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对比黏膜下注射止血与内镜下喷洒止血对合并肝硬化的肝外胆管结石患者行经内镜逆行胰胆管造影(ERCP)联合内镜下乳头括约肌切开术(EST)后出血的预防价值。选取2022年5月至2024年12月于衡水市第三人民医院就诊的154例合并肝硬化的肝外胆管结石患者作为研究对象，随机分为A组和B组。所有患者均接受全身麻醉下ERCP联合EST手术。A组和B组患者分别接受内镜下喷洒去甲肾上腺素盐水、黏膜下注射去甲肾上腺素盐水预防术后出血。比较两组患者一般资料、术后出血发生率及严重程度、术后出血再处理情况、术后其他并发症发生情况及死亡情况。154例患者中男性82例、女性72例，年龄38～64岁，中位年龄51岁，均完成ERCP联合EST治疗及术后随访。两组患者术后急性出血率、迟发性出血发生率、需输血治疗患者比例比较差异均无统计学意义(P>0.05);B组患者术后急性出血量、迟发性出血量、出血持续时间均低于A组患者(P<0.05)。两组术后出血再处理情况比较差异无统计学意义(χ2=1.257,P=0.869)。两组患者术后胰腺炎、感染发生率比较差异亦无统计学意义(χ2=0.362、0.107,P=0.548、0.744)；两组患者均未发生术后穿孔或死亡。黏膜下注射止血在减少肝硬化患者ERCP联合EST术后出血严重程度、提高术后出血患者再处理结局方面更具优势。
Abstract：[1]吴正东，徐刚，慕海峰，等.LC联合ERCP和EST治疗胆囊结石合并肝外胆管结石患者疗效研究[J].实用肝脏病杂志，2023,26(3):432-435. DOI:10.3969/j.issn.1672-5069.2023.03.033.
[2]张建锋，李智，杨帆，等.LCBDE-LC与ERCP/EST-LC对胆囊结石合并胆总管结石的疗效比较[J].中国现代普通外科进展，2018,21(3):198-201. DOI:10.3969/j.issn.1009-9905.2018.03.008.
[3]Kundumadam S, Phatharacharukul P, Reinhart K, et al. Bleeding after elective interventional endoscopic procedures in a large cohort of patients with cirrhosis[J]. Clin Transl Gastroenterol, 2020, 11(12):e00288. DOI:10.14309/ctg.0000000000000288.
[4]温暖，王正华，吴志伟，等.ERCP及EST术后迟发性出血的原因及防治[J].肝胆胰外科杂志，2020,32(1):56-58. DOI:10.11952/j.issn.1007-1954.2020.01.012.
[5]Li H, Zuo J, Wang W, et al. Efficacy of polysaccharide hemostatic powder on blood oozing among patients with postendoscopic sphincterotomy bleeding:a randomized controlled trial[J]. Am J Gastroenterol, Published online April 7, 2025. DOI:10.14309/ajg.0000000000003468.
[6]Chen R, Zhang Q, Hong S, et al. The clinical efficacy of"water-jet"hemostasis in gastrointestinal endoscopic submucosal dissection[J].Gastroenterol Rep(Oxf), 2024, 12:goae088. DOI:10.1093/gastro/goae088.
[7]Inoue S, Uedo N, Tabuchi T, et al. Usefulness of epinephrine-added injection solution to reduce procedure time for gastric endoscopic submucosal dissection[J]. Endosc Int Open, 2020, 8(8):E1044-E1051.DOI:10.1055/a-1192-4202.
[8]Maehara K, Esaki M, Sumida Y, et al. Comparison of hemostatic ability between spray coagulation and forced coagulation modes in endoscopic submucosal dissection in patients with early gastric neoplasms:a study protocol for multicenter randomized controlled trial(Spray-G trial)[J]. Trials, 2024, 25(1):53. DOI:10.1186/s13063-023-07852-6.
[9]Ito S, Nagasaka K, Komatsu H, et al. Improved hydration property of tissue adhesive/hemostatic microparticle based on hydrophobicallymodified Alaska pollock gelatin[J]. Biomater Adv, 2024, 159:213834. DOI:10.1016/j.bioadv.2024.213834.
[10]Katta N, Santos D, McElroy AB, et al. Laser coagulation and hemostasis of large diameter blood vessels:effect of shear stress and flow velocity[J]. Sci Rep, 2022, 12(1):8375. DOI:10.1038/s41598-022-12128-1.
[11]Esaki M, Sumida Y, Maehara K, et al. Spray and forced coagulation mode endoscopic submucosal dissection for early gastric neoplasms:a multicenter randomized controlled trial[J]. Am J Gastroenterol,Published online February 12, 2025. DOI:10.14309/ajg.0000000000003360.
[12]Chiang HC, Chen PJ, Yang EH, et al. Precise application of topical tranexamic acid to enhance endoscopic hemostasis for peptic ulcer bleeding:a randomized controlled study(with video)[J]. Gastrointest Endosc, 2023, 98(5):755-764. DOI:10.1016/j.gie.2023.06.013.
[13]Crăciun R, GrapăC, Mocan T, et al. The bleeding edge:Managing coagulation and bleeding risk in patients with cirrhosis undergoing interventional procedures[J]. Diagnostics(Basel), 2024, 14(22):2602. DOI:10.3390/diagnostics14222602.
[14]Inoue S, Uedo N, Tabuchi T, et al. Usefulness of epinephrine-added injection solution to reduce procedure time for gastric endoscopic submucosal dissection[J]. Endosc Int Open, 2020, 8(8):E1044-E1051. DOI:10.1055/a-1192-4202.
[15]Lee KJ, Lee TH, Cho JH, et al. Efficacy analysis of hemostatic spray following endoscopic papillectomy:A multicenter comparative study[J]. J Gastroenterol Hepatol, 2022, 37(11):2138-2144. DOI:10.1111/jgh.16004.
[16]Pecha RL, Ayoub F, Patel A, et al. Outcomes of endoscopic submucosal dissection in cirrhotic patients:First American cohort[J].World J Hepatol, 2024, 16(5):784-790. DOI:10.4254/wjh. v16.i5.784.
[17]Martines G, Picciariello A, Dibra R, et al. Efficacy of cyanoacrylate in the prevention of delayed bleeding after endoscopic mucosal resection of large colorectal polyps:a pilot study[J]. Int J Colorectal Dis, 2020, 35(11):2141-2144. DOI:10.1007/s00384-020-03678-9.
[18]Simonnot M, Deprez PH, Pioche M, et al. Endoscopic resection of early esophageal tumors in patients with cirrhosis or portal hypertension:a multicenter observational study[J]. Endoscopy, 2023, 55(9):785-795. DOI:10.1055/a-2085-3964.
[19]Tandan M, Pal P, Jagtap N, et al. Endoscopic interventions in pancreatic strictures and stones-A structured approach[J]. Indian J Gastroenterol, Published online August 15, 2024. DOI:10.1007/s12664-024-01644-9.
[20]Gao DJ, Wang SP, Fu XH, et al. Urgent endoscopy improves hemostasis in patients with upper gastrointestinal bleeding following biliary-pancreatic surgery:a retrospective analysis[J]. Surg Laparosc Endosc Percutan Tech, 2021, 32(2):228-235. DOI:10.1097/SLE.0000000000001027.
基本信息:
中图分类号:R657.4;R575.2
引用信息:
[1]张世喆,彭志敏,何国维,等.黏膜下注射止血与内镜下喷洒止血对肝硬化患者ERCP联合EST术后出血的预防价值比较[J].中国现代普通外科进展,2026,29(06):484-488.
基金信息:
河北省卫生健康委员会医学科学研究课题计划项目（20251592）
2026-06-15
2026-06-15