Heldwein W, Schreiner J, Pedrazzoli J, Lehnert P
Medizinische Klinik Innenstadt der Universität München, West-Germany.
Endoscopy. 1989 Nov;21(6):258-62. doi: 10.1055/s-2007-1010729.
A prospective controlled study was carried out to determine the validity of the Forrest classification in terms of improved laser therapy. Out of 153 consecutive patients with bleeding peptic ulcers, 137 patients--74 with arterial ulcer bleeding and 63 with non-arterial ulcer bleeding--were included in the trial. In arterial ulcer bleeding a significantly lower rate of permanent hemostasis was achieved, and the frequency of urgent surgery and mortality was higher than in non-arterial ulcer bleeding. Patients with spurting arterial bleeding (Forrest Ia) and those with large non-bleeding visible vessels (Forrest IIa) include almost all patients at risk of further bleeding and death. Combined laser therapy clearly minimizes the risk of rebleeding and death in small non-bleeding visible vessels (Forrest IIa). In contrast, decreased hemoglobin and a requirement for blood transfusion are of limited prospective value for the individual emergency patient. Overall, our results demonstrate that Forrest criteria are essential for proper planning of endoscopic therapy and urgent surgery in bleeding peptic ulcers. Emergency endoscopy must therefore be performed as early as possible.
开展了一项前瞻性对照研究，以确定福里斯特分类法在改进激光治疗方面的有效性。在153例连续性出血性消化性溃疡患者中，137例患者——74例动脉性溃疡出血患者和63例非动脉性溃疡出血患者——被纳入试验。在动脉性溃疡出血中，实现永久性止血的比率显著较低，紧急手术频率和死亡率高于非动脉性溃疡出血。喷射性动脉出血（福里斯特Ia级）患者和有大的非出血可见血管（福里斯特IIa级）患者几乎包括了所有有进一步出血和死亡风险的患者。联合激光治疗明显降低了小的非出血可见血管（福里斯特IIa级）再出血和死亡的风险。相比之下，血红蛋白降低和输血需求对个体急诊患者的前瞻性价值有限。总体而言，我们的结果表明，福里斯特标准对于出血性消化性溃疡内镜治疗和紧急手术的合理规划至关重要。因此，必须尽早进行急诊内镜检查。
