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目的分析比较内镜下金属夹与氩离子血浆凝固术(APC)对食管贲门黏膜撕裂综合征(MWS)的临床疗效。方法 48例MWS患者,随机分为金属夹组和APC组,每组24例。金属夹组采用内镜下金属夹治疗,APC组采用内镜下APC治疗,观察两组临床疗效。结果 1止血效果:金属夹组渗血15例、射血9例患者均成功止血,渗血、射血、总止血率均为100%。APC组16例渗血患者经治疗全部止血,8例射血患者中仅2例成功止血,其余6例需追加金属夹后才能止血,渗血止血率为100%、射血止血率为25%、总止血率为75%。金属夹组射血止血率及总止血率明显高于APC组,差异具有统计学意义(P<0.05);两组渗血止血率比较差异无统计学意义(P>0.05)。2并发症情况:两组术后均未见穿孔、发热等并发症发生。结论内镜下金属夹治疗MWS总体止血效果较内镜下APC好,其中对于渗血止血效果两者相当,而射血止血方面前者明显更好。
Objective To compare the clinical efficacy of endoscopic metal clip and argon plasma coagulation (APC) on esophageal and gastric cardia tear syndrome (MWS). Methods 48 patients with MWS were randomly divided into metal clamp group and APC group, 24 cases in each group. The metal clip group was treated with endoscopic metal clip, the APC group was treated with endoscopic APC, and the clinical curative effect was observed. Results 1 Hemostatic effect: In the metal clip group, 15 cases of bleeding and 9 cases of ejection were successfully hemostatic, bleeding, ejection, and total bleeding were 100%. In the APC group, 16 patients with hemostasis achieved hemostasis. Only 2 of 8 patients with hemorrhage succeeded in stopping bleeding, and the remaining 6 patients needed additional hemostasis. The bleeding rate was 100%, and the rate of hemostasis was 25% , The total hemostasis rate was 75%. The hemostatic rate and the total rate of hemostasis in the metal clip group were significantly higher than those in the APC group (P <0.05). There was no significant difference between the two groups in bleeding rate (P> 0.05). 2 complications: no postoperative perforation, fever and other complications occurred. Conclusion The endoscopic treatment of MWS is better than the endoscopic APC in the treatment of MWS, and the effect of hemostasis is similar to that of endoscopic bleeding, while the former is obviously better than the other.