Skok P
Maribor Teaching Hospital, Department of Gastroenterology and Endoscopy, Slovenia.
Hepatogastroenterology. 1997 May-Jun;44(15):861-5.
BACKGROUND/AIMS: Peptic ulcer hemorrhage is a common, worldwide problem and a major cause of morbidity and mortality. The aim of this study was to establish the percentage of patients with bleeding peptic ulcers who were treated surgically because endoscopy failed to stop the hemorrhage.
This retrospective analysis includes patients from our institution who underwent urgent endoscopic examination of the upper digestive tract and hemostatic interventions with injection therapy (sol. 1:10000 adrenaline and 1% polidocanol) between January, 1994 and November, 1995.
Two hundred thirty-three patients with bleeding peptic ulcers were examined: 111 with bleeding gastric ulcers (66 males, 45 females; average age 60.21 years, SD +/- 13.94; span 28-94 years) and 122 with bleeding duodenal ulcers (95 males, 27 females; average age 55.24 years, SD +/- 17.35; span 16-88 years). In all patients, injection sclerotherapy was performed. The ulcers were classified according to Forrest's classification of bleeding activity. In 10 patients (4.2%) with acute hemorrhage (6 males; average age 63.2 years, SD +/- 5.6; span 53-70 years: 4 females, average age 61.0 years, SD +/- 11.82; span 51-81 years), endoscopic hemostasis did not prove successful and they were treated operatively. In 5 cases, the cause of hemorrhage was a gastric ulcer and in 5 others, duodenal ulcer. During the postoperative period, 5 patients died of complications.
Endoscopic hemostasis has been a major therapeutic advancement in the management of peptic ulcer hemorrhage and has influenced surgical management. Injection sclerotherapy is a low cost, effective and safe procedure which is easy to implement in a variety of clinical settings. Early elective operation after initial endoscopic hemostasis is the wisest choice for elderly patients with co-existing disease and selected patients at high risk for recurrent bleeding.
背景/目的：消化性溃疡出血是一个常见的全球性问题，也是发病和死亡的主要原因。本研究的目的是确定因内镜检查未能止血而接受手术治疗的出血性消化性溃疡患者的比例。
这项回顾性分析纳入了1994年1月至1995年11月期间在我院接受上消化道紧急内镜检查并采用注射疗法（1:10000肾上腺素溶液和1%聚多卡醇）进行止血干预的患者。
对233例出血性消化性溃疡患者进行了检查：111例为出血性胃溃疡（男性66例，女性45例；平均年龄60.21岁，标准差±13.94；年龄范围28 - 94岁），122例为出血性十二指肠溃疡（男性95例，女性27例；平均年龄55.24岁，标准差±17.35；年龄范围16 - 88岁）。所有患者均接受了注射硬化治疗。溃疡根据福里斯特出血活动分类法进行分类。10例（4.2%）急性出血患者（男性6例；平均年龄63.2岁，标准差±5.6；年龄范围53 - 70岁：女性4例，平均年龄61.0岁，标准差±11.82；年龄范围51 - 81岁）内镜止血未成功，接受了手术治疗。其中5例出血原因是胃溃疡，另外5例是十二指肠溃疡。术后有5例患者死于并发症。
内镜止血是消化性溃疡出血治疗的一项重大进展，并影响了手术治疗。注射硬化治疗是一种低成本、有效且安全的方法，易于在各种临床环境中实施。对于有合并症的老年患者和部分有再出血高风险的患者，在内镜初次止血后早期进行择期手术是最明智的选择。
