Cipolletta L, Bianco M A, Marmo R, Rotondano G, Piscopo R, Vingiani A M, Meucci C
Department of Gastroenterology and Endoscopy, Maresca Hospital, Torre del Greco, Naples, Italy.
Gastrointest Endosc. 2001 Feb;53(2):147-51. doi: 10.1067/mge.2001.111386.
Endoscopic application of hemoclips (HC) was prospectively compared with heat probe (HP) treatment in patients with bleeding ulcers.
One hundred thirteen patients with major stigmata of ulcer hemorrhage were randomly assigned to receive HP (n = 57) or HC (n = 56). Clinical and endoscopic features were comparable in both groups. Recurrent bleeding was retreated with the modality previously used. Patients in whom treatment or retreatment was unsuccessful underwent emergency surgery.
Hemostasis, adequate treatment of visible vessel, 30-day mortality, and emergency surgery rates were similar for both groups. Recurrent bleeding was 21% for HP and 1.8% for HC (p < 0.05). Length of hospital stay and transfusion requirements were significantly lower in the HC group. There was no evidence of clip-induced tissue injury or impaired ulcer healing. Clips dislodged spontaneously in most patients within 8 weeks of treatment. No further hemorrhage occurred on a median follow-up of 11 months (range 1-23).
The hemoclip is safe and effective in the treatment of severe ulcer bleeding and is superior to HP in preventing early recurrent bleeding.
对出血性溃疡患者，前瞻性地比较了内镜下使用止血夹（HC）与热探头（HP）治疗的效果。
113例有溃疡出血主要征象的患者被随机分配接受HP治疗（n = 57）或HC治疗（n = 56）。两组的临床和内镜特征具有可比性。复发出血采用先前使用的方式进行再次治疗。治疗或再次治疗失败的患者接受急诊手术。
两组的止血效果、可见血管的充分治疗、30天死亡率和急诊手术率相似。HP组的复发出血率为21%，HC组为1.8%（p < 0.05）。HC组的住院时间和输血需求显著更低。没有证据表明夹子会导致组织损伤或溃疡愈合受损。大多数患者的夹子在治疗后8周内自行脱落。在中位随访11个月（范围1 - 23个月）期间未发生进一步出血。
止血夹在治疗严重溃疡出血方面安全有效，在预防早期复发出血方面优于热探头。
