Clinical Application And Analysis Of Endoscopic Gastric Cavity In The Treatment Of Acute Gastroduodenal Bleeding

Upper gastrointestinal bleeding is defined as more than 40% hours of >1000ml or >20% circulating blood volume in the digestive tract of flexor ligament over a short period of time.Gastric and duodenal bleeding accounted for 50-60%.Due to the limitations of the equipment,there are still about 5% of gastrointestinal bleeding is unknown.With drugs,endoscopic and interventional medicine treatment progress and standard,non operative therapy for most upper gastrointestinal bleeding is effective,but for some medical treatment is ineffective,especially the upper gastrointestinal hemorrhage reason is not clear,still a major problem in clinical.For upper gastrointestinal bleeding,if medical treatment actively,still unable to control symptoms,need surgical treatment,surgical treatment may be the last one with hope.With the rapid development of minimally invasive techniques,the application of laparoscopic surgery in gastrointestinal surgery is more and more widely.For patients with gastrointestinal bleeding,how to find the bleeding point as soon as possible to stop bleeding,how to reduce the surgical trauma,how to reduce postoperative complications,improve postoperative recovery.Many scholars have discussed the application of laparoscopic technique in these patients.Both the experimental study and clinical practice show that laparoscopic gastric surgery is feasible and can be used in clinical practice.But there are still many problems need to be further discussed.Objective: to investigate the feasibility and safety of endoscopic gastric cavity in the treatment of acute gastroduodenal bleeding.Methods: collected during 2012-2016 gastroduodenal bleeding 27 cases reviewed,which using the traditional method of treatment of gastrointestinal hemorrhage in 15 cases,male 13 cases,female 2 cases,aged 21-88 years;8 cases of duodenal bleeding,including 3 cases of vascular malformation,6 cases of gastric ulcer bleeding;bleeding in 7 cases,including 4 cases of gastric ulcer bleeding,2 cases of gastric malignant tumor(routine postoperative disease inspection results clearly)1 cases of Mallory Weiss syndrome.By using the research method of gastrointestinal bleeding in 12 cases,male 8 cases,female 4 cases,aged 23-68 years;4 cases of duodenal bleeding,including 2 cases of vascular malformation,2 cases of gastric ulcer bleeding;8 cases of hemorrhage in the gastric varices in 1 cases,3 cases of cardiac laceration syndrome.Stromal tumor vascular rupture in 1 cases,1 cases of gastric ulcer bleeding,gastric fundus blood vessel rupture and hemorrhage in 2 cases.This study used or built into the stomach endoscopic combined with gastroscopy and gastric cavity exploration of duodenal lesions treated in the stomach cavity,only 1-3 a 5mm hole in the wall of the stomach,the use of endoscopic equipment to complete the cavity flushing,revealed lesions,lesions and hemostasis operation,and the traditional method in operative time,postoperative time of indwelling gastric tube eating time,acid,medication use,postoperative analgesic use,hospitalization time and postoperative rebleeding were compared.Results: the laparoscopic group in the operation time,postoperative extubation time,postoperative eating time,acid medication use,hospitalization time were better than the open group,the difference was statistically significant(P<0.05,see table 4.2);the two groups in postoperative severe complications in the laparoscopic group is better than the open group,the difference was statistically significant(P=0.0001<0.05,see table 4.3.).The use of analgesic drugs were compared between the two groups in postoperative treatment,laparoscopic group than in open group,while the P=0.007<0.05 difference was statistically significant,but the need to consider the subjective factors of individual patients and the operation way is different,the further analysis of this area in future clinical further discussion and analysis.Conclusion: The method obviously reduces the operation damage of the patient,reduces the operation time,and the hemostatic effect is reliable.This technique,which combines diagnosis and treatment,has found a new method for the treatment of acute gastroduodenal hemorrhage.It is hopeful to be further popularized and applied.At present,the main problem is the clinical experience is still small,still need to be further explored and improved in clinical applications.