日本消化性溃疡和人工溃疡出血的治疗现状和结果。
Current managements and outcomes of peptic and artificial ulcer bleeding in Japan.
机构信息
Department of Endoscopy and Endoscopic Surgery, The University of Tokyo, Tokyo, Japan.
出版信息
Dig Endosc. 2010 Jul;22 Suppl 1:S9-14. doi: 10.1111/j.1443-1661.2010.00961.x.
The recent trend of gastroduodenal ulcer bleeding in Japan has not been elucidated in detail and the data for a new categorized type, artificial ulcer bleeding, is completely lacking. The purpose of this paper is to elucidate current managements and outcomes of peptic and artificial ulcer bleeding in Japan. A retrospective multicenter study of consecutive case series was carried out during one year at nine departments of high-volume hospitals in Japan. The study included 325 consecutive patients (239 with peptic ulcers and 86 with artificial ulcers) with bleeding nonmalignant gastroduodenal ulcers that were revealed by emergency endoscopy between January 2008 and December 2008. Hemostasis was carried out mainly using endoscopic treatments. Rates of successful initial hemostasis, rebleeding, transfer to surgery, and death were recorded according to peptic and artificial ulcer bleeding. Additionally, preferred endoscopic methods, concomitant use of antisecretory drugs, and timing of second-look endoscopy were also measured. A total of 227 (99.1%) of 229 peptic ulcer patients with endoscopic treatment and all (100%) 84 artificial ulcer patients underwent successful tentative hemostasis. Rebleeding occurred in 23 peptic ulcer patients (10.1%) and 10 artificial ulcer patients (11.9%). One peptic ulcer patient and two artificial ulcer patients had final surgical rescue due to rebleeding. No death was observed. Monotherapy was predominant (around 65% of cases) in both types of ulcers. The coagulation forceps method was more frequently applied in artificial ulcers (P < 0.05). A per oral proton pump inhibitor was more frequently used in artificial ulcers (P < 0.05), although an intravenous proton pump inhibitor was used in the majority of patients in both types of ulcers. The frequency of second-look endoscopy in peptic ulcers (88%) was significantly higher than that in artificial ulcers (71%) (P < 0.05). There seemed to be no rule as to the timing of second-look endoscopy, although it was most frequently performed on the day after hemostasis. The recent outcomes of endoscopic treatment for nonmalignant gastroduodenal bleeding in Japan were excellent in both peptic and artificial ulcers with similar efficacies. Although they were minor findings, some differences in applied endoscopic methods, concomitant use of antisecretory drugs, and presence of second-look endoscopy were observed.
日本胃十二指肠溃疡出血的近期趋势尚未详细阐明,关于新型分类的人工溃疡出血的数据则完全缺失。本文旨在阐明日本目前对消化性和人工溃疡出血的处理方法和结局。这是一项在日本 9 家大容量医院的 9 个科室进行的为期 1 年的回顾性多中心连续病例系列研究。该研究纳入了 2008 年 1 月至 12 月期间通过急诊内镜检查发现的非恶性胃十二指肠出血的 325 例连续患者(239 例消化性溃疡和 86 例人工溃疡)。止血主要采用内镜治疗。根据消化性和人工溃疡出血的情况,记录初始止血成功、再出血、转手术和死亡的比例。此外,还测量了首选的内镜方法、同时使用抑酸药物以及再次内镜检查的时间。共有 229 例(99.1%)接受内镜治疗的 227 例消化性溃疡患者和所有(100%)84 例人工溃疡患者成功进行了初步止血。23 例消化性溃疡患者(10.1%)和 10 例人工溃疡患者(11.9%)发生再出血。由于再出血,1 例消化性溃疡患者和 2 例人工溃疡患者最终进行了手术抢救。没有死亡病例。单一药物治疗(约 65%的病例)在两种溃疡中都占主导地位。在人工溃疡中更常应用止血夹法(P<0.05)。质子泵抑制剂经口给药在人工溃疡中更常用(P<0.05),尽管两种溃疡类型的患者多数都使用了静脉质子泵抑制剂。消化性溃疡行再次内镜检查的频率(88%)明显高于人工溃疡(71%)(P<0.05)。虽然多数情况下在止血后第 1 天进行再次内镜检查,但再次内镜检查的时间似乎没有规律。日本近期对非恶性胃十二指肠出血的内镜治疗效果在消化性和人工溃疡中均非常好,疗效相似。尽管这是一些次要发现,但在应用的内镜方法、同时使用抑酸药物和再次内镜检查的存在方面还是观察到了一些差异。