2022 年第 2 期 第 17 卷

抗栓治疗伴食管贲门黏膜撕裂综合征出血患者的特征和治疗策略

Characteristics and treatment strategies in patients of Mallory-Weiss syndrome bleeding with antithrombotic therapy

作者：王晓玥张杰孙亚梅郎海波高峰

英文作者：Wang Xiaoyue Zhang jie Sun Yamei Lang Haibo Gao Feng

单位：首都医科大学附属北京安贞医院消化内科，北京100029

英文单位：Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijng 100029 China

关键词：食管贲门黏膜撕裂综合征；抗栓治疗；消化道出血；内镜止血夹

英文关键词：Mallory-Weisssyndrome;Antithrombotictherapy;Gastrointestinalbleeding;Hemostaticclipping

• 摘要：

• 目的  探讨抗栓治疗伴食管贲门黏膜撕裂综合征（Mallory-Weiss综合征）出血患者独特的临床和内镜表现及治疗策略。方法  收集2017年1月至2021年6月在首都医科大学附属北京安贞医院进行胃镜检查并接受治疗的82例Mallory-Weiss综合征出血患者的临床资料进行回顾性分析。根据是否伴抗栓治疗分为抗栓治疗组（24例）和非抗栓治疗组（58例）。比较2组患者的Blatchford评分、撕裂的部位、长度及出血情况等资料，并对内镜下和保守治疗情况进行分析总结。结果  抗栓治疗组住院率和因病情严重入住重症监护病房比例、Blatchford评分≥7分比例高于非抗栓治疗组，差异均有统计学意义（均P<0.01）。2组内镜结果比较显示，抗栓治疗组更易累及食管和胃底，且撕裂长度>30 mm的患者更多（均P<0.05）。抗栓治疗组内镜下治疗、应用止血夹、局部喷洒凝血酶、质子泵抑制剂静脉泵入的比例高于非抗栓治疗组［79.2%（19/24）比37.9%（22/58）、75.0%（18/24）比29.3%（17/58）、75.0%（18/24）比37.9%（22/58）、79.2%（19/24）比17.2%（10/58）］，差异均有统计学意义（均P<0.01）。结论  伴抗栓治疗的Mallory-Weiss综合征患者病情更加危重，需要积极的内镜下和保守治疗，应用止血夹是首选的内镜治疗方法。

• Objective To investigate the unique clinical and endoscopic manifestations and treatment strategy  in patients of Mallory-Weiss syndrome bleeding with antithrombotic therapy. Methods The clinical data of 82 patients with Mallory-Weiss syndrome bleeding who underwent gastroscopy and received treatment in Beijing Anzhen Hospital, Capital Medical University from January 2017 to June 2021 were analyzed retrospectively. They were divided into antithrombotic treatment group(24 cases) and non-antithrombotic treatment group(58 cases) according to wether received antithrombotic treatment. The Blatchford score, and location, length and bleeding of tear in the two groups were compared. The endoscopic and conservative treatment were analyzed and summarized. Results In the antithrombotic treatment group, the hospitalization rate, the proportion of admission to intensive care unit due to serious condition and the proportion of Blatchford score ≥7 were significantly higher than those in the non-antithrombotic treatment group(all P<0.01). The comparison of endoscopy between the two groups showed that the antithrombotic treatment group was more likely to involve the esophagus and gastric fundus, and more patients with tear length >30 mm (all P<0.05). The proportions of endoscopic treatment, application of hemostatic clip, locally spraying thrombin and intravenous pumping proton pump inhibitor in the antithrombotic treatment group was higher than those in the non-antithrombotic treatment group［79.2%(19/24) vs 37.9%(22/58), 75.0%(18/24) vs 29.3%(17/58), 75.0%(18/24) vs 37.9%(22/58), 79.2%(19/24) vs 17.2%(10/58)］(all P<0.01). Conclusion Patients with Mallory-Weiss syndrome meanwhile treated with antithrombotics are severely ill, and are benefit from active endoscopic intervention and drug therapy. Hemostatic clipping is the preferred method for endoscopic treatment.