Fullarton G M, Birnie G G, MacDonald A, Murray W R
University Department of Surgery, Western Infirmary, Glasgow.
Endoscopy. 1990 May;22(3):110-3. doi: 10.1055/s-2007-1012813.
The introduction of early endoscopic diagnosis has not been associated with a reduction in either surgical intervention or overall mortality for peptic ulcer hemorrhage. Recent studies have suggested that endoscopic therapy can reduce rebleeding rates from peptic ulceration. We report a 2-year experience of the influence of endoscopic heater probe (HP) (Olympus CD 10Z) therapy on the outcome of patients admitted with peptic ulcer hemorrhage. Eight hundred and sixty-two patients admitted with peptic ulcer hemorrhage over a 5-year period (1978/9 and 1983/5) before endoscopic therapy (PRE-HP), and 263 patients admitted with peptic ulcer hemorrhage after introduction of endoscopic therapy (POST-HP: 1986-1988) were assessed. All 1,125 patients were managed by a joint physician/surgeon team. The introduction of HP therapy was associated with a reduction in surgical intervention and overall mortality rates for gastric ulceration from 16% and 8.9% PRE-HP to 7% and 2.6% POST-HP respectively (p less than 0.05). A similar but non-significant trend was noted for duodenal ulceration. The beneficial effects of HP therapy appear to be due to a reduction in the need for surgical hemostasis in patients with an ulcer base visible vessel. Our results suggest that a more widespread use of endoscopic therapy may result in an improved outcome from peptic ulcer hemorrhage.
早期内镜诊断的引入与消化性溃疡出血的手术干预或总体死亡率的降低并无关联。近期研究表明，内镜治疗可降低消化性溃疡的再出血率。我们报告了一项为期两年的关于内镜热探头（HP）（奥林巴斯CD 10Z）治疗对消化性溃疡出血患者预后影响的经验。对1978/9年至1983/5年这5年期间在内镜治疗前（HP治疗前）因消化性溃疡出血入院的862例患者，以及在内镜治疗引入后（HP治疗后：1986 - 1988年）因消化性溃疡出血入院的263例患者进行了评估。所有1125例患者均由内科医生/外科医生联合团队进行管理。HP治疗的引入使胃溃疡的手术干预率和总体死亡率分别从HP治疗前的16%和8.9%降至HP治疗后的7%和2.6%（p < 0.05）。十二指肠溃疡也呈现出类似但无统计学意义的趋势。HP治疗的有益效果似乎是由于减少了溃疡底部可见血管患者的手术止血需求。我们的结果表明，更广泛地应用内镜治疗可能会改善消化性溃疡出血的预后。
