特集名 | 内視鏡の偶発症とその対策 | |
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題名 | 内視鏡的止血の失敗と対策 | |
発刊年月 | 2002年 07月 | |
著者 | 田辺 聡 | 北里大学東病院消化器内科 |
著者 | 北村 匡 | 北里大学東病院消化器内科 |
著者 | 前澤 寧 | 北里大学東病院消化器内科 |
著者 | 樋口 勝彦 | 北里大学東病院消化器内科 |
著者 | 佐々木 徹 | 北里大学東病院消化器内科 |
著者 | 中山 昇典 | 北里大学東病院消化器内科 |
著者 | 今泉 弘 | 北里大学東病院消化器内科 |
著者 | 小泉 和三郎 | 北里大学東病院消化器内科 |
著者 | 西元寺 克禮 | 北里大学東病院消化器内科 |
著者 | 佐々木 真弓 | 北里大学東病院放射線科 |
【 要旨 】 | 出血性潰瘍に対する内視鏡的止血法は広く普及し,その止血成績も向上している.しかし,少数例ではあるが重度ショック状態や止血困難例が存在し,内視鏡医の判断が重要となる.止血不能となった要因として,潰瘍の性状では巨大露出血管,穿通性潰瘍,球後部潰瘍が,全身的因子では重篤基礎疾患の合併が挙げられた.また,初回止血やsecond lookの不徹底も重要な要素と考えられた.ショック状態のため内視鏡検査が施行不能な場合には,外科的治療に至るまでのone stepとしてinterventional radiology(IVR)は有用な方法である.内視鏡治療の限界を把握し,外科医や放射線科医と連携し集学的な治療を行うことが救命につながると考えられる. |
Theme | Complications and their Managements for Gastrointestinal Endoscopy | |
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Title | Management of Unsuccessful Endoscopic Hemostasis | |
Author | Satoshi Tanabe | Department of Gastroenterology, Kitasato University East Hospital |
Author | Tadashi Kitamura | Department of Gastroenterology, Kitasato University East Hospital |
Author | Yasushi Maesawa | Department of Gastroenterology, Kitasato University East Hospital |
Author | Katsuhiko Higuchi | Department of Gastroenterology, Kitasato University East Hospital |
Author | Toru Sasaki | Department of Gastroenterology, Kitasato University East Hospital |
Author | Norisuke Nakayama | Department of Gastroenterology, Kitasato University East Hospital |
Author | Hiroshi Imaizumi | Department of Gastroenterology, Kitasato University East Hospital |
Author | Wasaburo Koizumi | Department of Gastroenterology, Kitasato University East Hospital |
Author | Katsunori Saigenji | Department of Gastroenterology, Kitasato University East Hospital |
Author | Mayumi Sasaki | Department of Radiology, Kitasato University East Hospital |
[ Summary ] | Endoscopic hemostasis is widely used for upper gastrointestinal bleeding. Owing to advance in endoscopic hemostasis, many cases of upper gastrointestinal bleeding can now be managed with conservative therapy, but some critical cases still require surgical treatment. Several different techniques for endoscopic hemostasis can be applied. The mechanism of hemostasis by injection of pure ethanol is chemical coagulation, that of the heater probe is electrocoagulation. It is important to underatand the mechanism and characteristics of each method and perform endoscopic hemostasis carefully. The limitations of endoscopic hemostasis in the management of bleeding ulcers were investigated. The characteristics of patients with uncontrolled bleeding were ulcer with large visible vessels and severe concomitant disease. Endoscopic hemostatic therapy was of limited value in patients with severe shock. Recognizing such limitations in time, and thus switching over to IVR or the surgical approach, is important. |