Lin H J, Lee F Y, Kang W M, Tsai Y T, Lee S D, Lee C H
Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.
Gut. 1990 Jul;31(7):753-7. doi: 10.1136/gut.31.7.753.
We conducted a prospective randomised controlled trial of 137 patients with massive peptic ulcer haemorrhage over a period of 12 months to compare the haemostatic effects of endoscopic heat probe thermocoagulation and pure alcohol injection. Seventy eight patients (56.9%) were in shock at the time of randomisation to the trial. The age, sex, number of patients in shock, haemoglobin value at the time of entry to the trial, number of patients with severe medical illness, location of bleeders, and stigmata of recent haemorrhage were comparable among the heat probe, pure alcohol, and control groups. The initial haemostatic effect of the heat probe was better than that of the pure alcohol injection (44 of 45 v 31 of 46, p = 0.0004). The ultimate haemostasis achieved by the heat probe group (41 of 45) was better than that of the pure alcohol group (31 of 46, p = 0.012) and of controls (24 of 46, p = 0.0001). The duration of hospital stay was shorter for patients in the heat probe group than for the control group (6.2 days v 13.8 days, p less than 0.05). The incidence of emergency surgery was less for the heat probe than the control group (three of 45 v 12 of 46, p = 0.027). The mortality rate was less in the heat probe than in the control group (one of 45 v seven of 46, p = 0.031). We suggest that heat probe thermocoagulation should be the first treatment of choice for arrest of massive peptic ulcer haemorrhage.
我们进行了一项为期12个月的前瞻性随机对照试验，研究对象为137例大量消化性溃疡出血患者，以比较内镜热探头热凝术和纯酒精注射的止血效果。随机分组进入试验时，78例患者（56.9%）处于休克状态。热探头组、纯酒精组和对照组在年龄、性别、休克患者数量、进入试验时的血红蛋白值、患有严重内科疾病的患者数量、出血部位以及近期出血的征象方面具有可比性。热探头的初始止血效果优于纯酒精注射（45例中的44例对46例中的31例，p = 0.0004）。热探头组实现的最终止血效果（45例中的41例）优于纯酒精组（46例中的31例，p = 0.012）和对照组（46例中的24例，p = 0.0001）。热探头组患者的住院时间比对照组短（6.2天对13.8天，p < 0.05）。热探头组的急诊手术发生率低于对照组（45例中的3例对46例中的12例，p = 0.027）。热探头组的死亡率低于对照组（45例中的1例对46例中的7例，p = 0.031）。我们建议热探头热凝术应作为大量消化性溃疡出血止血的首选治疗方法。
