【摘要】 目的 评价单钳道胃镜下钛夹牵引尼龙绳缝合法在治疗上消化道溃疡合并急性上消化道出血的可行性、有效性和安全性。方法 回顾性分析2020年4月至2022年4月广东省中医院消化内镜中心治疗的235例上消化道溃疡合并急性上消化道出血患者的临床资料。其中，钛夹牵引尼龙绳缝合法115例(观察组),钛夹直接夹闭溃疡面120例(对照组),比较两组患者溃疡面直径、禁食时间、迟发性出血、术后平均住院时间及外科手术率。结果 观察组溃疡面直径为(9.80±4.74)mm,对照组为(6.35±2.63)mm(Z=-6.868,P=0.01);观察组禁食时间为(46.33±36.74)h,对照组为(55.00±39.48)h(Z=-1.918,P=0.055);观察组迟发性出血为18例，对照组为23例(χ~2=0.504,P=0.478);观察组住院时长(6.97±4.46)d,对照组为(7.53±4.37)d(Z=-1.578,P=0.115);观察组再次内镜下止血4人次，对照组为10人次(χ~2=2.471,P=0.116);观察组内镜下止血治疗后失败进行外科手术均为0例(P<0.05);观察组和对照组均因胃镜下治疗出现粘膜损伤、出血、穿孔以及梗阻等不良事件。结论 单钳道胃镜下钛夹牵引尼龙绳缝合法治疗较大面积上消化道溃疡(直径10 mm左右)合并急性上消化道出血与钛夹直接缝合溃疡较小面积上消化道溃疡(直径6 mm左右)的疗效相当，在术后禁食时间、迟发性出血、平均住院时间及外科手术率无统计学差异(P<0.05),无不良反应发生，该法安全且有效，可广泛应用于临床。更多还原

【Abstract】 Objective To evaluate the feasibility, efficacy and safety of single-clamp endoscopic titanium clip traction nylon rope suture in the treatment of upper gastrointestinal ulcer complicated with acute upper gastrointestinal bleeding. Methods The clinical data of patients with upper gastrointestinal ulcer and acute upper gastrointestinal bleeding who were treated in the Gastrointestinal Endoscopy Center of Guangdong Provincial Hospital of Traditional Chinese Medicine from April 2020 to April 2022 were retrospectively analyzed. Among them, 115 cases of titanium clip traction nylon rope suture method(observation group), 120 cases of titanium clips directly clip the ulcer surface(control group), the ulcer surface diameter, fasting time, delayed bleeding, postoperative average were compared between the two groups Length of hospital stay and surgical rate. Results The diameter of the ulcer surface in the observation group was(9.80±4.74) mm, and that in the control group was(6.35±2.63) mm(Z=-6.868, P<0.01). The fasting time in the observation group was(46.33±36.74) h, and the control group was(46.33±36.74) h. was(55.00±39.48) h(Z=-1.918, P=0.055); 18 cases of delayed bleeding in the observation group and 23 cases in the control group( χ~2=0.504,P=0.478); the length of hospital stay in the observation group(6.97±4.46) d, the control group was(7.53±4.37) d(Z=-1.578, P=0.115); the observation group underwent endoscopic hemostasis for 4 times, and the control group for 10 times( χ~2=2.471,P=0.116); In the observation group, there were 0 patients who failed to undergo surgery after endoscopic hemostasis treatment(P<0.05);both the observation group and the control group suffered mucosal damage, bleeding, perforation and Obstruction and other adverse events. Conclusion The titanium clip traction nylon rope suture method under single-clamp gastroscope in the treatment of large area of upper gastrointestinal ulcer(about 10 mm in diameter) combined with acute upper gastrointestinal bleeding and the titanium clip directly sutures the ulcer with a small area of upper gastrointestinal ulcer(about 6 mm in diameter) was comparable in efficacy, and there was no significant difference in postoperative fasting time, delayed bleeding, average hospital stay and surgical operation rate(P<0.05), and no adverse reactions occurred. This method is safe and effective, and can be widely used in clinical practice.更多还原