非静脉曲张导致的上消化道出血内镜下止血失败的原因分析
|
摘要
目的探讨非静脉曲张导致的上消化道出血内镜下止血失败的原因及治疗方案选择。方法选择2014年8月-2017年7月收治的3例内镜下止血失败的非静脉曲张导致的上消化道出血病例为研究对象,采用病史采集+临床诊疗过程及结局为分析点,归纳总结此类临床病例的特异性及治疗术式的选择,供临床医生参考。结果 3例非静脉曲张导致的上消化道出血患者,通过内镜下的积极治疗均再次出血,最后采用传统手术治疗取得良好结果。结论内镜下止血是目前治疗急性非静脉曲张性上消化道出血的最常见方法,但仍有部分患者疗效欠佳,临床医生应根据实际情况,对于年龄大、出血量大而迅速、凝血功能差、内科保守治疗+内镜止血无效的患者,仍应选择外科手术介入治疗,拯救患者生命。
引文
[1]DIRWEESH A,CHIKEZIE A,KHAN M Y,et al.Postural syncope and constipation:an unusual presentation of a duodenal Dieulafoy’s lesion[J].Case Rep Gastrointest Med,2017,2017:6983434.
[2]NOJKOV B,CAPPELL M S.Gastrointestinal bleeding from Dieulafoy’s lesion:clinical presentation,endoscopic findings,and endoscopic therapy[J].World J Gastrointest Endosc,2015,7(4):295-307.
[3]NGUYEN D C,JACKSON C S.The Dieulafoy’s lesion:an update on evaluation,diagnosis,and management[J].J Clin Gastroenterol,2015,49(7):541-549.
[4]HSU P I,LIN X Z,CHAN S H,et al.Bleeding peptic ulcer-risk factors for rebleeding and sequential changes in endcosopic findings[J].Gut,1994,35(6):746-749.
[5]CHOI C W,KANG D H,KIM H W,et al.Somatostatin adjunctive therapy for non-variceal upper gastrointestinal rebleeding after endoscopic therapy[J].World J Gastroenterol,2011,17(29):3441-3447.
[6]梁冬红,车筑平,许良璧.急性非静脉曲张性上消化道出血内镜下治疗失败的危险因素[J].世界华人消化杂志,2014,22(11):1547-1551.[6]LIANG D H,CHE Z P,XU L B.Risk factors associated with failure of endoscopic trerapy for acute non-variceal upper gastrointestinal bleeding[J].World Chinese Journal of Digestology,2014,22(11):1547-1551.Chinese
[7]杨建峰,张啸.内镜下十二指肠乳头括约肌切开并发出血的原因、处理及预防[J].中华消化内镜杂志,2008,25(7):386-388.[7]YANG J F,ZHANG X.The causes,management and prevention of duodenal sphincterotomy complicated with hemorrhage under endoscope[J].Chinese Journal of Digestive Endoscopy,2008,25(7):386-388.Chinese
[8]龚彪,王实,别里克,等.EST术后止血夹预防性止血的回顾性研究[J].中华消化内镜杂志,2006,23(3):183-185.[8]GONG B,WANG S,BIE L K,et al.Retrospective study on prophylactic hemostasis of postoperative hemostatic clip after EST[J].Chinese Journal of Digestive Endoscopy,2006,23(3):183-185.Chinese
[2]NOJKOV B,CAPPELL M S.Gastrointestinal bleeding from Dieulafoy’s lesion:clinical presentation,endoscopic findings,and endoscopic therapy[J].World J Gastrointest Endosc,2015,7(4):295-307.
[3]NGUYEN D C,JACKSON C S.The Dieulafoy’s lesion:an update on evaluation,diagnosis,and management[J].J Clin Gastroenterol,2015,49(7):541-549.
[4]HSU P I,LIN X Z,CHAN S H,et al.Bleeding peptic ulcer-risk factors for rebleeding and sequential changes in endcosopic findings[J].Gut,1994,35(6):746-749.
[5]CHOI C W,KANG D H,KIM H W,et al.Somatostatin adjunctive therapy for non-variceal upper gastrointestinal rebleeding after endoscopic therapy[J].World J Gastroenterol,2011,17(29):3441-3447.
[6]梁冬红,车筑平,许良璧.急性非静脉曲张性上消化道出血内镜下治疗失败的危险因素[J].世界华人消化杂志,2014,22(11):1547-1551.[6]LIANG D H,CHE Z P,XU L B.Risk factors associated with failure of endoscopic trerapy for acute non-variceal upper gastrointestinal bleeding[J].World Chinese Journal of Digestology,2014,22(11):1547-1551.Chinese
[7]杨建峰,张啸.内镜下十二指肠乳头括约肌切开并发出血的原因、处理及预防[J].中华消化内镜杂志,2008,25(7):386-388.[7]YANG J F,ZHANG X.The causes,management and prevention of duodenal sphincterotomy complicated with hemorrhage under endoscope[J].Chinese Journal of Digestive Endoscopy,2008,25(7):386-388.Chinese
[8]龚彪,王实,别里克,等.EST术后止血夹预防性止血的回顾性研究[J].中华消化内镜杂志,2006,23(3):183-185.[8]GONG B,WANG S,BIE L K,et al.Retrospective study on prophylactic hemostasis of postoperative hemostatic clip after EST[J].Chinese Journal of Digestive Endoscopy,2006,23(3):183-185.Chinese