内镜下组织胶注射联合钛夹治疗急性非静脉曲张性上消化道出血的止血效果观察

doi:10.3969/j.issn.1006-6233.2025.11.023

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摘要 目的: 探究内镜下组织胶注射联合钛夹治疗急性非静脉曲张性上消化道出血(ANVUGIB)的止血效果分析。方法: 将2023年1月至2024年2月间收治的ANVUGIB患者资料进行回顾性分析,根据治疗方法将其分为钛夹组(实施钛夹术治疗)与钛夹组织胶组(在钛夹组治疗方案基础上实施内镜下组织胶注射治疗),两组患者根据倾向性匹配评分法(卡钳值设置为0.02)排除基线资料混杂因素影响,最后两组各获得51例基线资料可比的患者,对比两组止血效果,引流变清,潜血转阴、呕血消失等症状改善时间,并发症,治疗前后血液指标[血红蛋白(Hb)、红细胞计数(RBC)及凝血酶原时间(PT)]及半年内再出血率。结果: 钛夹组织胶组72h止血成功率为96.08%,钛夹组为84.31%,两组比较差异有统计学意义(P<0.05);钛夹组织胶组患者引流变清、潜血转阴、呕血消失的症状改善时间均短于钛夹组,差异有统计学意义(P<0.05);钛夹组织胶组并发症发生率(5.88%)与钛夹组(13.73%)差异无统计学意义(P>0.05);术后,两组Hb与RBC均升高(P<0.05),PT下降,差异有统计学意义(P<0.05),且钛夹组织胶组手术前后各指标差值与钛夹组比较,差异有统计学意义(P<0.05);钛夹组织胶组半年内再出血率为1.96%,钛夹组为13.73%,两组比较差异有统计学意义(P<0.05)。结论: 内镜下组织胶注射联合钛夹术可有效治疗ANVUGIB,改善患者临床症状及血液指标,并发症少,再出血率低,安全有效,值得推广。

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关键词 ：急性非静脉曲张性上消化道出血, 组织胶注射, 钛夹术

Abstract：Objective: To explore the hemostatic effect of endoscopic tissue glue injection combined with titanium clip in treating acute non-variceal upper gastrointestinal hemorrhage (ANVUGIB). Methods: The data of patients with ANVUGIB from January 2023 to February 2024 were retrospectively analyzed, and the above patients were divided into titanium clip group (titanium clip therapy) and titanium clip tissue adhesive group (endoscopic tissue glue injection on the basis of the treatment regimen in titanium clip assembly) according to treatment methods. The two groups of patients were excluded from the influence of confounding factors of baseline data according to the propensity score matching method (caliper=0.02), and 51 patients with comparable baseline data were finally obtained in each group. The hemostatic effect, improvement times of symptoms such as drainage clearing, occult blood negative conversion and hematemesis disappearance, complications, blood indicators [hemoglobin (Hb), red blood cell count (RBC), prothrombin time (PT)] before and after treatment and re-hemorrhage within half a year were compared between the two groups. Results: The success rate of 72 h hemostasis was 96.08% in titanium clip tissue adhesive group and that in titanium clip group (84.31%), with a statistically significant difference (P<0.05). The improvement times of symptoms such as drainage clearing, occult blood negative conversion and hematemesis disappearance were shorter in titanium clip tissue adhesive group than those in titanium clip group, with statistically significant differences (P<0.05). There was no statistically significant difference in total incidence rate of complications between titanium clip tissue adhesive group (5.88%) and titanium clip group (13.73%) (P>0.05). After surgery, Hb and RBC were increased in both groups (P<0.05), and PT was reduced, the differences were statistically significant (P<0.05), and the differences of various indicators in titanium clip tissue adhesive group before and after surgery were statistically different than those in titanium clip group (P<0.05). The re-hemorrhage rate within half a year in titanium clip tissue adhesive group was 1.96% and that in titanium clip group was 13.73%, with a statistical difference (P<0.05). Conclusion: Endoscopic tissue glue injection combined with titanium clip can effectively treat ANVUGIB, and improve clinical symptoms and blood indicators of patients, and it has few complications and low re-hemorrhage rate, and it is safe and effective.

Key words： Acute upper gastrointestinal hemorrhage Tissue glue injection Titanium clip

基金资助:陕西省中医药管理局科技产业与发展处,(编号:2021-ZZ-LC030)

通讯作者: 李妮

引用本文:

段振刚, 荆玉洁, 卓王强, 魏静, 侯慧云, 李妮. 内镜下组织胶注射联合钛夹治疗急性非静脉曲张性上消化道出血的止血效果观察[J]. 河北医学, 2025, 31(11): 1896-1900.
DUAN Zhengang, JING Yujie, ZHUO Wangqiang, et al. Hemostatic Effect of Endoscopic Tissue Glue Injection Combined with Titanium Clip in the Treatment of Acute Non-Variceal Upper Gastrointestinal Hemorrhage. HeBei Med, 2025, 31(11): 1896-1900.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.11.023 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I11/1896

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