Dieulafoy病内镜诊治中的几个问题探讨（附22例报告）

目的 探讨上消化道粘膜下恒径小动脉破裂出血(Dieulafoy病)的内镜诊断与治疗.方法 对2005-04-2008-02胃镜检查诊断的22例Dieulafoy病住院病例进行分析.结果 22例患者用HLE液内镜粘膜下注射治疗,1次注射止血有效率77.3%,2次注射止血总有效率86.4%,有3例注射治疗后仍有活动性出血行手术治疗.平均住院天数11.7 d.结论 对于Dieulafoy引起的上消化道大出血,内镜FILE液粘膜下注射治疗是有效的;诊断上需与消化性溃疡、肿瘤等引起上消化道出血的原因相鉴别.     

Dieulafoy病诊断及治疗研究进展

Dieulafoy病（Dieulafoy’s disease，DD），也称为曲张动脉瘤或黏膜下动脉畸形，最早由Gallard于1884年描述,14年后法国外科医生Georges Dieulafoy将其命名为“单纯性溃疡痫（exulceratio simplex）”，他认为这种病变是胃溃疡病变的最初阶段，进一步发展可导致出血。尽管内镜治疗技术的进步大大降低了DD相关死亡率，但它仍然是上消化道出血诸多病因中最难诊断的疾病之一.     

内镜下注射联合射频治疗Dieulafoy病出血55例

Dieulafoy病是引起消化道尤其是上消化道突发大出血的少见原因,发生率在0．3％～6．7％。由于是动脉破裂出血,过去常需要手术治疗,病死率也较高。随着内镜技术的快速发展,不同的内镜止血方法,包括注射、热极治疗等,已被成功地用于Dieulafoy病出血的治疗,但最大的不足是术后早期有再出血的危险。我院近3年来对55例Dieulafoy病出血患者采用注射联合射频治疗,取得较好的疗效,现总结如下。     

内镜下治疗Dieulafoy病15例

Dieulafoy病又称为黏膜下恒径动脉破裂出血,是引起上消化道大出血的常见病因之一,该病内科保守治疗效果欠佳,现认为内镜下治疗是首选方法。我院2004年至2008年行胃镜检查共检出Dieulafoy病15例,予内镜下治疗,效果满意,现报道如下。     

经内镜检查诊断并治疗Dieulafoy病26例临床分析

Dieulafoy病（Dieulafoy＇s disease，DD）最早在1884年由Gallard报道．1898年法国外科医生Diieulafoy报道3例因为恒径动脉破裂致上消化道出血而死亡的病例，故该病被命名为Dieulafoy病，又称Dieulafoy溃疡、Dieulafoy损害、黏膜下恒径动脉综合征等，简称杜氏病，它是罕见的消化道出血的病因之一，因其部位隐匿，极易发生误诊漏诊，出血量大且反复发作，常导致失血性休克，可直接威胁患者生命，近年来我院共收治Dieulafoy病26例，均经内镜治疗，取得了良好疗效，现报告如下。     

Dieulafoy病12例临床分析

[目的]探讨Dieulafoy病的诊断、治疗与预后。[方法]对近8年通过急诊胃镜检查发现的Dieulafoy病进行回顾性分析。[结果]Dieulafoy病可导致急性上消化道出血，12例均经急诊内镜下止血或转外科手术治疗后治愈。[结论]Dieulafoy病为少见疾病，易危及生命，急诊内镜及内镜下治疗为首选诊治措施。     

Dieulafoy病19例诊治分析

目的探讨Dieulafoy病的发病情况、临床特征、诊断与治疗。方法收集我院1996年~2008年7月间收治的上消化道出血病人1 470例,对其中检出的19例Dieulafoy病病例的临床特征、内镜下表现及治疗方法进行回顾性分析。结果Dieulafoy病约占上消化道出血的1.3%,19例Dieulafoy病中,病灶位于胃底5例,胃体10例,胃窦部2例,贲门部1例,十二指肠球部1例,其中17例均于胃镜下可直接见破裂血管,有10例可见活动性出血。病灶直径1.0~3.0 mm。于内镜下行病灶黏膜下局部注射5%鱼甘油酸钠,1例因再出血予手术治疗。结论Dieulafoy病是上消化道大出血的少见而重要的病因,该病诊断主要依靠胃镜检查,通过内镜早期诊断和治疗可以取得很好的疗效。     

Dieulafoy病临床研究现状

Dieulafoy病是一种少见的消化道出血性疾病，近年发病率明显增多。由于病灶小、位置隐匿，临床诊断和治疗困难，病死率较高。近年来内镜治疗已演变为此病的标准治疗方法，包括内镜下注射、电凝、血管夹或套扎等方法。内镜治疗无效时可采取手术治疗。     

Dieulafoy病2例报告

Dieulafoy病是上消化道出血的少见病因之一。2000～2009年,我们共收治Dieulafoy病患者2例。现报告如下。     

直肠Dieulafoy病致下消化道大出血一例

Dieulafoy病为一种黏膜下恒径动脉破裂出血,临床中多见于胃部病变所致的上消化道出血,而我们发现了一例罕见的直肠Dieulafoy病所致的下消化道大出血病例,现将其诊治情况,结合文献进行了报道。     

Endoscopic injection treatment for gastric dieulafoy lesion in two newborn infants]

Dieulafoy lesion is an abnormally large calibered submucosal artery associated with a minute mucosal defect in the gastrointestinal mucosa. It is a rare cause of profuse, but intermittent gastrointestinal bleeding. The lesion is usually located in the stomach, although it may occur anywhere in the gastrointestinal tract. Dieulafoy lesion is extremely rare in the neonates. We report two newborn infants with a gastric Dieulafoy lesion which was treated by endoscopic epinephrine injection therapy without complication and recurrence.     

Jejunal Dieulafoy lesion with intraintestinal calcification on computerized tomography: A case report

Rationale:A Dieulafoy lesion is a rare cause of gastrointestinal (GI) bleeding, especially in the jejunum, and the presence of calcifications on CT might be suspicious of the diagnosis.Patient concerns:We describe a 72-year-old woman with anemia and melena. Hemoglobin was 6.0 g/dL, and the stools were positive for occult blood (4+). Blood pressure was 116/54 mm Hg. Physical examination showed pale face and pitting edema in both lower limbs. Abdominal computerized tomography showed calcification in the small intestine of the left lower abdomen. Capsule endoscopy showed a blood clot.Diagnoses:Dieulafoy lesion.Interventions:Single balloon endoscopy was performed via the oral approach and showed a blood clot on the suspected submucosal tumor of jejunum. A hemostatic clip was placed at the base of the lesion to allow the surgeon to locate it during the operation. Laparoscopy was performed, and the lesion was resected.Outcomes:The postoperative pathology showed a Dieulafoy lesion. The lower extremity edema subsided. GI bleeding did not recur over 1 year of follow-up, and hemoglobin was 12.2 g/dL. A Dieulafoy lesion is a rare cause of GI bleeding, and it is even rarer in the jejunum.Lessons:A Dieulafoy lesion does not have special imaging features, but the presence of calcifications in the small intestine on computerized tomography might be suspicious of the diagnosis. When endoscopic treatment is difficult, surgical treatment could be considered.     

Dieulafoy's disease: endoscopic treatment and follow up.

The findings from 480 patients who had emergency endoscopy for acute upper gastrointestinal bleeding of non-variceal origin at our institution were analysed. Twenty eight patients (5.8%) had a Dieulafoy lesion. In 27 patients (96.4%) bleeding could be successfully managed by injection of norepinephrine and polidocanol, in repeated sessions if needed. Two patients had to be treated surgically: one because of uncontrollable bleeding from the Dieulafoy lesion and one despite endoscopic control of the bleeding Dieulafoy lesion because of a concomitant bleeding from an anastomosal ulcer after gastric resection. Three patients died during hospital stay from causes unrelated to bleeding from Dieulafoy lesion. Out of the 25 patients discharged from the hospital 21 treated by endoscopy and two treated with surgery were followed up for a mean of 28.3 and 22.5 months, respectively. Twenty endoscopically treated patients (95%) had no recurrence of Dieulafoy's bleeding. One patient experienced severe rebleeding from the original site after a transient endoscopy confirmed complete disappearance. He had emergency operation without a further attempt to control bleeding by endoscopy. It is concluded that bleeding from Dieulafoy's disease can be successfully managed by endoscopic injection treatment. The longterm outcome is favourable.     

Dieulafoy lesion in mid-esophagus with esophageal varices.

Dieulafoy lesion is an uncommon cause of gastrointestinal (GI) bleeding. Most such lesions are reported in the stomach, though a few have been reported in the distal esophagus. We report a 54-year-old man who presented with upper GI bleeding and had esophageal varices but bled from a Dieulafoy lesion 5 cm above the proximal end of the varices.     

Management of Colonic Dieulafoy Lesions With Endoscopic Mechanical Techniques: Report of Two Cases

Although Dieulafoy lesion is generally located in the proximal stomach, other locations have been reported. We present two cases of bleeding colonic Dieulafoy in patients with chronic renal failure who were treated with mechanical methods. In the first case, an active arterial bleeding without mucosal defect was localized in the descending colon. In the second case, a protruding vessel with active bleeding was found in the transverse colon. The two patients were initially treated with epinephrine and hemostatic clips. In the second patient, an endoloop was attached to the base of the previously placed hemoclips because of rebleeding. To our knowledge, this is the first case of combined endoscopic approach with hemostatic clips and endoloop to treat a colonic Dieulafoy lesion. Colonic Dieulafoy lesions reported in the relevant literature and the hemostatic treatments used are reviewed.Supported in part by a grant from the Instituto de Salud Carlos III (C03/02).     

Endoscopic treatment of Dieulafoy hemorrhage

Bleeding from a Dieulafoy lesion is an underdiagnosed source of upper gastrointestinal bleeding. The literature is almost universally in support of surgical therapy as its treatment. We report three patients with bleeding Dieulafoy lesions who were treated successfully with endoscopic therapy--two by bipolar electrocoagulation and one by endoscopic sclerotherapy.     

经内镜皮圈套扎治疗Dieulafoy病变出血的临床研究

目的评价经内镜皮圈套扎(EBL)治疗Dieulafoy病变出血的疗效及安全性.方法对31例Dieulafoy病出血患者随机采用EBL(n=16)或硬化剂注射(EIS,n=15)治疗,20例患者病灶位于胃,8例位于胃肠吻合口,3例位于十二指肠球部.EBL组采用多连发套扎器,通过负压抽吸,使Dieulafoy病灶及周围组织吸入套扎帽内,然后释放弹力皮圈将其结扎.EIS组选用5%鱼肝油酸钠或1%乙氧硬化醇,绕Dieulafoy病灶周围注射止血.结果 EBL组套扎组织在内镜治疗后3～7 d内脱落;EBL组早期止血率、远期止血率和转外科手术率均与EIS组相似(分别为93.8%比86.7%,100.0%比86.7%,0比13.3%;P值均＞0.05),但再出血率显著低于EIS组(6.3%比40.0%,P＜0.05);EBL组并发症发生率为6.3%,EIS组为6.7%,差异无统计学意义(P＞0.05).结论 EBL是内镜治疗Dieulafoy病变出血一种安全和有效的方法.     

Management and long-term prognosis of Dieulafoy lesion

BACKGROUND: The Dieulafoy lesion is an important cause of gastrointestinal (GI) hemorrhage. Optimal treatment and long-term outcome are unknown. This study aimed to characterize the presentation of the Dieulafoy lesion and to summarize the results and report the long-term outcome of endoscopic therapy. METHODS: Data regarding diagnosis, treatment and outcomes were derived from our GI Bleed Team database, patient records and follow-up correspondence. RESULTS: Ninety Dieulafoy lesions were identified in 89 patients after a mean of 1.9 endoscopies. Their mean age was 72 years. Thirty-four percent of lesions were extragastric. Median transfusion requirement was 5 units. Two patients exsanguinated and 3 required surgery; all others were initially successfully treated endoscopically (with or without epinephrine injection): heat probe (71 patients), band ligation (3), hemoclip (1), laser (2), bipolar probe (4), sclerotherapy (2) and epinephrine alone (2). Gastric perforation occurred in 1 patient following sclerotherapy. Thirty-day mortality was 13%, 4 related to hemorrhage and 5 related to comorbidity. During median follow-up of 17 months, 34 patients (42%) died. One patient had recurrent bleeding 6 years after operation. CONCLUSIONS: Dieulafoy lesion is relatively common and often extragastric. Endoscopic therapy is safe and effective. Long-term recurrence was not evident following endoscopic ablation. Follow-up after ablative therapy appears unnecessary.     

Massive lower gastrointestinal bleeding due to Dieulafoy lesion of colon.

A 25-year-old man with massive lower gastrointestinal bleeding underwent emergency mesenteric angiography. An actively bleeding lesion was found in the cecum. Right hemicolectomy was performed. Histology revealed a Dieulafoy lesion of the cecum. This is an extremely rare lesion responsible for massive lower GI bleeding.     

The Dieulafoy gastric erosion. An infrequently recognized cause of upper gastrointestinal hemorrhage in the elderly

Definitive treatment of the Dieulafoy erosion--once recognized--has generally been surgery. Numerous surgical approaches have been suggested, including: simple oversewing of the lesion, wedge restriction, and gastrectomy with and without vagotomy and pyloroplasty. Attempts at endoscopic electrocoagulation and angiographic embolization have generally been disappointing; however, Pointer et al have recently reported satisfactory control of hemorrhage from Dieulafoy lesions with bipolar electrocoagulation and endoscopic injection sclerotherapy, either independently or in combination. These case reports describe two elderly patients with massive upper gastrointestinal tract bleeding from Dieulafoy's gastric erosion; it is hoped the geriatrician will be alerted to an often unrecognized source of hemorrhage.