支气管Dieulafoy病一例报告并文献复习

目的提高对支气管Dieulafoy病的认识。方法对1例临床确诊为支气管Dieulafoy病患者的临床资料进行分析，并结合文献复习。结果支气管Dieulafoy病是一种罕见病，以支气管黏膜下畸形的动脉破裂出血为病理特征，其病因及发病机制尚不清楚，可能与支气管肺动脉先天发育异常、气道慢性炎症或损伤有关。临床表现主要为突发大咯血或支气管腔内病灶活检后发生致命性大出血。支气管肺动脉造影是术前诊断的主要手段，手术或尸检标本的组织学检查可以确诊。支气管动脉栓塞可以作为一种治疗方法，但有复发和失败的可能，肺叶切除术可以达到根治目的。结论遇到原因不明的大咯血应注意排除支气管Dieulafoy病的可能；支气管镜检查若发现管腔内突起样病灶，不要盲目活检。     

支气管Dieulafoy病活检大出血窒息复苏成功1例并文献复习

目的 探讨支气管Dieulafoy病临床表现、诊断及治疗方法.方法 结合我院收治的1例支气管Dieulafoy病的临床资料及国内外文献报道的病例进行综合分析.结果 患者男性,70岁,反复间断咯血30年,大咯血8 h住院,胸部平片及CT未发现异常,行支气管检查发现气管黏膜呈"蚯蚓"样突起,活检过程中突然出现大出血窒息,经抢救复苏成功,后经病理及肺血管造影证实气管黏膜血管异常,考虑支气管Dieulafoy病,行栓塞治疗后好转.结论 支气管Dieulafoy病文献报道较少,发病原因不详,可能与支气管肺动脉先天发育异常和(或)后天的慢性炎症刺激、损伤有关,文献报道少可能与认识不足有关.遇有不明原因大咯血需行气管镜检查时,气管镜检查发现气管黏膜呈"蚯蚓"样突起,应想到该病的可能,不要盲目活检,应想到有大咯血窒息可能,如确需活检,应备好抢救措施.     

Dieulafoy病术后残胃再发出血1例报道并文献复习

Dieulafoy病是少见的上消化道大出血原因之一,临床资料相对较少,发病机制尚不明确,目前诊断及治疗均以内镜为主。而Dieulafoy病胃大部切除术后残胃再发Dieulafoy病更为罕见,本文报道1例并就相关文献进行复习,探讨可能的发病机制,总结临床治疗经验,以期对该病有更进一步认识。     

支气管Dieulafoy病1例

<正>Dieulafoy病是引起消化道大出血的原因之一,该疾病的特征为黏膜下畸形动脉破裂出血。该病由法国医生Dieulafoy 1898年首次报道,多发生于消化系统,而支气管Dieulafoy病则较为罕见,常以致命性大咯血为首发症状[1],在临床上非常容易造成漏诊和误诊。现报道一例于我院近期诊断的支气管Dieulafoy病,以期提高大家对此病的认知及警惕性。临床资料患者女性,63岁,因反复咯血40年余,再发3天入院。40余年前,始无明显诱因反复出现咯血,     

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。     

20例胃Dieulafoy病的诊治及随访

Dieulafoy病临床罕见,但由于此病常突发大出血,危及生命,因而颇受关注.我院1998年至2002年2000例上消化道出血患者中共检出Dieulafoy病20例(1%),现将其诊治及随访情况报道如下. 一、资料和方法     

急诊内镜诊治Dieulafoy病16例分析

目的 探讨急诊内镜对Dieulafoy病的诊断与治疗.方法 回顾性分析近4年收治的16例Dieulafoy病患者的临床资料.结果 仅1例患者因年龄大,一般情况差,患者自动出院,其余患者均在内镜下止血成功.结论 急诊内镜是Dieulafoy病诊断与治疗的首选方法.     

金属钛夹治疗Dieulafoy病活动性出血

目的观察金属钛夹治疗Dieulafoy病活动性出血的疗效.方法经胃镜检查确诊的Dieulafoy病活动性出血的病人31例,行钛夹止血治疗.结果 31例共使用金属钛夹47枚,最多3枚,最少1枚,平均1.5枚.48h后再出血2例（金属钛夹脱落）,再次行内镜下止血成功,总有效率为100%.结论金属钛夹对Dieulafoy病活动性出血是一种有效的止血方法,值得临床推广应用.     

急诊内镜联合选择性动脉造影诊治Dieulafoy病4例临床分析

目的探讨急诊内镜联合选择性动脉造影诊治Dieulafoy病的临床价值。方法我院消化内科2009年1月1日～2010年12月31日共收治Dieulafoy病18例,对其中急诊内镜联合选择性动脉造影救治Dieulafoy病所致上消化道大出血4例进行临床分析,通过急诊内镜联合选择性动脉造影的协同应用,观察对出血部位、病因的诊断价值和止血效果。结果 4例患者均在就诊1～24h内胃镜检查确诊Dieulafoy病,其中3例给予镜下钛夹止血或药物喷洒止血后仍有活动性出血随即行选择性动脉造影血管栓塞治疗,1例因镜下出血表现为喷射样,并血压下降,给予病灶旁钛夹标记后随即行选择性动脉造影血管栓塞治疗。本组4例在选择性动脉造影同时结合内镜所见均给予相应病变血管弹簧栓或明胶海绵栓塞止血治疗并成功止血。结论急诊内镜联合选择性动脉造影血管栓塞术协同诊治Dieulafoy病所致消化道出血,两者互为补充,是一种安全、有效、可靠的诊治方法。     

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。     

A case of pulmonary actinomycosis with recurrent hemoptysis diagnosed after right upper lobectomy]

The patient was a 58-year-old man who had been admitted in 1995 because of hemoptysis. Chest CT scans showed air-space consolidation with dilated bronchi and calcification in the right S3. He received a diagnosis of bronchiectasis with old tuberculosis. Bronchial arteriography showed arterialization in the right S3, and bronchial artery embolization was performed. But in 1996 hemoptysis reappeared. He was readmitted in May 1999 because of recurrent hemoptysis. Bronchial arteriography showed recurrence of arterialization in the same area, and chest CT scans showed growth of the mass shadow. Right upper lobectomy was performed, and the microscopic findings of the resected specimen showed sulfur granules in the dilated bronchus. We concluded that pulmonary actinomycosis should be considered in the differential diagnosis of abnormal chest shadows.     

Bronchial artery embolization can be effective for primary racemose hemangioma]

We report two cases of primary racemose hemangioma in patients with hemoptysis. In the first, a 59-year-old man had a pulsatile polypoid lesion in the bronchus of the lingula; and in the second, a 24-year-old woman had a nodule in the bronchus of the right lower lobe. In both patients, arteriography of the bronchial artery revealed enlargement and convolution of its branches. Primary racemose hemangioma was diagnosed in both patients. The arteriography also revealed a shunt between the pulmonary and bronchial arteries in the woman. Bronchial artery embolization (BAE) was an effective treatment for the hemoptysis. To date, eight months after the embolization, hemoptysis has not recurred. Bronchoscopy and arteriography of the bronchial artery are both useful for diagnosing primary racemose hemangioma. BAE seems to be effective in treating primary racemose hemangioma.     

A case of pulmonary actinomycosis with recurrent hemoptysis]

A 68-year-old man was admitted to our hospital because of hemoptysis in September 1999. Chest CT scans showed a nodular shadow with infiltration in the right S 7. Bronchial arteriography showed vascularization in the right S 7, and bronchial artery embolization was performed. However, in April and October 2000 hemoptysis recurred, and bronchial arteriography showed recurrence of vascularization in the same area, so embolization was performed again. Then, the patient was admitted in March 2001 because of recurrent hemoptysis. CT scans showed growth of the nodular shadow. Right lower lobectomy was performed, and the microscopic findings in the tissue from the resected lobe showed branching filamentous bacteria, and pulmonary actinomycosis was diagnosed. We concluded that pulmonary actinomycosis should be considered in the differential diagnosis of nodular shadows with recurrent hemoptysis.     

A case of primary racemose hemangioma of bronchial artery with recurrent hemoptysis]

A 42-year old man was admitted to our hospital because of hemoptysis. Bronchial arteriography revealed a tortuous and dilated left bronchial artery with a shunt formation between the bronchial and pulmonary arteries. Bronchial artery embolization using a sponge was performed three times to treat the hemoptysis, but all attempts failed. The patient therefore underwent left lower lobectomy, after which no hemoptysis was observed. Histopathologically, the resected tissue showed no inflammatory change. Interestingly, abnormal vessels resembling arteriovenous malformations were also found. Although the embolization therapy was effective in several reported cases, we concluded that surgery was required for this patient with persistent hemoptysis because of the development of collaterals and a bronchial-pulmonary artery shunt.     

支气管动脉栓塞治疗支气管扩张大咯血28例

目的回顾性分析支气管动脉栓塞治疗支气管扩张大咯血。方法对28例支气管扩张大咯血患者进行选择性支气管动脉造影，用明胶海绵颗粒等材料进行栓塞。结果左支气管动脉栓塞10例，右支气管动脉栓塞12例，左右支气管动脉共干6例。确定出血血管栓塞后，28例患者咯血停止，27例3日内未再咯血，有1例仍有咯血，1周后再行栓塞术后，咯血停止。结论支气管扩张大咯血进行内科保守治疗效果不佳而又无法耐受外科手术者，应及时行支气管动脉造影并栓塞治疗。     

隐源性咯血的介入诊断和治疗

目的 探讨隐源性咯血的支气管动脉造影 (BAG)的影像表现与病理机制之间的关系,为其诊断和出血定位寻求可靠依据。方法 1 选择隐源性咯血病人52例,包括以下两种情况：(1)常规影像学检查阴性 (胸部平片、断层阴性,部分病人同期CT及支气管碘油造影阴性) (2)一个肺叶或一侧肺内有少量病变,但BAG证实为非咯血病灶,而另叶或另段肺内有出血征象,计17例。全部病例行Seldinger穿刺技术,导管经主动脉置入双侧支气管动脉造影,确认有造影的直接或间接出血征象,行双重栓塞术。2 另选5例术前影像学检查证实为支气管病变、BAG检查证实为出血部位和出血原因的病例,因栓塞止血无效或其他病变而行手术切除。对5例手术切除标本进行病理镜下检查,分析其与BAG所见的相关性。结果 全部咯血病例,BAG均有不同程度的血管增生紊乱,典型者为扫帚状或网状增生、紊乱的血管束,严重者伴有肺内出血病灶。结合支气管扩张手术标本中的病理所见,如支气管周围支气管动脉的血管数增多、扭曲等,两者的血管改变呈一致性。结论 1 隐源性咯血的病理机制为支气管动脉损伤,而支气管动脉的损伤又为支气管动脉感染所致。故经BAG提示的血管异常改变可以为隐源性咯血的诊断和出血定位提供依据。2 支气管动脉造影和栓塞集诊断与治疗为一体,病人创伤小,且安全有效,在抢救大咯血方面具有实际意义,为控制大咯血提供了一种实用的新途径。     

A case of bronchial arterial aneurysm associated with recurrent massive hemoptysis]

A 69-year-old man was admitted to our hospital because of massive hemoptysis. Bronchial arteriography showed no abnormal findings. Bronchoscopic findings revealed a small, reddish elevated lesion on the posterior surface of the left upper lobe bronchus. Since the patient developed massive hemoptysis four times in a month, he underwent ligation and transection of the left bronchial artery, and bronchoplasty. Histopathologically, the resected tissue showed a bronchial arterial aneurysm without any inflammatory changes. We concluded that the aneurysm had developed in a malformed vessel.     

支气管动脉栓塞治疗肺结核大咯血31例

目的回顾性分析支气管动脉栓塞治疗肺结核合并大咯血。方法对31例肺结核大咯血在影像监视下行选择性支气管动脉造影后用明胶海绵颗粒进行栓塞。结果31例中右侧支气管动脉出血15例,左侧12例,还有4例为两侧支气管动脉共干。结论对肺结核合并大咯血内科保守治疗效果不佳又无条件进行外科手术者,应尽早行支气管动脉造影并栓塞。