内镜下联合治疗胃肠吻合术后24h内吻合口出血的探讨

目的：探讨内镜下联合治疗胃肠道术后24h内吻合口出血的疗效。方法：回顾性分析2010年1月-2014年4月在本院内镜中心接受内镜下联合治疗的胃肠吻合术后24h内吻合口出血的20例患者的临床资料。创面以渗血为主，吻合口情况较好时优先采用硬化剂＋电凝烧灼联合治疗；出血迅猛，动脉搏动性出血，表现为涌血，或吻合口组织水肿，采用硬化剂＋金属止血夹联合治疗。术后保留胃管，予止血、制酸等对症治疗。结果：内镜下止血即刻止血成功，立即止血成功率100％；无近期再出血病例，总有效率100％。结论：内镜下硬化剂注射＋高频电凝、硬化剂注射＋金属夹钳夹联合治疗胃肠吻合术24h内吻合口出血成功率高、并发率少、安全有效，应在临床上推广应用。

Study on Endoscopic Management of Gastrointestinal Anastomosis Postoperative 24 h Anastomotic Hemorrhage

Objective： To evaluate the efficacy of endoscopic sequential treatment for postoperative anastomotic hemorrhage during 24 hours. Method： 20 patients experienced an endoscopic combined treatment of postoperative anastomotic hemorrhage during 24 hours and were treated endoscopically from January 2010 to April 2014.The clinical data was analyzed retrospectively. For patients whose anastomotic tissues were in good condition and hemorrhage was not so much which show up as errhysis, it chose therapy of injection of hardening agent combined with electrocoagulation; for patients of massive haemorrhage and the anastomotic tissues were edema and brittle, it chose therapy of injection of hardening agent combined with endoscopic hemoclipping. After the surgery all patients were given hemostatic treatment and acid treatment as well as gastric canal retained. Result： Anastomotic hemorrhage were stopped immediately in all cases during endoscopic sequential treatment, the instant hemostasis rate was 100%. No patients had experienced rebleeding, the total effective rate was 100%.Conclusion： Endoscopic approach for the management of early postoperative anastomotic hemorrhage is a worthy of clinical reference technology with safe and effective, high success rate and associated with no complications.