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首页> 外文期刊>Surgical Endoscopy >Postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method for the prevention of delayed bleeding after ESD
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Postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method for the prevention of delayed bleeding after ESD

机译：术后采用凝血加动脉选择性钳夹（2C）方法进行联合治疗，以防止ESD后延迟出血

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Background: The incidence of delayed bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasms is reported to be approximately 5 %. We examined whether postprocedural combined treatment using the coagulation plus artery-selective clipping (2C) method is a useful measure for preventing delayed bleeding after ESD. Methods: A total of 234 gastric epithelial neoplasms were treated from June 2007 to May 2012. Post-ESD coagulation (PEC) and clipping for part of the vessels was performed for 154 lesions from June 2007 to June 2010. A total of 80 lesions were treated using the 2C method from July 2010 to May 2012. During ESD, the locations of the arteries were recorded on a schematic diagram of the lesion. Arteries were defined as regions of arterial bleeding that required coagulation or apparent arteries in which preventive coagulation was performed. When ESD was completed, soft coagulation was performed for arteries in the resection area using hemostatic forceps, followed by arterial clipping for additional strength. Coagulation also was performed continuously for visible vessels in the resection area. This was a retrospective study. The incidence rates of delayed bleeding after ESD, as evidenced by hematemesis or melena, or the presence of anemia (decline in Hb >2 g/dl) that required emergency endoscopy were recorded. Results: Delayed bleeding occurred in 7 (4.5 %) of the 154 cases treated using PEC and in 1 (1.3 %) of the 80 cases treated using the 2C method. The mean time required for the 2C method was 15.0 ± 7.0 min (range, 5-44 min). The mean number of clippings per lesion was 3.8 ± 2.8 (range, 0-13). Almost all clips fell off within 2 months of the procedure. Conclusions: Coagulation plus artery-selective clipping (the 2C method) of post-ESD ulcers might effectively reduce the incidence of delayed bleeding after ESD for gastric neoplasms.
机译：背景：据报道，胃肿瘤的内镜黏膜下剥离术（ESD）后延迟出血的发生率约为5％。我们检查了使用凝血加动脉选择性钳夹（2C）方法进行的术后综合治疗是否是预防ESD后延迟出血的有用措施。方法：自2007年6月至2012年5月，共治疗234例胃上皮肿瘤。从2007年6月至2010年6月，对154处病变进行了ESD凝固（PEC）和部分血管夹扎术，共80处病变。从2010年7月至2012年5月使用2C方法进行治疗。在ESD期间，将动脉位置记录在病变示意图上。动脉定义为需要凝结的动脉出血区域或进行预防性凝结的表观动脉。 ESD完成后，使用止血钳对切除区域的动脉进行软凝，然后进行动脉夹固以增加强度。还对切除区域中的可见血管连续进行凝血。这是一项回顾性研究。记录了ESD引起的延迟性出血的发生率，如呕血或黑便，或需要紧急内窥镜检查的贫血（Hb> 2 g / dl下降）的出现。结果：使用PEC治疗的154例病例中有7（4.5％）发生了延迟出血，使用2C方法治疗的80例病例中有1（1.3％）发生了出血。 2C方法所需的平均时间为15.0±7.0分钟（范围5-44分钟）。每个病变的平均修剪次数为3.8±2.8（范围为0-13）。手术后2个月内几乎所有夹子掉落。结论：ESD后溃疡的凝血加动脉选择性钳夹（2C方法）可有效降低胃肿瘤ESD术后延迟出血的发生率。

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