上消化道出血-21课件.pptVIP

The use of a metallic hemoclip as a mechanical method to prevent re-bleeding can be a good alternative for visible vessels. Left: A small vessel with an adherent clot seen at the GE junction in a patient presenting with hematemesis. Right: The lesion was coagulated with the heater probe with formation of a superficial iatrogenic ulcer thereafter. Ooze bleeding during the initial treatment with the heater probe of this angiodysplasia. Hemoclipping A Dieulafoy lesion on the anterior wall of the antrum with active bleeding Hemoclipping Sequential images demonstrating the hemoclipping technique in this case used to prevent further bleeding from a? post-polypectomy ulcer in the stomach. EIS EIS EVL 其他治疗 微波止血 激光止血 电凝止血 三腔二囊管压迫止血 适于食管胃底静脉曲张破裂出血。 解释工作 准备石蜡油、检查漏气、注气量、压力 压迫方法：先压胃囊，后压食管囊 放置24小时需放气15分钟，必要时再充气；如出血停止24小时可放气，如24小时内未再出血可拔管，放管最长不超过72小时 并发症：窒息、食管下段溃疡、肺部感染 Balloon tamponade modified Sengstakan-Blakemore tube: Immediate cessation of bleeding more than 85% of patients Widespread available Recurrent hemorrhage up to 50% after deflation A stopgap of definite treatment From Rikkers LF: Portal hypertension. In Goldsmith H [ed]: Practice of Surgery. Philadelphia, Harper Row, 1981, pp 1-37. 200ml 150ml 其他治疗 腹腔动脉造影（Therapeutic angiography） 检查同时进行治疗。 外科手术：内科保守治疗无效者(24小时以上)，急诊外科手术治疗。 病因治疗：针对前面所述的上消化道出血原因进行治疗。 介入治疗 严重消化道大出血,无法进行内镜治疗 不能耐受手术 选择性肠系膜动脉造影 进行血管栓塞治疗 Endoscopic variceal ligation After identifying the target varix, endoscopic suction is activated and the varix suctioned into the ligating cylinder to finally release the elastic ring. Active bleeding from a varix in the distal esophagus (left). The bleeding was stopped after rubber-band ligation (right). Superficial ulcerations appearing a few days after ligation therapy. Elastic rings still remaining in necrosed areas. Scarring of the esophagus as a result of endoscopic variceal treatment. A small remaining varix is seen on the lower right picture. Injection Sclerotherapy of Esophageal Varices At present, injection