Dieulafoy溃疡15例临床特征  

Clinical characteristics of dieulafoy lesion： analysis of 15 cases

作　　者：王斌[1] 郑亚安[1] 

机构地区：[1]北京大学第三医院急诊科,北京100191

出　　处：《中华急诊医学杂志》2013年第9期1030-1033,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨Dieulafoy溃疡的临床特点与治疗方法，以提高临床早期诊治水平。方法对北京大学第三医院急诊科15例Dieulafoy溃疡的临床资料进行回顾性分析。结果男性多于女性，男女比例为6．5：1，平均年龄48．3岁，大部分患者无明显诱因，少数患者存在饮酒（1／15）、服用NSAID药物（2／15），进食刺激性食物（2／15）等诱因，所有患者既往均无消化性溃疡及肝硬化病史，部分患者有糖尿病（3／15）、高血压（5／15）病史，患者均以突发呕血、便血发病伴失血性休克，中重度贫血，病灶部位以胃后壁（9／15）、近小弯侧多见（10／15）。急诊内镜检查为首选的诊断方法，14例内镜下药物注射、钳夹止血成功（14／15），1例手术治疗。结论Dieulafoy溃疡以突发致命性大出血为特点，中老年男性多见，好发于胃后壁、近胃小弯侧区域，内镜检查是诊断Dieulafoy病最简单有效的手段，急诊内镜下钳夹止血治疗Dieulafoy溃疡的疗效可靠。Objective To investigate the clinical characteristic and treatment of dieulafoy lesion in order to improve the early diagnosis and treatment. Methods A retrospective review of clinical records of 15 cases of dieulafoy lesion admitted to our emergency department from October 2005 to August 2012 was carried out. Results The male patients were more vulnerable to this disease than female patients, thereby the ratio of male to female patients was 6. 5： 1, and the mean age was 48.3 years. The precipitating factors were often obscure, and some possible factors were related with certain amount of wine （ 1/15 ） , using nonsteroidal anti-inflammatory drugs （2/15） , and eating irritant food （2/15） , and a few patients had a past history of hypertension （3/15） or diabetes mellitus （5/15） and no patient had past history of peptic lesion and cirrhosis of liver. The Dieulafoy＇ s lesion occurred suddenly without premonitory symptoms such as pain or upset of stomach, presented with the episodes of hematemesis or hemafecia, and the patients were in a stage of shock and moderate to severe anemia because of massive blood loss. The majority of lesions located at the posterior wall of the stomach （9/15） or adjacent to the lesser curvature （10/15）. Endoscopy was of prime importance for confirming the diagnosis of Dieulafoy＇ s lesions. Endoscopic treatments included hemostasis with clipping combined with epinephrine submucosa injection and successfully excising the lesion in 14 patients （ 14-/15 ）. Surgical treatment was done in 1 patient after failure of endoscopic treatments. Conclusions Dieulafoy lesion is characterized by sudden massive hemorrhage of the alimentary tract, it most commonly locates in the pars posterior of stomach adjacent to the lesser curvature in the middle-aged and the elderly males. Endoscopy is the most simple and essential method to confirm the diagnosis, and emergency endoscopic hemostasis with clipping for treating Dieulafoy lesion is an effective therapeutic strategy.

关 键 词：DIEULAFOY溃疡 临床特点 诊断 治疗 

分 类 号：R573.2[医药卫生—消化系统]