消化性溃疡经药物及内镜下止血失败患者的临床特点分析及介入治疗效果研究
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摘要
目的:探讨药物及内镜下止血失败患者的消化性溃疡特点及介入治疗效果。方法:收集本院2013年12月-2017年6月予药物及内镜止血失败,且内镜诊断为消化性溃疡,并进一步行DSA检查或治疗的患者48例,分析统计其内镜下特点及介入治疗效果。结果:药物及内镜止血失败的消化性溃疡以十二指肠球部、降部最为多见占58.33%,男性患者占70.83%,溃疡直(长)径>2.0 cm占22.91%。DSA检查发现出血征象阳性率为87.50%,进一步行栓塞止血治疗成功率为78.57%,手术成功率较高,患者痛苦较小。结论:消化性溃疡出血血管以胃十二指肠动脉出血最为多见。内镜下表现为巨大溃疡、溃疡合并裸露血管患者止血效果较差,应引起医师高度重视;患者经药物及内镜下止血失败,DSA检查及治疗在药物及内镜下止血失败后可选择的重要方法,发现出血血管阳性率较高,治疗效果较为肯定。
Objective:To investigate the characteristics and interventional treatment of peptic ulcer failed by drugs and endoscopy.Method:48 patients with peptic ulcer diagnosed by endoscopy who failed to stop bleeding by drugs and endoscopy in our hospital from December 2013 to June 2017 were collected and further examined or treated by DSA.Result:The most common peptic ulcer was duodenal bulb and descending part,accounting for58.33%,70.83% of the male patients,22.91% of the peptic ulcer had a diameter of more than 2.0 cm.DSA showed that the positive rate of hemorrhage sign was 87.50%,and the success rate of embolization and hemostasis was78.57%. The success rate of operation was higher,and the pain of patients was less.Conclusion:Bleeding from peptic ulcer is the most common bleeding from gastroduodenal artery. Endoscopic hemostasis in patients with large ulcers and ulcers complicated with bare blood vessels is not effective and should be highly valued by physicians.Patients with drug and endoscopic hemostasis failure,DSA examination and treatment in drug and endoscopic hemostasis failure can choose an important method,found that the positive rate of bleeding vessels is high,the treatment effect is more positive.
Objective:To investigate the characteristics and interventional treatment of peptic ulcer failed by drugs and endoscopy.Method:48 patients with peptic ulcer diagnosed by endoscopy who failed to stop bleeding by drugs and endoscopy in our hospital from December 2013 to June 2017 were collected and further examined or treated by DSA.Result:The most common peptic ulcer was duodenal bulb and descending part,accounting for58.33%,70.83% of the male patients,22.91% of the peptic ulcer had a diameter of more than 2.0 cm.DSA showed that the positive rate of hemorrhage sign was 87.50%,and the success rate of embolization and hemostasis was78.57%. The success rate of operation was higher,and the pain of patients was less.Conclusion:Bleeding from peptic ulcer is the most common bleeding from gastroduodenal artery. Endoscopic hemostasis in patients with large ulcers and ulcers complicated with bare blood vessels is not effective and should be highly valued by physicians.Patients with drug and endoscopic hemostasis failure,DSA examination and treatment in drug and endoscopic hemostasis failure can choose an important method,found that the positive rate of bleeding vessels is high,the treatment effect is more positive.
引文
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[3]钟英强.肠道溃疡性疾病[M].北京:人民卫生出版社,2009:145-163.
[4]李静宇.内镜下电凝与钛夹联合注射血凝酶治疗重症消化性溃疡出血的临床疗效分析[J].中国实用医刊,2017,44(6):37-39.
[5]中华消化杂志编委会.消化性溃疡病诊断与治疗规范建议[J].中华消化杂志,2008,28(7):447-450.
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[7]钟智,吴阿兰,杨丽霞,等.内镜下止血夹治疗消化性溃疡出血疗效观察[J].当代医学,2012,18(14):78-79.
[8]张佳莹,王晔,张静等.急性非静脉曲张性上消化道出血内镜治疗失败的危险因素分析[J].北京大学学报:医学版,2010,42(1):703-707.
[9]刘志伟.DSA诊断及介入治疗用于不明原因消化道出血的临床分析[J].现代预防医学,2014,39(9):2264-2268.
[10]王立国,庄丽维,汪丽燕,等.不明原因消化道出血的DSA和介入治疗[J].胃肠病学,2011,16(3)167-169.
[11]CheynelN,PeschaudF,HagryO,etal.Bleeding gastroduodenal ulcer:results of surgical management[J].Ann Chir,2001,126(29):232-235.
[12] Li J P,Tang G S,Huang Y H.Application of digital subtraction angiography and interventional treatment in gastrointestinal arterial hemorrhage[J].Zhonghua Weichang Waike Zazhi,2009,12(3):1524-1528.
[13]王吉耀,廖二元,黄从新,等.内科学[M].北京:人民卫生出版社,2010:566.
[14]王世鑫.消化性溃疡并发症的诊断与治疗[J].中华全科医师杂志,2005,4(10):22-25.
[15]丁善平.胃镜介入治疗消化性溃疡出血的疗效分析[J/OL].中西医结合心血管病电子杂志,2017,5(7):82-83.
[16]丁世华,郭海建,吴东海,等.不同剂量埃索美拉唑预防消化性溃疡并出血内镜止血后再出血的临床观察[J].实用药物与临床,2015,18(5):614-616.
[17]王海燕.无痛内镜下止血联合大剂量奥美拉唑治疗消化性溃疡出血的效果分析[J].中国农村卫生,2017(18):9-10.
[18]LoffroyRF,AbualsaudBA,LinMD,etal.Recent advances in en-dovascular techniques for management of acute nonvariceal upper gastrointestinal bleeding[J].World Journal of Gastrointestinal Surgery,2011,3(7):89-100.
[19]杨杰,欧艳,杨娟,等.重症消化性溃疡出血患者行内镜下电凝或钛夹联合注射康复新治疗的疗效评价[J].现代消化及介入诊疗,2017,22(1):65-67.
[20]赵华,赵亚静,卢英.不同剂量奥美拉唑联合内镜下止血夹治疗消化性溃疡伴出血患者的疗效对比分析[J].现代消化及介入诊疗,2017,22(3):395-397.
[2]郭宏卫.联用内镜下注射药物法和内镜下钛夹止血法治疗消化性溃疡出血的效果分析[J].当代医药论丛,2017,15(22):46-47.
[3]钟英强.肠道溃疡性疾病[M].北京:人民卫生出版社,2009:145-163.
[4]李静宇.内镜下电凝与钛夹联合注射血凝酶治疗重症消化性溃疡出血的临床疗效分析[J].中国实用医刊,2017,44(6):37-39.
[5]中华消化杂志编委会.消化性溃疡病诊断与治疗规范建议[J].中华消化杂志,2008,28(7):447-450.
[6]季锐,李延青.消化性溃疡病诊断与治疗规范建议(解读)[J].临床内科杂志,2014,31(8):575-576.
[7]钟智,吴阿兰,杨丽霞,等.内镜下止血夹治疗消化性溃疡出血疗效观察[J].当代医学,2012,18(14):78-79.
[8]张佳莹,王晔,张静等.急性非静脉曲张性上消化道出血内镜治疗失败的危险因素分析[J].北京大学学报:医学版,2010,42(1):703-707.
[9]刘志伟.DSA诊断及介入治疗用于不明原因消化道出血的临床分析[J].现代预防医学,2014,39(9):2264-2268.
[10]王立国,庄丽维,汪丽燕,等.不明原因消化道出血的DSA和介入治疗[J].胃肠病学,2011,16(3)167-169.
[11]CheynelN,PeschaudF,HagryO,etal.Bleeding gastroduodenal ulcer:results of surgical management[J].Ann Chir,2001,126(29):232-235.
[12] Li J P,Tang G S,Huang Y H.Application of digital subtraction angiography and interventional treatment in gastrointestinal arterial hemorrhage[J].Zhonghua Weichang Waike Zazhi,2009,12(3):1524-1528.
[13]王吉耀,廖二元,黄从新,等.内科学[M].北京:人民卫生出版社,2010:566.
[14]王世鑫.消化性溃疡并发症的诊断与治疗[J].中华全科医师杂志,2005,4(10):22-25.
[15]丁善平.胃镜介入治疗消化性溃疡出血的疗效分析[J/OL].中西医结合心血管病电子杂志,2017,5(7):82-83.
[16]丁世华,郭海建,吴东海,等.不同剂量埃索美拉唑预防消化性溃疡并出血内镜止血后再出血的临床观察[J].实用药物与临床,2015,18(5):614-616.
[17]王海燕.无痛内镜下止血联合大剂量奥美拉唑治疗消化性溃疡出血的效果分析[J].中国农村卫生,2017(18):9-10.
[18]LoffroyRF,AbualsaudBA,LinMD,etal.Recent advances in en-dovascular techniques for management of acute nonvariceal upper gastrointestinal bleeding[J].World Journal of Gastrointestinal Surgery,2011,3(7):89-100.
[19]杨杰,欧艳,杨娟,等.重症消化性溃疡出血患者行内镜下电凝或钛夹联合注射康复新治疗的疗效评价[J].现代消化及介入诊疗,2017,22(1):65-67.
[20]赵华,赵亚静,卢英.不同剂量奥美拉唑联合内镜下止血夹治疗消化性溃疡伴出血患者的疗效对比分析[J].现代消化及介入诊疗,2017,22(3):395-397.