CAJ | 학술논문

目的：评估十二指肠乳头切开术（endoscopic sphincterotomy，EST）中出血的局部因素，评判不同内镜下止血方式对EST术中出血的止血疗效。方法：回顾性分析皖南医学院附属弋矶山医院2011年9月～2014年9月接受EST手术患者共1336例。回顾资料包括每例患者的十二指肠乳头类型及切开范围和是否出血，每例出血患者的内镜下止血方式及止血效果。评估不同十二指肠乳头类型及切开方式对术中出血发生的影响，评估拉式切开刀电凝止血、针状刀电凝止血、球囊压迫止血、钛夹止血的内镜下止血效果。计量资料采用t检验、分类资料χ2检验，有序的多组分类资料用秩和检验进行统计分析。结果：十二指肠乳头大切开312例，出血患者22例；十二指肠乳头中切开674例，出血患者37例；十二指肠乳头小切开350例，出血患者9例。三组之间出血发生率有显著差异（P＝0．026，χ2＝7．298）。正常乳头1063例，出血41例，憩室旁乳头273例，出血27例，两组之间出血率差异有显著差异（ P＝0．000，χ2＝16．366）。拉式切开刀止血34例，成功34例；针状刀止血19例，成功18例，1例转为血管介入手术；球囊压迫止血14例，成功12例，2例转为血管介入手术；钛夹止血1例，成功1例。结论：憩室旁乳头切开出血风险大于正常乳头切开风险，大切开和中切开的出血风险大于小切开风险。对不同的出血方式选择不同的内镜下止血方式可以有效地达到止血效果。
목적：평고십이지장유두절개술（endoscopic sphincterotomy，EST）중출혈적국부인소，평판불동내경하지혈방식대EST술중출혈적지혈료효。방법：회고성분석환남의학원부속익기산의원2011년9월～2014년9월접수EST수술환자공1336례。회고자료포괄매례환자적십이지장유두류형급절개범위화시부출혈，매례출혈환자적내경하지혈방식급지혈효과。평고불동십이지장유두류형급절개방식대술중출혈발생적영향，평고랍식절개도전응지혈、침상도전응지혈、구낭압박지혈、태협지혈적내경하지혈효과。계량자료채용t검험、분류자료χ2검험，유서적다조분류자료용질화검험진행통계분석。결과：십이지장유두대절개312례，출혈환자22례；십이지장유두중절개674례，출혈환자37례；십이지장유두소절개350례，출혈환자9례。삼조지간출혈발생솔유현저차이（P＝0．026，χ2＝7．298）。정상유두1063례，출혈41례，게실방유두273례，출혈27례，량조지간출혈솔차이유현저차이（ P＝0．000，χ2＝16．366）。랍식절개도지혈34례，성공34례；침상도지혈19례，성공18례，1례전위혈관개입수술；구낭압박지혈14례，성공12례，2례전위혈관개입수술；태협지혈1례，성공1례。결론：게실방유두절개출혈풍험대우정상유두절개풍험，대절개화중절개적출혈풍험대우소절개풍험。대불동적출혈방식선택불동적내경하지혈방식가이유효지체도지혈효과。
Objective:To investigate the local factors associated with hemorrhage in endoscopic sphincterotomy ( EST) the endoscopic strategies for man-agement of the bleeding.Methods: The clinical data were reviewed in 1 336 patients undergone EST in our hospital between September 2011 and 2014 concerning the lesion location of the duodenal papilla,level of incision,and presence or absence of hemorrhage in procedure as well as bleeding manage-ment strategy for individual case .All data were measured with t-test and χ2 test for evaluation of the effects on hemostasis .Results: Hemorrhage occurred in 22 of 312 by large cut,37 of 674 by medium cut,and 9 of 350 by small cut.Incidence of the hemorrhage was in 43 of 1 063 cases with normal duodenal papilla,and in 27 of 273 with involvement of duodenal papilla by the diverticulum,and the two groups were statistically different(P =0.000,χ2 =16.366).Hemostasis achieved in 34 cases by clever knife electrocoagulation therapy,18 of 19 by needle knife electrocoagulation therapy,12 of 14 by bal-loon compression therapy and 1 by clip therapy.Conclusion: Cut-through of the duodenal papilla by the diverticulum is associated with greater risk of bleeding in EST compared to cut of normal duodenal papilla ,and larger cut has more risks than the small cut .However,appropriate endoscopic strategy can lead to effective hemostasis.