19.4%);急症内镜检查溃疡出血阳性检出率(95.2%)高于非急症内镜(60.0%),P<0.05;内镜治疗主要采用:圈套、注射、电凝、钛夹、喷洒生物胶等,同时对曲张静脉行套扎治疗,止血有效率96.1%。结论内镜检查是肝源性溃疡出血确诊的主要依据;内镜止血治疗迅速、确切可靠,可作为肝源性溃疡出血者止血治疗的首选方法。

The roles of endoscopy in the diagnosis and treatment of haemorrhage from hepatogenic ulcer

Objective To explore endoscope's roles in the diagnosis and treatment of haemorrhage from hepatogenic ulcer.Methods Clinical manifestation,ulcer characteristics under endoscope,and treatment and outcomes of 31 cases of haemorrhage from hepatogenic ulcer(ulcer group) and those of 159 cases of bleeding caused by esophageal and gastric fundus varices(varixgroup)were reviewed,analyzed and compared.Results There was no difference regarding gender,age,hemoglobin at admission,and liver function between two groups.Clinical manifestations(upper abdominal pain、sour regurgitation、belching) of ulcer group were more significant than that of varix group(P<0.01) while there was no difference regarding the form and degree of hemorrhage(P>0.05).In ulcer group,there were 26 cases(83.9%) with positive hemorrhage under endoscope.Of them,32.3% were capillary hemorrhage,25.8% were blood clot or crust cohering,and 19.4% had exposed vessel.Positive rate of ulcer hemorrhage(95.2%) in emergency endoscopic examination was significantly higher than that(60.0%) of non-emergency endoscopic examination.Endoscopic treatment included endoscopic variceal ligation,injection,electrocoagulation,haemostatic clip and fibringlue spraying.At the same time,endoscopic variceal ligation was employed with an effective haemostasis rate of 96.1%.Conclusions Main evidences of diagnosis of hemorrhage from hepatogenic ulcer were from endoscope examination.The endoscopic therapy aim to stop the bleeding is quick,accurate,and reliable,and can be considered as the first choice of haemostasis for hemorrhage from hepatogenic ulcer.