The value of endoscopic closed perforation suture in the treatment of patients with gastroduodenal ulcer hemorrhage / 中国医师进修杂志

ABSTRACT

Objective:To investigate the clinical value of endoscopic closed perforation suture in the treatment of patients with gastroduodenal ulcer hemorrhage.Methods:Eighty-five patients with gastroduodenal ulcer hemorrhage admitted to Wenshui County People′s Hospital of Shanxi Province from January 2018 to December 2019 were enrolled, and 30 patients received single forceps endoscopic closed perforation suture(observation group), and 55 patients received traditional open repair (control group). The clinical efficacy, perioperative indexes, postoperative complications, and the levels of stress reactive index serum epinephrine (E), norepinephrine (NE), cortisol (Cor) and the pyroptosis index NOD-like receptor pyrin domain 3(NLRP3), caspase-1, interleukin-18 (IL-18) and soluble vascular cell adhesion factor-1(sVCAM-1) before and after the operation were compared between the two groups. The patients were followed up for 18 months to compare the differences in Visick grading between the two groups.Results:The total effective rate in the observation group was higher than that in the control group: 96.67% (29/30) vs. 80.00% (44/55), there was statistical difference ( χ2 = 4.45, P<0.05). The amount of intraoperative blood loss, time of getting out of bed, time of eating and hospitalization in the observation group were less than those in the control group: (20.38 ± 5.39) ml vs. (63.98 ± 10.35) ml, (20.88 ± 4.27) h vs. (39.98 ± 5.81) h, (58.03 ± 10.34) h vs. (76.02 ± 14.27) h, (6.04 ± 1.21) d vs. (8.74 ± 2.05) d, there were statistical differences ( P<0.05). The levels of Cor, E , NE, NLRP3, caspase-1, IL-18 and sVCAM in the observation group after operation were lower than those in the control group: (54.73 ± 8.57) μg/L vs. (87.46 ± 10.53) μg/L, (25.15 ± 4.21) μg/L vs. (37.08 ± 5.17) μg/L, (29.38 ± 4.09) μg/L vs. (46.85 ± 6.26) μg/L, (6.53 ± 1.17) μg/L vs. (7.86 ± 1.23) μg/L, (15.35 ± 2.23) μg/L vs. (18.73 ± 2.54) μg/L, (239.32 ± 31.19) ng/L vs. (275.68 ± 36.07) ng/L, (24.97 ± 5.61) nmol/L vs. (33.61 ± 7.19) nmol/L, there were statistical differences ( P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group: 3.33%(1/30) vs. 20.00%(11/55), there was statistical difference ( χ2 = 4.45, P<0.05). After 18 months of follow-up, there was significant difference in Visick grading between the two groups ( P<0.05). Conclusions:The single forceps endoscopic closed perforation suture has significant efficacy in the treatment of patients with gastroduodenal ulcer hemorrhage, with little influence on the patient′s body, faster postoperative recovery, reduction of hospitalization time, better long-term efficacy, shorten recurrence rate of re-bleeding and postoperative complications, it is safe and efficiency.