APC治疗EST术后迟发性出血 .doc
http://www.100md.com
参见附件(21KB)。
APC治疗EST术后迟发性出血
刘明东 韩树堂
南京大学医学院附属鼓楼医院消化科
目的：回顾性分析和总结乳头切开术后出血的治疗方法。
方法：本文对我院2004年7月-2005年7月一年中出现的2例乳头切开术后迟发性出血的内镜治疗方法进行回顾性的分析和总结。
结果：2例患者均为男性，年龄在38和64岁，因胆总管结石行EST+取石。均有慢性肝损害病史，其中一例PT时间延长超过正常对照3秒，出血发生于EST术后5-7天，临床表现为黑便，出血量均超过1000ml。内镜表现为切开部位的周围组织渗血，2例均可见活动性出血。我们先给予局部注射1：1万肾上腺素止血治疗病在出血严重的部位上金属钛夹止血治疗。2例患者仍然有消化道出血，再次行内镜检查仍可见活动性出血，我们给予APC治疗，烧灼周围糜烂的组织，活动性出血停止，患者出院，达到满意的内镜下止血效果。
结论：对于EST术后迟发性出血的患者，由于出血原因并不是血管损伤而是组织的糜烂以及凝血机制障碍，出血部位较弥散，所以APC治疗是一种有效的止血方法。
APC Therapy for Delayed Bleeding after Endoscopic Sphincterotomy
Mingdong LiuShutang Han
Department of Gastroenterology, Affiliated Gulou Hospital of Medical School, Nanjing University
OBJECTIVES: To assess the management for delayed bleeding after endoscopic sphincterotomy (EST) restrospectively.
METHODS: Two cases of patients with delayed bleeding after EST from July 2004 to July 2005 were analyzed.
RESULTS: Two male patients, aging 38 and 64, were both diagnosed as common bile duct stones and complicated with chronic hepatic diseases. The prothrombin time (PT) of one patient was 3 seconds longer than normal control. EST was successfully performed and delayed bleeding occurred 5-7 days after the operation. The clinical manifestation was melena and the volume of bleeding were more than 1000ml. On endoscopy, active errhysis can be seen at the site of operation. After local injection with large amounts of epinephrine (1:10,000), hemoclips were placed. However, the symptoms of active bleeding persisted and massive errhysis was still detected on following endoscopy. Argon plasma coagulation (APC) was then performed to coagulate the erosive tissue surrounding the cut site and active bleeding was stopped in both cases.
CONCLUSIONS: In case of delayed bleeding after EST, APC therapy is an effective method to achieve hemostasis, since the causes of bleeding are tissue erosion and disturbances of blood coagulation rather than injury of blood vessel.
APC治疗EST术后迟发性出血
刘明东 韩树堂
南京大学医学院附属鼓楼医院消化科
目的：回顾性分析和总结乳头切开术后出血的治疗方法。
方法：本文对我院2004年7月-2005年7月一年中出现的2例乳头切开术后迟发性出血的内镜治疗方法进行回顾性的分析和总结。
结果：2例患者均为男性，年龄在38和64岁，因胆总管结石行EST+取石。均有慢性肝损害病史，其中一例PT时间延长超过正常对照3秒，出血发生于EST术后5-7天，临床表现为黑便，出血量均超过1000ml。内镜表现为切开部位的周围组织渗血，2例均可见活动性出血。我们先给予局部注射1：1万肾上腺素止血治疗病在出血严重的部位上金属钛夹止血治疗。2例患者仍然有消化道出血，再次行内镜检查仍可见活动性出血，我们给予APC治疗，烧灼周围糜烂的组织，活动性出血停止，患者出院，达到满意的内镜下止血效果。
结论：对于EST术后迟发性出血的患者，由于出血原因并不是血管损伤而是组织的糜烂以及凝血机制障碍，出血部位较弥散，所以APC治疗是一种有效的止血方法。
APC Therapy for Delayed Bleeding after Endoscopic Sphincterotomy
Mingdong LiuShutang Han
Department of Gastroenterology, Affiliated Gulou Hospital of Medical School, Nanjing University
OBJECTIVES: To assess the management for delayed bleeding after endoscopic sphincterotomy (EST) restrospectively.
METHODS: Two cases of patients with delayed bleeding after EST from July 2004 to July 2005 were analyzed.
RESULTS: Two male patients, aging 38 and 64, were both diagnosed as common bile duct stones and complicated with chronic hepatic diseases. The prothrombin time (PT) of one patient was 3 seconds longer than normal control. EST was successfully performed and delayed bleeding occurred 5-7 days after the operation. The clinical manifestation was melena and the volume of bleeding were more than 1000ml. On endoscopy, active errhysis can be seen at the site of operation. After local injection with large amounts of epinephrine (1:10,000), hemoclips were placed. However, the symptoms of active bleeding persisted and massive errhysis was still detected on following endoscopy. Argon plasma coagulation (APC) was then performed to coagulate the erosive tissue surrounding the cut site and active bleeding was stopped in both cases.
CONCLUSIONS: In case of delayed bleeding after EST, APC therapy is an effective method to achieve hemostasis, since the causes of bleeding are tissue erosion and disturbances of blood coagulation rather than injury of blood vessel.
相关资料1：
- 肝硬化门静脉高压食管胃静脉曲张出血的防治共识（2008，杭州）.PDF
- 尼莫地平治疗蛛网膜下腔出血30例疗效观察.pdf
- 老年人顽固性鼻出血的特点及处理.pdf
- 脉曲张性上消化道出血诊治指南(草案).pdf
- 微创经皮肾镜取石术后迟发出血原因及介入治疗.pdf
- 尼莫地平对高血压脑出血血肿体积和周围水肿带的影响.pdf
- 预防拔牙术后出血的体会.pdf
- 新生儿肺出血的诊断与治疗方案.pdf
- 钩虫病致消化道出血临床分析.pdf
- 功能失调性子宫出血的性激素治疗.pdf
- 2007_严重创伤出血的处理_欧洲指南(2).pdf
- 2007AHA“成人自发性脑出血治疗指南”全文.pdf
- 社区小儿鼻出血的中医治疗.pdf
- 国消化道出血诊疗新进展研讨会资料.pdf
- 脑出血诊疗指南.pdf