内镜下黏膜注射联合金属钛夹与两者单用治疗溃疡病出血的临床对比研究

目的内镜下黏膜注射联合金属钛夹治疗溃疡出血和单纯黏膜注射及单纯钛夹止血进行疗效比较,为临床治疗溃疡出血寻找新方法。方法选取2011年6月-2013年6月公安县人民医院收治的非静脉曲张性溃疡病出血患者75例作为研究对象,将其按照数字随机表法分为三组:钛夹止血联合黏膜注射止血组25例、钛夹止血组25例和黏膜注射止血组25例,比较三组患者治疗后的即时止血率、再出血率、止血有效率、转外科手术率及并发症发生情况,总结钛夹止血联合黏膜注射止血的临床效果。结果三组患者的即时止血率分别为:联合止血组100%、钛夹止血组80.00%、黏膜注射组76.00%,三组即时止血率行χ2检验,单纯钛夹组和单纯黏膜组均明显低于联合治疗组,差异具有统计学意义(P0.05);单纯钛夹组和单纯黏膜治疗组比较,差异无统计学意义(P0.05)。三组患者72 h后再出血发生率分别为:联合止血组4.00%、钛夹止血组16.00%、黏膜注射组12.00%,三组72 h后再出血率行χ2检验,单纯钛夹组和单纯黏膜组均明显高于联合治疗组,差异具有统计学意义(P0.05)。单纯钛夹组和单纯黏膜治疗组比较,差异无统计学意义(P0.05)。联合组有效止血率达到96.00%,明显高于单纯钛夹止血组和单纯黏膜注射组,组间行χ2检验,联合治疗组明显高于单纯钛夹组和单纯黏膜注射液组,差异均具有统计学意义(P0.05);单纯钛夹组和单纯黏膜注射组比较,差异无统计学意义(P0.05)。外科手术发生率联合治疗组为4.00%,单纯钛夹组为16.00%,单纯黏膜注射组为20.00%,组间行χ2检验,联合治疗组明显低于单纯钛夹组和单纯黏膜注射液组,差异均具有统计学意义(P0.05);单纯钛夹组和单纯黏膜注射组比较,差异无统计学意义(P0.05)。结论内镜下金属钛夹止血联合黏膜注射止血治疗溃疡病出血较单纯钛夹止血和单纯黏膜注射止血的临床效果更优,且并发症发生率和单纯注射治疗及单纯钛夹治疗无明显差异,故该治疗方案作为治疗溃疡出血可进行更深入的研究,以规范治疗方法,稳定治疗效果。

Research on clinical comparison of endoscopic mucosa injection combined with hemoclip and single usage of them treating ulcer bleeding

Objective To compare the efficacy of endoscopic mucosa injection combined with hemoclip and single mucosa injection and single hemoclip for hemostasis,for providing a new method for clinical treating ulcer bleeding.Methods Seventy-five cases of non-variceal ulcer bleeding treated in the People＇s Hospital of Gong＇an from Jun.2011 to Jun.2013 were selected as research objects and divided into three groups randomly：the titanium clip combined with mucosa injection hemostasis group for 25 cases,titanium clip hemostasis group for 25 cases and mucosa injection hemostasis group for 25 cases.The immediate hemostatic rate,re-bleeding rate,effective rate of hemostasis,surgical operation rate and incidence rate of complications of three groups were compared.And the clinical effect of mucosa injection combined with hemoclip hemostasis was summarized.Results The immediate hemostatic rate of the combination hemostasis group was 100%,that of titanium clip hemostasis group was 80.00% and that of mucosa injection group was 76.00%.The immediate hemostatic rate of three groups received Х^2 test.The immediate hemostatic rate of single titanium clip group and single mucosa injection group was evidently lower than that of the combined treatment group,which had statistical significance （P 〈 0.05）.The difference between single titanium clip group and single mucosa injection group had no statistical significance （P 〉 0.05）.The re-bleeding rate 72 h after operation of the combination hemostasis group was 4.00%,that of titanium clip hemostasis group and mucosa injection group was 16.00%,12.00% respectively,and the re-bleeding received Х^2 test.The re-bleeding rate 72 h after operation of single titanium clip group and single mucosa injection group were evidently higher than that of the combined treatment group,which had statistical significance （P 〈 0.05）.The difference between single titanium clip group and single mucosa injection group had no statistical significance （P 〉 0.05）.The effective hemostatic rate of the combination group was 96.00%,which was evidently higher than that of the single titanium clip group and single mucosa injection group.The groups received Х^2 test.The combination group was evidently higher than the single titanium clip group and single mucosa injection group,which had statistical significance （P 〈 0.05）.The difference between single titanium clip group and single mucosa injection group had no statistical significance （P 〉 0.05）.The incidence rate of surgical operation of the combination treatment group was 4.00%,that of the single hemoclip group was 16.00% and that of the single mucosa injection group was 20.00%.Three groups received Х^2 test.The combination group was evidently lower than the single titanium clip group and single mucosa injection group,which had statistical significance （P 〈 0.05）.The difference between single titanium clip group and single mucosa injection group had no statistical significance （P 〉 0.05）.Conclusion The clinical effect of endoscopic mucosa injection combined with titanium clip treating ulcer bleeding was evidently better than single titanium clip and mucosa injection,and the incidence rate of complications had no evident difference from single treatment,so the treatment scheme can be studied deeply for specifying the treatment method and stabilizing treatment effect.