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.[26,28]

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- (A.S.G.E. = American Society of Gastro inte stinal Endo -sco py, S.A.G.E.S. = Sosiety of Ame rican Gastro inte sti nalEndoscopic Surgeons)[26,29] ( 5). - - - 50-75, 50, 15, 15, E.R.C.P. 35-50.[11]

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13 1

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- - .[33]

- , - .[9]

1. Dent LT, Arbor A. The surgeon and fiberoptic endoscopy. SurgGynecol Obstet, 137:278, 1973.

2. Hirschowitz B. Development and application of endo scopy.

14

Gastroenterology, 104:337-342, 1993.3. Manegold BC. Editorial. Surg Endosc, 1:1, 1987.4. Moody GF. Surgical Gastroenterology; Problems and solutions.

Am J Surg, 145:2-5, 1983.5. Donahue P, Sugitani A. Gastrointestinal endoscopy and general

surgical practice. Gastrointest Endosc, 5:330-333, 1991.6. . . -

. . 60, 1988.7. Manegold BC. Progress in Gastrointestinal Endoscopy. World J

Surg, 13:41, 1989.8. Danzi JT, Sayre PA. Endoscopy and the surgeon. Am Coll Surg

Bull, 69:30-32, 1984.9. Dent LT, Kukora I, Leibrandt T. Teaching surgical endo scopy of

the gastrointestinal tract. World J Surg, 13:202-205, 1989.10. Berci G. Is surgical endoscopy necessary? Surg Endosc, 1:2-3,

1987.11. Achord LJ. Who said surgeons had to be trained in Gas -

trointestinal Endoscopy? Am J Gastroenterol, 79:322-323, 1984.12. . . -

. - , , 1994.

13. Schapiro M. Who should be doing gastrointestinal endo scopy?JAMA, 254, 1981.

14. Dent LT. Surgeons, gastroenterologists, endoscopists. SurgGynecol Obstet, 153:733, 1981.

15. Kukora J, Clericuzio C, Dent T. The case for surgical training ingatrointestinal endoscopy. Am J Gastroenterol, 79:907-909, 1984.

16. Dent LT. Credentialing and priviliging for Endoscopic andLaparoscopic Surgery. In Endoscopic Surgery, edited by Greeneand Ponsky, Saunders, 1994.

17. Cuschieri A, Buess G, Perissat J (eds). Operative Manual ofEndoscopic Surgery. Springer-Verlag, Berlin, Heidel berg, 1992.

18. Barkin J, Cesar A, Rhelan D. Advanced Therapeutic Endo scopy.

Raven Press, 1990.19. Chung R. Therapeutic endoscopy in Gastrointestinal Surgery.

Churchill Livingstone, 1987.20. Demling L, Koch H. Operative Endoscopy. Past and Fu ture.

Schattauer FK, Verlag, 1977.21. Greene, Ponsky. Endoscopic Surgery. WB Saunders Com pany,

1994.22. Classen M, Geenen J, Kawai K. Nonsurgical Biliary Drain age.

Springer-Verlag, 1984.23. Demling L. Operative Endoscopie. Schattauer FK, Verlag, Stuttgart,

New York, 1976.24. Silen W. Surgeons and Gastrointestinal Endoscopy. Am J

Gastroenterol, 80:232, 1986.25. Mansberger A, Bowden T, Hooks VH. Gastrointestinal en doscopy

and the surgeon. Surgical Rounds, 4:24-28, 1981.26. American Board of Surgery. Inc: Booklet of Information.

Philadelphia, 1985.27. Rodning C, Zingarelli W, Webb W, Curreri PW. Surgical

endoscopy training in a university program. Ann Surg, 203:272-274, 1986.

28. Guide for Residency Programs in Surgery and PediatricSurgery 1980. Chicago: American Board of Surgery and AmericanCollege of Surgeons, 1980.

29. SAGES Guidelines. Surg Endosc, 7:144-145, 1993.30. Riemann JF. Ausbildung in der Endoscopie-aus internistischer

sicht. Endoskopie heute 4:209-211, 1990.31. Schwesinger W, Levine B. Endoscopy training in a gen eral

surgery program. Arch Surg, 119:384-386, 1984.32. Myers OJ, Ragland JJ. Fiberoptic endoscopy of the gas -

trointestinal tract in surgical training. Surg Gynecol Ob stet,170:283-286, 1990.

33. Dasmahapatra K, Najem A, Cheung N. Surgical endo scopy train-ing in a university program. Am Surg, 6:287-290, 1986.

15 1

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22

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24

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26

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.[10] - , - . [21] , , , - , . - - , 78%.[11]

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- , , - - - , .[14] , , , - . [15,16]

, - - (Forrest III) (50% ). , 5%[8] . - ,

28

, .

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(Forrest I) - 15% 20% - . - 30%, .[17,18] , - , .[18]

, - - . - - (1:100.000) . , .[19] .

(Forrest ) 20% . - 40-50% , - , - .[8] - , .

- , - (Forrest I) 15%. - 50% .[8] (Forrest I), - 29% , - (Forrest I), 70%. - , - . , - .

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60 , - . 0,4-1% - 60 7-25% 60 -. .

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, - , - , , .. 4 , 71%.

, - , -. , , , -

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30

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1% - - . - , . -

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-, - , . , . - , :

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32

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clips

clips - 1975 Hoyashi. -. - , - (. 4).

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34

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. 7. H - .

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, , , - . [26,27]

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- . - , - .

- , - 81-94%. - - - . , .

K , - , - 2 mm , . , - (. 7).

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35 2

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. K , - - .

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K , -

. - , . - 250 C .

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36

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. 11. (Heat probe). , - .

.[28,29] 30 Joules, - . - 4 8 , 15-20 Joules.

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Tabuse. - , - , 300 MHz 3.000 GHz, - -.

- , . - . , - , - .

-, 2.500MHz. 2,4 mm, - . . . - - - .

, - . - , -. - 94%, .

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Laser , - - , , , - . K Laser, (Ar) -Yag (Nd-Yag),

37 2

. 12. . . , .

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- , . , , , - , , - - . , , , - .

Laser - - . - Laser. - - Silece-Silicone, CO2 (Coaxial gasflow Fiber), - - . - CO2 - , , .

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, . - [31]

- .

Nd-Yag Laser (1,06 m) - 2 mm. , - - Laser.

, - , , -. - (. 13).

- 60-70 Watt, 2 cm 0,5 sec. - , - , (0,1-0,2 sec).

, , . - (80-90 Watt), 1 2 sec , - .

10 0,5-1 sec 80 Watt, - . , - - .

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Laser - - . - 90% .

38

. 13. (Nd-Yag Laser). -, .

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(Argon PlasmaCoagulation, APC) -, , - . , . .

. - - ( 5.000 Volt). - - 2,3 mm, Teflon - . 0,5 lit/min. . - - 40-60 Watt.

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-

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39 2

. , . - , : , , - , , - ( 7).

, - . 1-2% . - Nd-Yag Laser - , 48 72 , - - .

- , . - , , , , ,

- . , , - .

(enface). , - - , (. 14). , - .

, - - . - , - , , . - .

K 24 - , - . - , monitoring - . - , - .

, - .[32,33,34,35]

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K - , . , -

40

. 14. - , .

, . , Nd-Yag Laser - , -, .

, - . - - 2 4 . - . , (1%).

, - . - -.

30 , - , - . - : - (wait and see). - - , - , - .

- (20-30%), , - , - - .

, , , - - ,

.

, 80% 48 . - - 3%.

5% , 15% 72 . - , 20-40%.

K , - 20% , .

, - - - , - . - , - (Forrest I, I) - - (Forrest II, II).

K , :

1. , .2. , - -.3. .4. . -

90-95%. -, , - .

, , - - . ,

41 2

, , - .

- , , - , - , - .

10-15% , - , 72 . - - 50%, 14,7%, - .[36]

- , , - wait and see. - , , - ( , ..).

, - -. , - - .

, - - - , .

, - - , , , - , .

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, - : ( 3 5). - - . - 6 - , - , - .

.

, , - , - , - - . - , - . - . , , 5%, .

42

43 2

- - 9.

- . , .

- . (1/3) 1 3 . [37] , .

- . , - , - . - - . , .

- - . - . 1.500 ml - , - . - , 1.000 ml .

, : - , , - , ,

, , , - ( , , ), -, , ..

, - (shock). - - .[44]

, - , - .

- , . , , - , , , - . , , , - .

- , , - . , , - . , , . - . - - . - .

, - - . - .

44

- . - - Mallory-Weiss.

- 10-12 cm - . - . - Kocher - , - - ( , - , , - , ..).

: , , . -.

, -

Billroth I .[45] - , .

- , , - , - , - (. 15).[46] , -. , .

-, - . , , - (10%), (26-45%).[47]

-

45 2

. 15. , . .

. 16. , - - .

, , , , - . K , - -.[48] 2 cm - -. - , - - , (. 16).

- 10%, 5%. - - 5 10%.

, - , - . Billroth II. , . ( Kocher), - , .

- , Folley , - , Kehr - , .[49]

- Vater - , - Vater . , Kehr ( Laheys).

-. - - , , . , - . - , , - . , , - , - ( Roux en Y).

-, - . (10%) . , -, , - . , -, (30-50%).

- ( 2- ), - , - , - .

, - . , - 36% 9%.[38]

90% - 70% , - .[39] -

46

, - . -, - - .[40,41,42,43]

, - , - . - , . , - .

- - - , .

, - - - . - - - .

B

1. Silverstein FE, Gibert DA, Tedesco FJ, et al. The national ASGEsurvey on upper gastrointestinal bleeding. II. Clinical prognos-tic factors. Gastrointest Endosc 27:80-93, 1981.

2. NIH Consensus Conference. Therapeutic endoscopy and bleed-ing ulcers. JAMA 262:1369-1372, 1989.

3. Rockall TA, Logan RFA, Delvin HB, Northfield TC. Incidence andmortality from acute upper gastrointestinal haemorrhage in theUnited Kingdom. BMJ 311:222-226, 1995.

4. Branicki FJ, Coleman SY, Fok PJ, et al. Bleeding peptic ulcer: Aprospective avaluation of risk factors for rebleeding and mor-tality. World J Surg 14:262-270, 1990.

5. Fleischer D. Etiology and prevalence of severe persistent uppergastrointestinal bleeding. Gastroenterology 84:538-543, 1983.

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49 2

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