CAJ | 학술논문

目的：探讨术前使用质子泵抑制剂对胃部内镜黏膜下剥离术相关性出血的预防作用。方法148例患者按病灶大小（2 cm）随机分为术前用药组（n＝76）和对照组（n＝72）进行内镜黏膜下剥离术（ESD），术前用药组术前1 d口服泮托拉唑片40 mg，手术当天上午静滴泮托拉唑40 mg，下午行ESD，两组术后当天静滴泮托拉唑40 mg，第1至第3天早晚各静滴泮托拉唑40 mg，术后第4天改泮托拉唑口服40 mg/d，术后d1、d7、d28复查胃镜，并将溃疡进行Forrest分级，ESD术前、术后检测胃液pH值，并统计两组术中及术后延迟性出血的比例。结果术前用药组ESD时胃液pH值明显高于对照组（P＜0.05），而术后无差异；两组均未出现术中大量出血，术中少量出血术前用药组1例，对照组10例（P＜0.05）；在术后迟发性出血术前用药组4例，对照组3例（P＞0.05）；术后第1天复查胃镜 Forrest Ⅱa级溃疡术前用药组3例，对照组9例（P＜0.05），Forrest Ⅱb级溃疡术前用药组5例，对照组14例（P＜0.05）。结论术前使用质子泵抑制剂能减少胃部ESD术中出血，但并不能减少术后迟发性出血的发生。
목적：탐토술전사용질자빙억제제대위부내경점막하박리술상관성출혈적예방작용。방법148례환자안병조대소（2 cm）수궤분위술전용약조（n＝76）화대조조（n＝72）진행내경점막하박리술（ESD），술전용약조술전1 d구복반탁랍서편40 mg，수술당천상오정적반탁랍서40 mg，하오행ESD，량조술후당천정적반탁랍서40 mg，제1지제3천조만각정적반탁랍서40 mg，술후제4천개반탁랍서구복40 mg/d，술후d1、d7、d28복사위경，병장궤양진행Forrest분급，ESD술전、술후검측위액pH치，병통계량조술중급술후연지성출혈적비례。결과술전용약조ESD시위액pH치명현고우대조조（P＜0.05），이술후무차이；량조균미출현술중대량출혈，술중소량출혈술전용약조1례，대조조10례（P＜0.05）；재술후지발성출혈술전용약조4례，대조조3례（P＞0.05）；술후제1천복사위경 Forrest Ⅱa급궤양술전용약조3례，대조조9례（P＜0.05），Forrest Ⅱb급궤양술전용약조5례，대조조14례（P＜0.05）。결론술전사용질자빙억제제능감소위부ESD술중출혈，단병불능감소술후지발성출혈적발생。
Objective To evaluate the effect of starting proton pump inhibitor (PPI) treatment 1 day before endoscopic submucosal dissection (ESD) of gastric diseases to prevent bleeding related to the procedure. Methods After stratification by lesion size (i.e.≤2 cm or >2 cm), a total of 148 patients who underwent ESD were randomly assigned to the preoperative administration group(n=76) and control group (n=72). All patients received standard ESD. Patients in the preoperative group were administered lansoprazole from the day before ESD, and patients in the control group received lansoprazole after ESD. Follow-up endoscopy was performed on day 1, day 7, and day 28. Intragastric pH was measured from samples of gastric juice. The incidence of bleeding during and after ESD were counted. Results 75 of 76 patients in preoperative group and 71 of 72 in control group were analyzed. Intragastric pH at ESD in the control group was lower than that in the preoperative group (P<0.05). Bleeding during ESD occurred in one patient in preoperative group and 10 in the control group (P<0.05). Bleeding after ESD occurred in 4 in preoperative group and 3 in the control group(P>0.05). The frequency of typeⅡa andⅡb lesions on day 1 were significantly higher in the control group compared with the preoperative group(P<0.05). Conclusion Preoperative administration of PPI could prevent bleeding during ESD, but could not offer additional benefit over postoperative administration alone in the prevention of delayed bleeding after ESD.