内镜治疗和介入治疗在非静脉曲张性血管源性消化道出血中治疗价值的回顾性分析

摘要

Background:Non-variceal vascular originated gastrointestinal bleeding has been attracted more and more attention in clinical practice. Because of the poor efficacy of conventional drug therapy and the high rebleeding rate,endoscopic therapy or interventional therapy have become the first choice. Aims:To investigate the therapeutic value of endoscopic therapy and interventional therapy in non-variceal vascular originated gastrointestinal bleeding. Methods:Retrospective analysis was performed in 77 patients with non-variceal vascular originated gastrointestinal bleeding who underwent endoscopic therapy or interventional therapy from January 2010 to May 2016 at Daping Hospital of the Third Military Medical University. The therapeutic efficacy of the two therapies was compared. Results:In 77 patients,48 patients received endoscopic therapy and 29 patients received interventional therapy. Compared with interventional therapy group, hemoglobin was significantly higher (P = 0. 007)and Blatchford score was significantly lower in endoscopic therapy group (P = 0. 021). Stomach lesion was found in 22 patients,25 in duodenum,18 in small intestine,9 in colon and 3 in rectum. Angiodysplasia lesion was found in 35 patients,ulcer combined with angiodysplasia in 26 patients,arterial rupture in 13 patients,and angiotelectasis in 3 patients. Rebleeding occurred in 7 patients underwent endoscopic therapy within 72 hours. No rebleeding was found in patients underwent interventional therapy,however,1 patients died from pulmonary embolism. Conclusions:Most patients with upper gastrointestinal angiodysplasia can benefit from endoscopic therapy. Surgery may be a better choice for those with more severe mucosal damage and rebleeding within 72 hours after treatment. Interventional treatment may be a first choice for those who have bleeding from small intestinal angiodysplasia,lower hemoglobin and a higher Blatchford score.%背景:非静脉曲张性血管源性消化道出血在临床上越来越引起广泛的重视,其常规药物的止血效果差,再出血率高,目前急诊内镜治疗或介入治疗已成为首选治疗措施.目的:评价内镜治疗和介入治疗在非静脉曲张性血管源性消化道出血中的治疗价值.方法:回顾性分析2010年1月—2016年5月第三军医大学大坪医院77例接受内镜治疗或介入治疗的非静脉曲张性血管源性消化道出血患者的临床资料,比较两种治疗方法对非静脉曲张性血管源性消化道出血的疗效.结果:77例患者中,48例接受内镜治疗,29例接受介入治疗.内镜治疗组血红蛋白水平显著高于介入治疗组(P=0.007),而Blatchford评分显著降低(P=0.021).病变部位分别为胃22例、十二指肠25例、小肠18例、结肠9例、直肠3例.病变性质分别为血管畸形35例、溃疡病变合并血管畸形26例、动脉血管破裂13例、毛细血管扩3例.7例患者接受内镜治疗后72 h内发生再出血,而接受介入治疗者均未发生再出血,但1例患者因肺栓塞而死亡.结论:大部分上消化道血管畸形患者可通过内镜治疗获益,而对于黏膜损伤较严重且治疗72 h内再出血者可能需接受外科手术干预.对于小肠血管畸形出血者、血红蛋白水平较低者、Blatchford评分较高者,介入治疗可作为首选治疗措施.