陈茂顺

[摘要] 目的 探究OTSC吻合夾治疗胃Dieulafoy病出血临床效果。 方法 从2015年9月—2018年2月随机选取在该院治疗胃Dieulafoy病的患者共60例，分为对照组和实验组、观察组，每组20例，对照组采用镜下注射肾上腺素，观察组采用钛夹治疗，实验组采用OTSC吻合夹治疗，分别观察3组患者第一次止血成功率、再次出血率、再次手术率、手术中出血量、住院时间、手术所需时间。 结果 实验组第一次止血成功率、再次出血率、再次手术率均优于观察组（100.00% vs 55.00%;5.00% vs 30.00%;5.00% vs 40.00%）;差异有统计学意义（χ2=10.14，P<0.05;χ2=4.32，P<0.05;χ2=7.02，P<0.05）实验组第一次止血成功率、再次出血率、再次手术率均优于对照组（100.00% vs 50.00%;5.00% vs 60.00%;5.00% vs 50.00%）（χ2=13.33，P<0.05;χ2=4.32，P<0.05;χ2=7.02，P<0.05）;实验组手手术中出血量、住院时间、手术所需时间少于对照组，差异有统计学意义（P<0.05）。 结论 与注射肾上腺素、钛夹治疗相比，OTSC吻合夹治疗胃Dieulafoy病不仅利于减少患者在手术中出血量、手术所需要时间、住院时间，更利于降低患者再次手术治疗率，该模式可作为内镜下治疗止血的首先方案，值得临床推广使用。

[关键词] OTSC吻合夹;钛夹;内镜下注射肾上腺素;胃Dieulafoy病;出血

[中图分类号] R573.2          [文献标识码] A          [文章编号] 1674-0742（2018）08（c）-0017-03

Evaluation of Bleeding Effect of Gastric Dieulafoy Disease Treated with OTSC Anastomotic Clip

CHEN Mao-shun

Department of Gastroenterology， the Third Hospital of Zhangzhou， Zhangzhou， Fujian Province， 363000 China

[Abstract] Objective To investigate the clinical effect of OTSC anastomosis clip for the treatment of gastric Dieulafoy's disease bleeding. Methods From September 2015 to February 2018， 60 patients with gastric Dieulafoy disease were randomly selected from the hospital. The patients were divided into control group， experimental group， and observation group， 20 in each group. The control group received subcutaneous injection of adrenal glands. The observation group was treated with titanium clips and the experimental group was treated with OTSC anastomotic clips. The first hemostasis success rate， rebleeding rate， reoperation rate， intraoperative blood loss， length of stay， and time required for surgery were observed in the three groups. Results The first hemostasis success rate， rebleeding rate and reoperation rate in the experimental group were better than those in the observation group （100.00% vs 55.00%; 5.00% vs 30.00%; 5.00% vs 40.00%）; the difference was statistically signficant （χ2= 10.14， P<0.05; χ2= 4.32， P<0.05; χ2= 7.02， P<0.05）， the first hemostatic success rate， rebleeding rate， and reoperation rate in the experimental group were all superior to those in the control group （100.00% vs 50.00%; 5.00% vs 60.00%; 5.00% vs 50.00%） （χ2=13.33， P<0.05; χ2=4.32， P<0.05; χ2=7.02， P<0.05）; The time required for hospitalization， hospitalization， and surgery was less than that in the control group. The difference was statistically signficant（P<0.05）. Conclusion Compared with the injection of epinephrine and titanium clips， OTSC anastomotic clamp for gastric Dieulafoy disease not only helps reduce the amount of blood loss during surgery， the time needed for surgery， and hospital stay， but also helps to reduce the rate of reoperation. This model can be used as Endoscopic treatment of hemostasis first program， which is worthy of clinical use.

[Key words] OTSC anastomosis clip; Titanium clip; Endoscopic injection of epinephrine; Gastric Dieulafoy disease; Bleeding

作为临床上引起消化道出血原因中最为少见的病因之一，胃Dieulafoy病又称为迪厄拉富瓦病，该疾病可以发生在肠胃道的任何部位，具有较高的致死率，临床发病特征为：反复发作性呕血、粪便呈柏油样、失血性休克等[1-3]。如若患者得不到及时救治，则会威胁到患者生命安全，甚至出现死亡。可见，给予合适的治疗方式是非常必要的。该研究从2015年9月—2018年2月随机选取在该院治疗胃Dieulafoy病的患者共60例作为该次探析的对象，现报道如下。

1  资料与方法

1.1  一般资料

随机选取在该院治疗胃Dieulafoy病的患者共60例，分为对照组和实验组、观察组，每组20例，对照组采用镜下注射肾上腺素，观察组采用钛夹治疗，实验组采用OTSC吻合夹治疗。全部患者均在知情并同意下实施探究。纳入标准：①黏膜损伤面积为3 mm，并且伴有喷射性出血和渗血;②病灶部位处于胃贲门小弯侧;③患者无其他严重性合并疾病。……