Church N I, Palmer K R
Gastrointestinal Unit, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
Baillieres Best Pract Res Clin Gastroenterol. 2000 Jun;14(3):427-41. doi: 10.1053/bega.2000.0088.
Endoscopic injection is widely used for the arrest of active ulcer bleeding and for prevention of re-bleeding from ulcers with visible vessels. Although of proven value in clinical trials, mechanisms of action are unclear; tamponade, vasoconstriction, endarteritis and a direct effect upon the clotting process at the site of the arterial defect have been proposed. Clinical trials show that dilute adrenaline is an effective agent and that the addition of sclerosants or alcohol confirms no extra benefit, yet risks serious side-effects. The best results are associated with injection of fibrin glue or thrombin which stimulate formation of a stable blood clot. The efficacy of injection, thermal modalities such as the heater probe and electrocoagulation using BICAP are comparable. In general, there is an advantage in combining injection with a thermal modality, although this may have merit in patients with severe, active ulcer bleeding. Patients who re-bleed following successful primary haemostatic injection treatment can be considered for further endoscopic intervention, but the decision to undertake a surgical operation or repeat endoscopic therapy is a matter of clinical judgement.
内镜注射广泛应用于活动性溃疡出血的止血以及预防可见血管溃疡的再出血。尽管在临床试验中已证实其价值，但作用机制尚不清楚；有人提出了填塞、血管收缩、动脉炎以及对动脉缺损部位凝血过程的直接作用等机制。临床试验表明，稀释的肾上腺素是一种有效的药物，添加硬化剂或酒精并无额外益处，但会带来严重的副作用。最佳结果与注射纤维蛋白胶或凝血酶有关，它们可刺激形成稳定的血凝块。注射、热凝方式如热探头以及使用BICAP进行电凝的疗效相当。一般来说，将注射与热凝方式联合使用有优势，尽管这对于严重活动性溃疡出血的患者可能也有价值。初次止血注射治疗成功后仍再出血的患者可考虑进一步的内镜干预，但决定进行手术或重复内镜治疗则需临床判断。
