Loizou L A, Bown S G
National Medical Laser Centre, University College Hospital, London.
Gut. 1991 Oct;32(10):1100-3. doi: 10.1136/gut.32.10.1100.
Forty two patients with haemorrhage from peptic ulcers with visible vessels were enrolled in a randomised study comparing endoscopic haemostasis with adrenaline (1:10,000) injections (adrenaline group) and adrenaline injection + neodymium yttrium-aluminium-garnet (Nd:YAG) laser photocoagulation (adrenaline + laser group). The two groups (21 patients each) were well matched for factors affecting outcome. Surgery was performed for continued haemorrhage uncontrolled by endoscopic treatment or rebleeding after two endoscopic treatments. Haemostasis after one treatment was similar in the two groups: adrenaline 16/21 (76%), adrenaline + laser 18/21 (86%). Haemostasis after two treatments was numerically (0.05 less than p less than 0.10) greater in the adrenaline + laser group: 21/21 (100%) v 18/21 (86%). Three patients (14%) in the adrenaline group underwent uneventful emergency surgery. There were no deaths or procedure related complications in either group. Most bleeds from peptic ulcers with visible vessels can be controlled endoscopically without the need for surgery. Both treatments in this study proved highly efficacious in securing haemostasis. Adrenaline injection treatment seems to be the treatment of choice in view of its simplicity, low cost, and availability. Additional Nd:YAG laser treatment may provide a marginal improvement in efficacy, although a much larger trial would be required to prove this.
42例患有可见血管的消化性溃疡出血患者被纳入一项随机研究，该研究比较了内镜下用肾上腺素（1:10,000）注射止血（肾上腺素组）和肾上腺素注射加钕钇铝石榴石（Nd:YAG）激光光凝止血（肾上腺素+激光组）。两组（每组21例患者）在影响预后的因素方面匹配良好。对于内镜治疗无法控制的持续性出血或两次内镜治疗后再出血的情况，则进行手术治疗。两组一次治疗后的止血效果相似：肾上腺素组16/21（76%），肾上腺素+激光组18/21（86%）。肾上腺素+激光组两次治疗后的止血效果在数值上（0.05＜p＜0.10）更好：21/21（100%）对18/21（86%）。肾上腺素组有3例患者（14%）顺利接受了急诊手术。两组均无死亡或与手术相关的并发症。大多数有可见血管的消化性溃疡出血可通过内镜控制，无需手术。本研究中的两种治疗方法在确保止血方面均被证明非常有效。鉴于肾上腺素注射治疗简单、成本低且易于获得，它似乎是首选治疗方法。额外的Nd:YAG激光治疗可能在疗效上有轻微改善，尽管需要更大规模的试验来证实这一点。
