上消化道Dieulafoy病18例内镜诊治体会  

Endoscopic diagnosis and therapy of 18 patients with Dieulafoy disease in upper gastrointestinal tract

作　　者：翟云[1] 孟江云[1] 梁浩[1] 

机构地区：[1]解放军总医院消化科,北京100853

出　　处：《武警医学》2008年第2期134-137,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨消化道Dieulafoy病的临床及内镜诊治特点。方法搜集2003年8月-2007年1月我院消化内镜中心823例上消化道出血患者的临床资料，并对经内镜确诊的18例Dieulafoy病患者资料进行回顾性分析。结果Dieulafoy病好发于胃（55．6％），男性患者多于女性（5：1），40岁以上居多（63．6％）。本病以反复发作性上消化道出血为主要症状，出血前无明显腹部不适或疼痛。内镜检查及治疗为本病主要诊疗手段。镜下表现特点为片状黏膜糜烂伴中央血管断端显露（44．4％）、仅有血管断端显露（33．3％）、仅有血栓或血凝块附着（22．2％）。内镜治疗以局部注射1：10000肾上腺素盐水溶液（35．7％）及使用金属夹（21．4％）居多，两种方法同时使用者占14．3％，首次止血成功率达100％。结论临床医师尤其是内镜医师，应提高对本病的认识，对患者进行细致、反复的内镜检查以及及时、有效的镜下治疗。Objective To investigate the features of endoscopic diagnosis and therapy of Dieulafoy disease.Methods Out of 823 patients with gastrointestinal bleeding,the data of 18 patients with Dieulafoy disease diagnosed by endoscopy from August 2003 through January 2007 were reviewed.Results Dieulafoy disease was usually originated from the stomach（55.6%）.Males were in larger proportion than females （5： 1） .Most of the patients（63.6% ） were above 40 years old.Recurrent upper gastrointestinal bleeding without abdominal discomfort or pain was an important clinical manifestation. Endoscopy was the choice for diagnosis and treatment of this disease.The appearance of the lesion consisted of a vascular stump which protrudes from mucosa through a small erosion（44.4% ）,an isolated vascular stump（33.3% ）,and an isolated thrombus or blood dot（22.2% ）. In endoscopic therapy, a millesimal solution of epinephrine（ 1 ： 10,1300） was injected in 35.7%, hemoclipping in 21.4%, and both treatments in 14.3% of the patients.The hemostasis rate was 100%. Conclusions The clinician, especially the endoscopist,should enhance the understanding of this disease.It is important to do endoscopy carefully and repeatly and do endoscopic treatment timely and effectively.

关 键 词：DIEULAFOY病 内镜 出血 

分 类 号：R57[医药卫生—消化系统]