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[目的]评价双联抗血小板药物(阿司匹林和氯吡格雷)服用者上消化道早癌及癌前病变内镜黏膜下剥离术(ESD)后,对创面喷洒医用组织胶预防迟发性出血的安全性及疗效。[方法]选取2015年1月~2016年10月在我院因上消化道早癌及癌前病变行ESD术,同时因合并心脑血管疾病而服用双联抗血小板药物的患者共17例,术前5d停用双联抗血小板药物,对ESD创面常规APC、止血钳及钛夹止血后,再喷洒医用胶,术后24h服用双联抗血小板药物,分析迟发性出血及心脑血管不良事件发生率。[结果]ESD术后72h、7d及30d内迟发性出血0例,无心脑血管不良事件发生。[结论]内镜下医用胶喷洒预防双联抗血小板治疗患者ESD术后迟发性出血疗效确切、操作简单、安全性高,尚需大样本前瞻性研究进一步证实。
[Objective] To evaluate the efficacy of endoscopic mucosal dissection (ESD) for upper gastrointestinal cancer and precancerous lesions in patients with dual antiplatelet drugs (aspirin and clopidogrel) Safety and efficacy. [Methods] From January 2015 to October 2016 in our hospital due to upper gastrointestinal precancerous lesions and precancerous lesions underwent ESD surgery, at the same time due to cardiovascular and cerebrovascular diseases and taking double antiplatelet drugs in a total of 17 patients, 5d preoperative anti-dual antiplatelet drugs discontinuation, the conventional APC ESD wound, hemostatic forceps and titanium clip to stop bleeding, and then spray medical adhesive, anti-platelet drugs after 24h double antiplatelet drugs, analysis of delayed bleeding and cardiovascular and cerebrovascular dysfunction Incident rate. [Results] There were 0 cases of delayed hemorrhage within 72h, 7d and 30d after ESD operation, and no cardiovascular and cerebrovascular adverse events occurred. [Conclusion] The application of endoscopic medical glue to prevent the double haemorrhage after ESD in patients with double antiplatelet therapy is simple, safe and easy to operate. It needs to be further confirmed by large sample prospective study.