Hajiro K, Matsui H, Tsujimura D, Yamamoto T
Gastroenterol Jpn. 1985 Feb;20(1):65-70. doi: 10.1007/BF02774675.
We have reviewed 50 cases of upper gastrointestinal bleeding treated by endoscopic bipolar electrocoagulation (BPEC) and assessed its value in the management of massive bleeding. Initial hemostasis was achieved in 94% of cases with an overall rebleeding rate of 19.1%. The rebleeding rate was high among patients requiring blood transfusions more than 2,000 ml (47.3%) and those with acute gastric mucosal lesion (AGML) (35.3%). In AGML one or two primary sites of bleeding can be effectively controlled initially, but rebleeding tends to occur from other sites. Mortality from the direct effects of bleeding was also high in massive bleeders (33.3%) and those with AGML (22.2%); the overall mortality, including deaths from ongoing underlying diseases, was 38%. Although BPEC failed to alter the fatal outcome of patients with massive acute mucosal bleeding, permanent or temporary hemostasis contributed to reducing the amount of blood transfusions, avoiding emergency operation, preventing rapid deterioration and prolonging the survival time. Endoscopic BPEC has proven to be an effective emergency hemostatic method in massive bleeding of the upper gastrointestinal tract as an alternative to surgical intervention.
我们回顾了50例采用内镜下双极电凝术（BPEC）治疗的上消化道出血病例，并评估了其在处理大量出血中的价值。94%的病例实现了初始止血，总体再出血率为19.1%。在需要输血超过2000毫升的患者（47.3%）和患有急性胃黏膜病变（AGML）的患者（35.3%）中，再出血率较高。在AGML患者中，一两个主要出血部位最初可得到有效控制，但其他部位容易再次出血。大出血患者（33.3%）和AGML患者（22.2%）因出血直接导致的死亡率也较高；包括因基础疾病持续发展导致的死亡在内，总体死亡率为38%。尽管BPEC未能改变急性黏膜大出血患者的致命结局，但永久性或临时性止血有助于减少输血量、避免急诊手术、防止病情迅速恶化并延长生存时间。内镜下BPEC已被证明是上消化道大出血有效的紧急止血方法，可替代手术干预。
