Wara P
Surgical-gastroenterological Department, Aarhus University Hospital, Denmark.
J Gastroenterol Hepatol. 1990;5 Suppl 1:22-31. doi: 10.1111/j.1440-1746.1990.tb01779.x.
Several endoscopic modalities have the potential of controlling major, life-threatening ulcer bleeding. Although none of the modalities has emerged to be more efficacious than the other, current evidence favours thermal methods and injection therapy. When successful, the endoscopic methods are equally safe (associated with a risk of perforation less than 2%), although a rebleeding rate of 10-30% is of concern. Endoscopic therapy is in general operator-dependent, and the experience of a team is probably more important than the choice of equipment. Selection of patients for endoscopic therapy should be based on the identification of high-risk patients who tolerate rebleeding or surgery poorly, and high-risk lesions likely to rebleed. Endoscopic therapy for ulcer bleeding is simply a new way of applying surgery. Realizing this, it is difficult to understand why therapeutic endoscopy for bleeding ulcer has not yet been widely adopted by surgeons.
几种内镜治疗方法有控制严重的、危及生命的溃疡出血的潜力。虽然没有一种方法被证明比其他方法更有效，但目前的证据支持热凝法和注射疗法。如果成功，内镜治疗方法同样安全（穿孔风险小于2%），不过10%-30%的再出血率令人担忧。内镜治疗总体上依赖操作者，团队的经验可能比设备的选择更重要。选择接受内镜治疗的患者应基于识别出难以耐受再出血或手术的高危患者，以及可能再出血的高危病变。溃疡出血的内镜治疗仅仅是一种实施手术的新方式。认识到这一点，就很难理解为什么外科医生尚未广泛采用治疗性内镜治疗出血性溃疡。
