Kim Young-Il, Choi Il Ju
Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
Clin Endosc. 2015 Mar;48(2):121-7. doi: 10.5946/ce.2015.48.2.121. Epub 2015 Mar 27.
Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated.
肿瘤出血在无法手术的胃癌患者中并非罕见的并发症。内镜检查在肿瘤出血的诊断和初始治疗中具有重要作用，这与其在其他非静脉曲张性上消化道出血病例中的作用相似。尽管相关研究有限，但内镜治疗在实现初始止血方面非常成功。一种或多种内镜治疗方式的组合，如注射治疗、机械治疗或消融治疗，可用于有近期出血内镜征象的患者止血。然而，内镜治疗成功止血后再出血经常发生。内镜治疗可能是成功控制这种再出血的一种治疗选择。当内镜治疗失败时，应考虑经动脉栓塞或姑息性手术。对于肿瘤出血的一级和二级预防，可开具质子泵抑制剂，尽管其预防出血的有效性仍有待研究。
