111例血管相关性非静脉曲张性上消化道出血临床分析  

Clinical Characteristics of Nonvariceal Vascular Upper Gastrointestinal Bleeding: Analysis of 111 Cases

作　　者：邵小娟[1] 陈东风[1] SHAO Xiaojuan CHEN Dongfeng(Department of Gastroenterology, Research Institute of Field Surgery, Daping Hospital, the Third Military Medical University, Chongqing （400042)

机构地区：[1]第三军医大学大坪医院野战外科研究所消化内科,400042

出　　处：《胃肠病学》2017年第7期411-414,共4页Chinese Journal of Gastroenterology

摘　　要：背景:血管相关性非静脉曲张性上消化道出血(NVUGIB)是NVUGIB的一种特殊类型,病情凶险,死亡率高,需引起临床医师的重视。目的:分析血管相关性NVUGIB的病因和治疗策略,以期提高其诊治水平。方法:收集第三军医大学大坪医院2012年1月—2016年12月期间经胃镜、腹部CT或血管造影确诊的111例血管相关性NVUGIB患者的病史资料进行回顾性分析。结果:105例患者于入院24 h内行胃镜检查。最常见的出血原因为消化性溃疡侵及血管(62.2%)和血管畸形(22.5%),其他还包括Dieulafoy病、胃肠道间质瘤、恶性肿瘤、腹腔内感染、外伤和胃毛细血管扩张。78例(70.3%)患者行内镜治疗,19例仅行内科保守治疗,13例行经血管介入栓塞治疗,5例行外科手术治疗。107例(96.4%)患者经治疗止血成功,4例死亡患者中3例为内镜、介入治疗失败后未及行外科手术治疗者。结论:消化性溃疡和血管畸形是血管相关性NVUGIB最常见的病因。内镜治疗为首选治疗方法,但必要时应直接行经血管介入栓塞治疗或外科手术治疗。Nonvariceal vascular upper gastrointestinal bleeding is a special type of nonvariceal upper gastrointestinal bleeding （NVUGIB） with serious disease course and high mortality rate, which should be paid more attention by clinicians. Aims： To explore the etiological factors and therapeutic strategies of vascular NVUGIB for improving the diagnosis and treatment of the disease. Methods： Clinical data of 111 cases of vascular NVUGIB admitted from Jan. 2012 to Dec. 2016 at Daping Hospital, the Third Military Medical University were retrospectively analyzed. All cases were diagnosed by gastroscopy, abdominal CT or angiography. Results： One hundred and five patients underwent a gastroscopy within 24 hours of hospital admission. The major causes of bleeding were peptic ulcer involving blood vessels （62.2%） and vascular malformation （22.5%） ; other causes included Dieulafoy disease, gastrointestinal stromal tumor, malignant tumor, intra-abdominal infection, trauma and gastric angiotelectasis. Seventy-eight patients （70.3%） received endoscopic hemostasis, 19 received conservative medical therapy only, 13 were treated by interventional embolization and 5 underwent surgical operation. Hemostasis was achieved in 96.4% of the patients （ 107 cases） ; in four deceased, 3 were failures of endoscopic and interventional therapies. Conclusions： Peptic ulcer and vascular malformation are the major causes of vascular NVUGIB. Endoscopic therapy has generally been recommended as the first-line treatment, however, interventional embolization or surgical operation should be used directly if necessary.

关 键 词：血管相关性非静脉曲张性上消化道出血 消化性溃疡 血管畸形 内镜治疗 回顾性研究 

分 类 号：R573.2[医药卫生—消化系统]