Incidence of Massive Rebleeding from Nonbleeding Visible Vessels in Benign Gastroduodenal Lesions and Prospective Study in Assessing the Efficacy of Endoscopic Hemostasis with Local Ethanol Injection

1987年2月至1988年2月，上消化道大量出血病人，於緊急內視鏡檢查時發現胃、十二指腸良性病灶上有“未出血之裸露血管”(Nonbleeding Visible Vessel )，計27例。非隨意的將其分為兩組，實驗組，17例接受經內視鏡純酒精局部注射，而對照組，10例則只接受一般內科治療。以期前膽性的評估：(1)在較嚴謹定義下，內視鏡所觀察到的“未出血之裸露血管”再大量出血之頻率，及(2)經內視鏡純酒精局部注射預防該病灶再出血之效果。結果顯示，對照組10例中9例 (99%)發生了再大量出血，而實驗組17例只有2例 (12%)發生 (p＜0.0002)。而純酒精局部注射亦減少了進一步輸血之需求。我們認為，上消化道大量出血之病人，緊急內視鏡檢查發現胃、十二指腸良性病灶上有“未出血之裸露血管”意味著相當高的再度大出血的可能性並將危及病人之性命，故需要某種型式之治療。經內視鏡純酒精局部注射則為一安全，有效之預防治療方式。

關鍵字

無資料

並列摘要

Twenty-seven patients presenting with massive upper gastrointestinal bleeding in whom endoscopy revealed nonbleeding visible vessels in benign gastroduodenal lesions were prospectively and nonrandomly allocated to receive endoscopic injection therapy with pure ethanol or conservative treatment. Those who received conservative therapy were used as a control group. The purpose of this study is to evaluate the incidence of massive rebleeding from the nonbleeding visible vessel which was defined by a more rigid criteria and to evaluate the efficacy of endoscopic pure ethanol local injection to prevent rebleeding. Nine out of the 10 (90%) controls had recurrent major bleeding, in contrast to the 2/17 (12%) of those who received hemostatic endoscopy (p＜0.0002). Pure ethanol local injections also minimized further transfusion requirements (p＜0.03). The complications of hemostatic endoscopy in this study are negligible. It is concluded that 1) by restrictive definition nonbleeding vissible vessels in benign gastroduodenal lesions carry a high potential of recurrent massive bleeding; 2) rebleeding can be safely and effectively prevented by pure ethanol local injection.

並列關鍵字

nonbleeding visible vessel ； rebleeding ； endoscopic hemostasis ； local pure ethanol injection

國際替代計量

Incidence of Massive Rebleeding from Nonbleeding Visible Vessels in Benign Gastroduodenal Lesions and Prospective Study in Assessing the Efficacy of Endoscopic Hemostasis with Local Ethanol Injection

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