Pulanić R, Vucelić B, Rosandić M, Opacić M, Rustemović N, Krznarić Z, Brkić T, Jokić-Begić N
Department of Internal Medicine, University Hospital Rebro, Zagreb, Croatia.
Endoscopy. 1995 May;27(4):291-7. doi: 10.1055/s-2007-1005695.
The most widely used endoscopic procedures in the management of patients with bleeding peptic ulcer are at present sclerotherapy and thermal methods. In an attempt to assess the most effective method of achieving hemostasis, we compared injection sclerotherapy and laser photocoagulation in terms of the efficacy of initial hemostasis, rebleeding, need for surgery, mortality, and the appearance of the ulcer after the hemostatic procedure.
In this prospective, randomized trial, 160 patients were treated with injection sclerotherapy (1% polidocanol), and 155 patients with laser photocoagulation (Nd:YAG laser) in cases of Forrest I, Forrest IIa, and Forrest IIb hemorrhage. The bleeding activity was classified according to the modified Forrest criteria. Polidocanol injection and Nd:YAG laser photocoagulation were not preceded by epinephrine administration.
There were no significant overall differences between the groups in the outcome in terms of definitive hemostasis, rebleeding, urgent surgery, and death (p = 0.487). In the case of the subgroup with Forrest I lesions, laser photocoagulation was more efficacious than sclerotherapy (p = 0.0078). In the Forrest IIa and Forrest IIb subgroups, the two methods were equally effective (p = 0.202 and 0.513 respectively). In the sclerotherapy patients, definitive initial hemostasis in Forrest IIa was achieved in 100%, whereas in the laser group this rate was 92%, with 28% of patients initially developing hemorrhage after one or two laser pulses. Ulcer healing was slower following sclerotherapy than after photocoagulation.
Injection sclerotherapy and laser photocoagulation are equally effective in achieving definitive hemostasis in bleeding peptic ulcers. Laser photocoagulation is more efficacious in patients with active bleeding, whereas injection sclerotherapy is more effective in patients with a nonbleeding visible vessel.
目前，在消化性溃疡出血患者的治疗中，应用最广泛的内镜治疗方法是硬化疗法和热凝疗法。为了评估实现止血的最有效方法，我们比较了注射硬化疗法和激光光凝疗法在初始止血效果、再出血情况、手术需求、死亡率以及止血治疗后溃疡外观方面的差异。
在这项前瞻性随机试验中，160例 Forrest I、Forrest IIa 和 Forrest IIb 级出血的患者接受了注射硬化疗法（1%聚多卡醇）治疗，155例患者接受了激光光凝疗法（Nd:YAG 激光）治疗。出血活动度根据改良的 Forrest 标准进行分类。聚多卡醇注射和 Nd:YAG 激光光凝治疗前均未给予肾上腺素。
两组在确定性止血、再出血、急诊手术和死亡方面的总体结果无显著差异（p = 0.487）。在 Forrest I 级病变亚组中，激光光凝疗法比硬化疗法更有效（p = 0.0078）。在 Forrest IIa 和 Forrest IIb 亚组中，两种方法同样有效（分别为 p = 0.202 和 0.513）。在接受硬化疗法的患者中，Forrest IIa 级患者的确定性初始止血率为100%，而在激光治疗组中该率为92%，28%的患者在接受一或两个激光脉冲后最初出现出血。硬化疗法后溃疡愈合比光凝疗法后慢。
注射硬化疗法和激光光凝疗法在实现消化性溃疡出血的确定性止血方面同样有效。激光光凝疗法对活动性出血患者更有效，而注射硬化疗法对无出血可见血管的患者更有效。
