【摘要】：目的分析結(jié)直腸病變腸鏡治療后延遲性出血的原因及再次腸鏡治療價(jià)值。方法回顧第三軍醫(yī)大學(xué)大坪醫(yī)院2010年1月至2016年12月收治的結(jié)直腸隆起性病變(息肉、腺瘤、早癌、脂肪瘤)腸鏡下給予氬氣刀凝固術(shù)、黏膜下切除術(shù)、黏膜下剝離術(shù)或尼龍繩套扎術(shù)治療后延遲出血的45例患者,針對(duì)其延遲性出血的病因,總結(jié)再次腸鏡治療的方式及臨床結(jié)局。結(jié)果腸鏡治療后延遲性出血的好發(fā)部位依次是直腸(28.89%),乙狀結(jié)腸(24.44%),升結(jié)腸(22.22%);腺瘤及上皮內(nèi)瘤變病灶更易發(fā)生(88.89%)。延遲性出血的形式主要為病灶切除處創(chuàng)面滲血,也可有血管涌血或噴血。本組延遲性出血腸鏡下治療方式主要是鈦夾夾閉和圈夾縫合,5例黏膜下注射1∶10 000腎上腺素及氬氣刀凝固術(shù)治療,35例氬氣刀凝固術(shù)合并鈦夾夾閉術(shù)治療,3例鈦夾夾閉治療,2例圈夾止血治療。42例一次性腸鏡止血成功,3例又出血,再次行腸鏡下治療,1例重新給予鈦夾夾閉及圈夾止血后出血停止,另2例轉(zhuǎn)外科行結(jié)腸切除術(shù)。本組43例延遲性出血患者均經(jīng)腸鏡下止血成功,痊愈出院。腸鏡治療后牢固的創(chuàng)面處理對(duì)預(yù)防延遲性出血十分重要,患者的基礎(chǔ)疾病及術(shù)后飲食管理也是延遲性出血的重要因素。結(jié)論對(duì)于腸鏡治療后延遲性出血患者及時(shí)再次進(jìn)行腸鏡檢查及有效治療,可取得滿意的臨床效果。
[Abstract]:Objective to analyze the causes of delayed bleeding after colonoscopy for colorectal lesions and the value of re-colonoscopy. Methods from January 2010 to December 2016, colorectal protuberance lesions (polyps, adenoma, early cancer, lipoma) were treated by argon coagulation and submucosal resection in Daping Hospital of the third military Medical University. Forty-five patients with delayed bleeding after submucosal dissection or nylon rope ligation were reviewed for the etiology of delayed hemorrhage and the clinical outcome of re-colonoscopy was summarized. Results the most common sites of delayed bleeding after endoscopy were rectum (28.89%), sigmoid colon (24.44%), ascending colon (22.22%), adenoma and intraepithelial neoplasia (88.89%). The main form of delayed hemorrhage is bleeding at the excision site of the lesion, and there may also be blood gushing or spurting blood. The main methods of endoscopic treatment for delayed hemorrhage were titanium clip clamping and ring suture combined with submucosal injection of 1:10 000 epinephrine and argon knife coagulation in 35 cases of argon knife coagulation combined with titanium clip closure in 3 cases of titanium. Two cases of clipping and hemostasis. 42 cases of one-time endoscopy hemostasis. 3 cases of bleeding. One case was retreated with titanium clip and the bleeding stopped after hemostasis by coil clamp. The other 2 cases were transferred to colectomy. All 43 cases of delayed hemorrhage were successfully hemostasis under enteroscopy and were cured and discharged. Solid wound management after endoscopy is very important to prevent delayed hemorrhage, and the basic diseases and postoperative diet management are also important factors for delayed hemorrhage. Conclusion for the patients with delayed hemorrhage after endoscopy, the clinical effect can be achieved by re-examination and effective treatment in time.
【作者單位】： 重慶市綦江區(qū)疾病預(yù)防控制中心;第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所消化內(nèi)科;
【分類號(hào)】：R574

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