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目的 比较溃疡病合并非喷射性出血患者不同内镜征象者临床表现、内镜治疗效果及转归的差异。方法 参考Forrest分级将143 例患者分为3 组:单纯渗血(Ⅰb)、渗血伴血管裸露(Ⅰb+ Ⅱa)和渗血伴血凝块(Ⅰb+ Ⅱb)。所有患者均接受内镜药物喷洒治疗,未止血者继续予内镜下注射治疗,反复大出血者外科手术。结果 内镜喷洒的即时止血率为Ⅰb 50.0% ,Ⅰb+ Ⅱa 0.0% ,Ⅰb+ Ⅱb 25.4% ;注射的即刻止血率均为100.0% 。3种不同征象的患者治疗后的再出血率为15.0% ～23.5% ,差异无显著性意义;注射治疗的再出血率低于喷洒治疗(13.7% 与37.5% ,P< 0.01)。4.0%～9.0% 的病例需要手术治疗,各组之间手术率差异无显著性意义。结论 Ⅰb+ Ⅱa、Ⅰb+ Ⅱb 者临床表现较重。内镜下注射治疗的即时效果优于喷洒治疗,且再出血的发生率较低。经内镜成功治疗的患者,尤其是接受注射者再出血和手术率与内镜征象无关
Objective To compare the clinical manifestations, endoscopic treatment outcomes and outcome of different endoscopic signs in patients with ulcer disease and non-injecting hemorrhage. Methods According to Forrest classification, 143 patients were divided into 3 groups: simple bleeding (Ⅰb), bleeding with blood vessels (Ⅰb + Ⅱ a) and bleeding with blood clots (Ⅰb + Ⅱ b). All patients received endoscopic drug spraying treatment, without hemorrhage continued to endoscopic treatment, repeated bleeding surgery. Results The immediate hemostatic rate of endoscopic spraying was Ⅰ b 50.0%, Ⅰb + Ⅱ a 0.0%, Ⅰb + Ⅱ b 25.4%. The immediate rate of hemostasis was 100.0%. The rate of rebleeding was 15.0% ~ 23.5% after treatment in 3 different signs. The difference was not statistically significant. The rate of rebleeding after injection was lower than that of spraying treatment (13.7% vs 37.5%, P <0.01). 4.0% ~ 9.0% of the cases require surgical treatment, the difference between the operation rates was not significant. Conclusion The clinical manifestations of Ⅰb + Ⅱ a, Ⅰb + Ⅱ b are serious. The immediate effect of endoscopic injection is superior to spraying and the incidence of rebleeding is lower. Successful endoscopic treatment of patients, especially those who received the injection of rebleeding and surgical rates and endoscopic signs have nothing to do