Stallemo A, Bang C, Børkje B, Hausken T, Pedersen R, Odegaard S, Berstad A
Gastroenterologisk seksjon, Medisinsk avdeling, Haukeland sykehus, Bergen.
Tidsskr Nor Laegeforen. 1990 Feb 10;110(4):497-500.
Today, most upper GI-haemorrhages can be handled without surgery. We discuss the available endoscopic haemostatic methods. Injection therapy seems to be as effective as laser-, heater probe- and bipolar electrocoagulation, and is often preferred because the equipment is inexpensive. In a pilot study of 37 patients with haemorrhage from peptic ulcer (13 with active bleeding and 24 with stigmata of recent hemorrhage) we injected thrombin in the ulcer base and treated the patients systemically with an antifibrinolytic drug (tranexamic acid) for five days. Endoscopic follow-up revealed stigmata of recent haemorrhage in 23 patients on day 1 and in eight patients on day 5. "Blood in stomach" was seen in eight patients on day 1 and in two patients on day 5. Four patients had clinical signs of rebleeding, but only one of them needed operation (definite hemostasis 97%). There were no obvious side effects of the treatment. Contrary to other endoscopic methods, local injection of thrombin does not damage the normal mucosa. However, the method has not been sufficiently explored as yet, and cannot be recommended without strict control and follow-up measures. Early control endoscopy seems to be a sensitive way of monitoring haemostasis.
如今，大多数上消化道出血无需手术即可处理。我们讨论了现有的内镜止血方法。注射疗法似乎与激光、热探头和双极电凝疗法效果相当，且因其设备价格低廉而常被选用。在一项针对37例消化性溃疡出血患者（13例活动性出血，24例近期出血迹象）的初步研究中，我们在溃疡底部注射凝血酶，并对患者全身使用抗纤溶药物（氨甲环酸）治疗五天。内镜随访显示，第1天有23例患者存在近期出血迹象，第5天有8例。第1天有8例患者胃内见血，第5天有2例。4例患者有再出血的临床体征，但仅1例需要手术（确切止血率97%）。治疗未出现明显副作用。与其他内镜方法不同，局部注射凝血酶不会损伤正常黏膜。然而，该方法尚未得到充分探索，若无严格的控制和随访措施则不能推荐使用。早期控制性内镜检查似乎是监测止血情况的一种敏感方法。
