设为首页 | 加入收藏
| 欢迎光临本站!

我的博文

内镜黏膜下剥离术后短期内胃镜检查对防治迟发性出血的价值评价

(2014-10-22 12:24:03)

    【摘要】

    目的  探讨胃黏膜病变内镜黏膜下剥离术(ESD)后短期内再行胃镜检查在防治迟发性出血中的临床价值。

    方法  回顾性分析20115月至11月间,行ESD治疗的67例胃黏膜病变患者的临床资料,患者年龄3184岁,中位年龄63岁。所有患者术后第1天、第3天常规胃镜复查,观察有无创面迟发性出血,并给予适当处理及随访。

    结果  67例患者中,病变位于贲门5例、胃体6例、胃底3例、胃窦35例、胃角16例、残胃2例。病变最大直径2.07.0 cm,平均(3.73 ±1.24cmESD术中无大量出血和穿孔等并发症,术后9.0%6/67)的患者发生迟发性出血,5例发生在术后第3天,1例在术后第4天。迟发性出血者中Forrest分级Ⅰb 2例,Ⅱb 4例,均经内镜下成功止血。本组中迟发性出血的发生率远高于既往仅根据患者的临床表现判断迟发性出血所得的出血发生率,但从随访结果看,两者治疗效果及安全性相当。

    结论  ESD术后迟发性出血的实际发生率较高,但大多无临床症状,无严重不良后果,故可以不常规行ESD术后短期内胃镜检查,以减轻患者的痛苦和精神负担。

    【关键词】  内镜黏膜下剥离术;手术后并发症;手术后出血


     

    Post-ESD Endoscopy For prevention of delayed Bleeding

    ZHONG Yun-shi, SHI Qiang, YAO Li-qing, ZHOU Ping-hong, XU Mei-dong, REN Zhong, CHEN Tao. Endoscopy CenterZhongshan HospitalFudan UniversityShanghai200032China

    Corresponding authorYAO Li-qing,Email:yao.liqing@zs-hospital.sh.cn

    [Abstract] Objective   To evaluate a second endoscopy for prevention of delayed bleeding after ESD. Methods   Data of 67 patients with gastric epithelial neoplasms undergoing ESD from May to November 2011 were reviewed. The median age was 63 (3184) years. All patients were followed up by endoscopy on the first and the third day after ESD. Results   Of 67 lesions, 5 were located at cardia, 6 at gastric body, 3 at fundus, 35 at antrum, 16 at gastric angle, and 2 at residual stomach. The mean maximum diameter of the lesions was 3.73 ±1.242.07.0cm. There were no intraoperative complications. Post–ESD delayed bleeding was detected by endoscopy in 6 (9.0%) patients, with 5 on the third day and 1 on the fourth day. Forrest grading showed 2 cases of Ib, and 4 of IIb. All 6 cases were cured by endoscopy. The incidence of postoperative bleeding was far more than that evaluated based on the patients’ clinical manifestations only. But therapeutic effect and safety were the same according to the follow-up results. Conclusion   incidence of post-ESD bleeding is high, but there are no symptoms or severe consequences, so a second endoscopy after gastric ESD may contribute little to the prevention of delayed bleeding.

    [Key words] Endoscopic submucosal dissection;Postoperative complications;Postoperative hemorrhage

     

阅读(1741)评论(0)转载(0)收藏(0)
发布评论
用户名: 登录
全部评论
个人资料
    周平红 单位:复旦大学附属中山医院
    所属科室:消化科
    出生:1916-12-01
更多>>相册
更多>>推荐博文