CAJ | 학술논문

目的探讨肝移植术后上消化道大出血患者急诊内镜治疗经验及疗效。方法回顾性分析2012年5月至2013年12月在中山大学附属第三医院消化内镜中心行急诊内镜治疗的3例肝移植术后上消化道大出血患者临床资料。3例患者均为男性，年龄分别为44、54、61岁，均出现不同程度的呕血、大量黑便和休克症状。所有患者均签署知情同意书，符合医学伦理学规定。术前给予禁食、补充血容量、心理疏导，准备内镜器械、药品及抢救物品。患者保持呼吸道通畅，术中医护人员默契配合，密切观察患者生命体征，保持内镜视野清晰，根据不同情况采用相应止血措施。待术后病情稳定后护送患者回病房，与病房医师、护士做好交接班工作。结果例1十二指肠球部上角对侧裸露血管活动性出血，采用止血夹止血，局部注射硬化剂。例2见食管静脉曲张破裂口活动性出血，COOK 套扎器套扎止血；胃底静脉重度曲张见出血点，注射组织胶止血。例1、例2止血成功。例3胃内大量血凝块及暗红血液，反复冲洗、吸引后仍无法观察，行出血动脉栓塞术，术后患者由于肺部感染、失血性休克、心功能不全死亡。结论肝移植术后上消化道大出血患者在行急诊内镜止血的过程中，应做好充分的术前准备，术中医护默契配合、密切观察病情、保持内镜视野清晰、采用合适的止血方法等以提高治疗效果。
목적탐토간이식술후상소화도대출혈환자급진내경치료경험급료효。방법회고성분석2012년5월지2013년12월재중산대학부속제삼의원소화내경중심행급진내경치료적3례간이식술후상소화도대출혈환자림상자료。3례환자균위남성，년령분별위44、54、61세，균출현불동정도적구혈、대량흑편화휴극증상。소유환자균첨서지정동의서，부합의학윤리학규정。술전급여금식、보충혈용량、심리소도，준비내경기계、약품급창구물품。환자보지호흡도통창，술중의호인원묵계배합，밀절관찰환자생명체정，보지내경시야청석，근거불동정황채용상응지혈조시。대술후병정은정후호송환자회병방，여병방의사、호사주호교접반공작。결과례1십이지장구부상각대측라로혈관활동성출혈，채용지혈협지혈，국부주사경화제。례2견식관정맥곡장파렬구활동성출혈，COOK 투찰기투찰지혈；위저정맥중도곡장견출혈점，주사조직효지혈。례1、례2지혈성공。례3위내대량혈응괴급암홍혈액，반복충세、흡인후잉무법관찰，행출혈동맥전새술，술후환자유우폐부감염、실혈성휴극、심공능불전사망。결론간이식술후상소화도대출혈환자재행급진내경지혈적과정중，응주호충분적술전준비，술중의호묵계배합、밀절관찰병정、보지내경시야청석、채용합괄적지혈방법등이제고치료효과。
Objective To investigate the experience and effect of emergency endoscopic treatment for massive upper gastrointestinal bleeding (UGB) of patients after liver transplantation. Methods Clinical data of 3 patients with massive UGB after liver transplantation receiving emergency endoscopic treatment in Digestive Endoscopy Center, the Third Affiliated Hospital of Sun Yat-sen University from May 2012 to December 2013 were analyzed retrospectively. All the patients were male with the age of 44, 54 and 61 years old, and all had symptoms of haematemesis, massive melena and shock to various degrees. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were prepared by fasting, supplementing blood volume, psychologically nursing before operation. And the endoscopic instruments, medicine and emergency rescue items were prepared. The patients were kept the airway clear, doctors and nurses well cooperated and the vital signs were closely observed. Clear endoscopic field was kept during the operation and appropriate hemostasis were performed according to different situations. The patients were sent back to bed- <br> ward after they were stable after the operation and were handed over to the attending physician meticulously. Results For case 1, hemostatic clips were used to stop the active bleeding from contralateral bare vessels on the horn of duodenal bulb and a local injection of sclerosing agent was given. For case 2, the COOK ligator was used to ligate the esophageal varices rupture to stop the active bleeding, and tissue glue was injected at the bleeding spots of severe gastric fundus varices. The bleedings in case 1 and 2 were stopped successfully. For case 3, the stomach was filled with masses of blood clots and dark red blood and still couldn't be visible after being repeatedly washed and drainage. Thus the patient was urgently transferred to undergo embolization of the bleeding artery. This patient died of pulmonary infection, hemorrhagic shock and cardiac insufficiency after the operation. Conclusions Preoperative preparation should be well made during the emergency endoscopic hemostasis in patients with massive UGB after liver transplantation, and well cooperation of doctors and nurses, close observation on patients' condition, clear endoscopic field, appropriate hemostasis are necessary for improving the outcome.