[十二指肠镜治疗十二指肠憩室活动性出血的有效性和安全性：一项回顾性研究]

摘要(中文译文)

对2016年至2024年间9例初次胃镜下止血失败的十二指肠憩室活动性出血患者进行了回顾性分析。所有患者随后均接受了十二指肠镜下止血干预。主要结局为技术成功率和并发症发生率。次要结局包括所采用的内镜下止血技术、麻醉类型、血红蛋白水平变化以及是否需要补救性动脉栓塞或手术。十二指肠镜下止血的技术成功率为8/9。十二指肠镜下应用的止血方式包括钛夹夹闭、电凝联合钛夹置入、氩离子凝固术、止血粉喷洒、肾上腺素注射联合钛夹夹闭，以及肾上腺素注射联合电凝及钛夹置入。3例患者在静脉全身麻醉下接受手术，6例在清醒镇静下完成操作。1例患者在止血粉喷洒后出现持续性呕血和黑便，属于治疗失败；次日，该患者成功接受了介入放射学引导下的栓塞治疗。在成功治疗的病例中未发生操作相关并发症。8例技术性止血成功的患者术后血红蛋白水平均趋于稳定。对于初次胃镜下止血失败的十二指肠憩室活动性出血患者，十二指肠镜下止血是一种安全且有效的治疗方法。

Abstract

A retrospective analysis was conducted on nine patients with active duodenal diverticular bleeding for whom initial gastroscopic hemostasis had failed between 2016 and 2024. All patients subsequently underwent duodenoscopic hemostatic interventions. Primary outcomes were the technical success rate and complication rate. Secondary outcomes comprised the endoscopic hemostatic techniques employed, anesthesia type, changes in hemoglobin levels, and the need for salvage arterial embolization or surgery. The technical success rate for duodenoscopic hemostasis was 8/9. The hemostatic modalities applied under duodenoscopy included clip application, electrocoagulation combined with clip placement, argon plasma coagulation, hemostatic powder spray, epinephrine injection combined with clipping, and epinephrine injection combined with electrocoagulation and clip placement. Three patients underwent the procedure under intravenous general anesthesia, while six were managed under conscious sedation. One patient experienced persistent hematemesis and melena after hemostatic powder spray application, representing a treatment failure; the following day, the patient underwent successful interventional radiology-guided embolization. No procedure-related complications occurred in the successfully treated cases. Postoperative hemoglobin levels stabilized in all eight patients who achieved technically successful hemostasis. Duodenoscopic hemostasis represents a safe and effective therapeutic approach for patients with active duodenal diverticular hemorrhage for whom initial gastroscopic hemostasis has failed.

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