Guo Shi-Bin, Gong Ai-Xia, Leng Jing, Ma Jing, Ge Lin-Mei
Department of Gastroenterology, the Affiliated First Hospital of Dalian Medical University, Dalian 116001, Liaoning Province, China.
World J Gastroenterol. 2009 Sep 14;15(34):4322-6. doi: 10.3748/wjg.15.4322.
To investigate acute nonvariceal bleeding in the upper gastrointestinal (GI) tract and evaluate the effects of endoscopic hemoclipping.
Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated.
The 68 cases (male:female = 42:26, age from 9 to 70 years, average 54.4) presented with hematemesis in 26 cases (38.2%), melena in nine cases (13.3%), and both in 33 cases (48.5%). The causes of the bleeding included gastric ulcer (29 cases), duodenal ulcer (11 cases), Dieulafoy's lesion (11 cases), Mallory-Weiss syndrome (six cases), post-operative (three cases), post-polypectomy bleeding (five cases), and post-sphincterotomy bleeding (three cases); 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery (three cases had peptic ulcers, one had Dieulafoy's lesion, and two were caused by sphincterotomy); three patients died (two had Dieulafoy's lesion and one was caused by sphincterotomy); and one had recurrent bleeding with Dieulafoy's lesion 10 mo later, but in a different location.
Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.
探讨上消化道急性非静脉曲张性出血并评估内镜下止血夹治疗的效果。
对68例上消化道急性非静脉曲张性出血患者进行内镜下止血夹治疗。评估临床资料、内镜检查结果及治疗效果。
68例患者（男∶女 = 42∶26，年龄9至70岁，平均54.4岁）中，26例（38.2%）出现呕血，9例（13.3%）出现黑便，33例（48.5%）两者均有。出血原因包括胃溃疡（29例）、十二指肠溃疡（11例）、Dieulafoy病（11例）、马洛里-魏斯综合征（6例）、术后（3例）、息肉切除术后出血（5例）及括约肌切开术后出血（3例）；42例有活动性出血。平均使用止血夹数量为4个。59例通过应用止血夹实现永久性止血；6例需要急诊手术（3例为消化性溃疡，1例为Dieulafoy病，2例由括约肌切开术引起）；3例患者死亡（2例为Dieulafoy病，1例由括约肌切开术引起）；1例患者10个月后Dieulafoy病部位复发出血，但位置不同。
内镜下应用止血夹是治疗上消化道急性非静脉曲张性出血的一种有效且安全的方法，效果满意。
