Dieulafoy病的紧急内镜诊断与治疗

目的：探讨上消化道大出血少见病因Dieulafoy病的诊断及治疗方法。方法：回顾性分析1998年1月—2002年10月收治的12例Dieulafoy病的内镜下特征及内镜治疗效果。结果：12例患者均在急诊胃镜下确诊，出血部位为胃底2例，贲门2例，胃体上段8例。病灶特点为直径在10mm内的浅溃疡或糜烂，中央见血管裸露渗血或喷血、哨兵样突起血痴。10例经内镜局部注射肾上腺素生理盐水或电凝止血成功，2例经3次内镜止血失败改手术治疗，无一例死亡。结论：紧急内镜检查是诊断与治疗Dieulafoy病的首选方法。     

胃Dieulafoy病16例内镜诊治分析

目的探讨胃Dieulafoy病的内镜诊断与治疗。方法回顾性分析16例引起上消化道出血的胃Dieulafoy病的临床表现、内镜下特征、治疗方法与效果。结果16例中有12例(75％)为1次检查确诊，4例为2次或2次以上检查确诊；其中14例经内镜止血成功，首次治疗成功10例(62．5％)。4例经2次内镜止血成功(25％)，2例需外科手术(12．5％)。结论在胃Dieulafoy病的诊断及治疗中，内镜为首选方法。     

Dieulafoy病的诊断与治疗(附18例报告)

目的：探讨Dieulafoy病的内镜诊断与治疗。方法：回顾性分析18例引起上消化道出血的Dieulafoy病的临床表现，内镜下特征，治疗方法与效果。结果：18例中有13例（72.2%)为1次检查确诊，5例为2次或2次以上检查确诊；其中15例经内镜止血成功，首次治疗成功12例（66.7%)，3例经2次内镜止血成功（16.6%)，3例需外科手术（16.6%)。结论：在Dieulafoy病的诊断及治疗中，内镜为首选方法。     

Dieulafoy病19例临床诊治分析

目的 探讨Dieulafoy病发病情况、诊断及治疗方法。方法 回顾性分析19例Dieulafoy病的临床表现、诊断、治疗方法及疗效。结果 全部病例均是突发上消化道大出血；初次胃镜检查确诊12例(63．2％)，第二次检查确诊4例，术中探查确诊3例；13例经一次内镜下止血成功，1例经二次内镜下止血成功，4例行外科手术。结论 急诊胃镜是诊断Dieulafoy病首选方法；治疗首选内镜下止血，内镜下止血不成功，立刻外科手术。     

Dieulafoy病致上消化道大出血的诊断和治疗 (附8例临床报告)

目的 旨在探讨Dieulafoy病的诊断与治疗原则,以期为该病的诊治提供一定临床经验,方法 8例患者行急诊胃镜11次（3例各为2次,3例行选择性血管造影各1次,1例在剖腹探查术中行胃镜检查,结果 （1）4例在首次急诊胃镜后即明确诊断,1例在第2次急诊胃镜时发现出血病灶;2例经血管造影后发现出血部位：1例在剖腹探查术中再经胃镜检查而确诊。（2）3例在胃镜下局部喷洒止血药,硬化剂注射,电凝等联合治疗后止血成功;1例在血管造影中经动脉灌注药物后止血;3例经外科单纯血管缝扎术后止血,1例行胃大部切除术后止血,结论 Dieulafor病可经急诊胃镜和（或）血管造影获得早期诊断,出血部位采用药物,电凝等治疗仍不能止血者,应尽早手术治疗。     

49例急诊内镜诊治Dieulafoy病的护理配合

目的：探讨急诊内镜下诊治Dieulafoy病的护理配合方法。方法：在内镜下对49例Dieulafoy病病人进行诊治护理,内容主要包括内镜检查前常规准备,活动性出血伴休克的抢救及术中止血治疗的护理配合等。结果：本组病人均在消化道出血12 h内行急诊诊治,其中4例诊断后直接转外科治疗,其余45例经内镜成功止血。49例Dieulafoy病病人均成功获救。结论：急诊内镜诊治应争取在消化道出血后24 h内进行,生命体征不平稳的病人,可在内科抗休克的同时进行内镜下治疗。护士熟练掌握配合内镜止血治疗的护理措施至关重要。     

Dieulafoy病19例临床诊断分析

目的　探讨Dieulafoy病发病情况、诊断及治疗方法。方法　回顾性分析 19例Dieulafoy病的临床表现、诊断、治疗方法及疗效。结果　全部病例均是突发上消化道大出血 ;初次胃镜检查确诊 12例 (6 3 2 % ) ,第二次检查确诊4例 ,术中探查确诊 3例 ;13例经一次内镜下止血成功 ,1例经二次内镜下止血成功 ,4例行外科手术。结论　急诊胃镜是诊断Dieulafoy病首选方法 ;治疗首选内镜下止血 ,内镜下止血不成功 ,立刻外科手术。     

胃Dieulafoy病诊断与治疗

目的:探讨胃Dieulafoy病临床特点及诊断、治疗方法.方法:回顾性分析23例胃Dieulafoy病患者的临床资料.结果:内镜检查确诊18例.手术确诊4例,血管造彩确诊1例.13例首次内镜下止血成功未发生再出血,3例再次行内镜止血,短期内未出血.7例患者行手术治疗.结论:内镜为诊断和治疗Dieulafoy病的首选方法,对治疗失败者可再行外科手术或栓塞治疗.     

胃Dieulafoy病的内镜诊治5例

目的：探讨胃Dieulafou病的病因、诊断和治疗。方法：发病24小时内行急诊胃镜检查；治疗为胃镜下高频电凝。结果：5例均在出血24小时内行胃镜下电凝止血治疗，4例出血停止，1例于24小时后再次出血转外科手术治疗。结论：胃镜检查和镜下止血是诊断和治疗胃Dieulafoy病的主要方法。     

Dieulafoy 病的诊断与治疗(附17例报告)

目的 分析Dieulafoy病引起消化道大出血的发病机制,探讨其临床特点和诊断、治疗方法.方法 回顾性分析10年间经内镜、消化道造影及实验室检查和/或手术、病理确诊的17例患者的临床资料.结果 17例确诊为Dieulafoy病的住院患者均行急诊胃镜检查,阳性9例,其中2例为胃镜复查阳性;结肠镜检查9例,阳性6例;血管造影2例,阳性1例;胶囊内镜检查1例阳性.手术治疗小肠Dieulafoy病2例,其余内镜下止血治疗均一次成功.所有患者出血停止出院.结论 消化道大出血是Dieulafoy病的主要临床表现,其诊断主要依靠内镜检查和血管造影,确诊须靠手术和病理诊断.内镜诊断和治疗是Dieulafoy病诊治的首选方法.内镜治疗安全方便,创伤小;手术对Dieulafoy病的治疗仅适用于多次内镜治疗无效、小肠血管畸形以及诊断未明而大量反复出血患者.     

Dieulafoy's lesion: management and long-term outcome

BACKGROUND AND STUDY AIMS: Dieulafoy's lesion is usually considered to be a rare cause of gastrointestinal bleeding and little information is available about the long-term follow-up of this condition. We studied the clinical pattern and long-term outcome in patients with Dieulafoy's lesion who were managed in a gastrointestinal intensive care unit. PATIENTS AND METHODS: We reviewed the data on the diagnosis, treatment, and outcome of 70 patients admitted to our unit for acute upper gastrointestinal bleeding due to Dieulafoy's lesion. Endoscopic hemostasis was performed in 69 cases. Patients underwent surgery if endoscopic therapy failed. A phone interview was carried out to assess the long-term clinical outcome. RESULTS: Dieulafoy's lesion accounted for 4 % of cases of upper gastrointestinal bleeding in patients admitted during the period studied. The mean number +/- SD of endoscopies required to establish the diagnosis was 1.4 +/- 0.75. Endoscopic hemostasis was initially successful in 91.3 % of patients, while nearly 16 % of patients required surgery because endoscopic therapy failed. The overall mortality rate was 8.6 %. None of the 52 patients who were followed up by phone reported recurrent bleeding after discharge from hospital, in a mean follow-up period of 69 months. CONCLUSIONS: Dieulafoy's lesion is a not uncommon cause of severe recurrent gastrointestinal bleeding. Endoscopic therapy is safe and effective in achieving permanent hemostasis. The long-term prognosis for Dieulafoy's lesion is excellent, even when patients are treated using endoscopic methods alone.     

经内镜金属钛夹治疗消化道急性大出血

目的 探讨经内镜金属钛夹治疗消化道急性出血的适应证、疗效及安全性.方法 使用Olympus HX-600-135型钛夹治疗非静脉曲张性消化道急性大出血患者94例.结果 94例中即时止血率91.5%（86/94）,止血后再发出血率仅2.3%（2/86）.结论 内镜钛夹治疗各种非静脉曲张性消化道急性大出血是一种安全、有效、经济、简便的治疗措施.     

A prospective, randomized trial of endoscopic band ligation versus endoscopic hemoclip placement for bleeding gastric Dieulafoy's lesions

BACKGROUND AND STUDY AIMS: Dieulafoy's lesion is a rare cause of massive gastrointestinal hemorrhage, most commonly in the proximal stomach. Mechanical endoscopic methods have recently become the standard therapeutic approach. However, there have been few studies comparing the efficacy of different mechanical endoscopic methods in treating gastric Dieulafoy's lesions. This study was therefore carried out to compare the hemostatic efficacy and safety of endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP) in the treatment of bleeding gastric Dieulafoy's lesions. PATIENTS AND METHODS: Between January 2002 and October 2003, 26 consecutive patients with bleeding gastric Dieulafoy's lesions were prospectively enrolled and were randomly assigned to undergo EBL (13 patients) or EHP (13 patients). Demographic characteristics, endoscopic variables, and outcome parameters, including rates of hemostasis and recurrent bleeding, were analyzed. RESULTS: One O-ring was applied in each case in the EBL group, and the median number of hemoclips applied was one (range one to four) in the EHP group. There were no significant differences between the groups with regard to age, sex, presence of shock, initial hemoglobin level, coagulopathy, concurrent diseases, location of the lesion, type of bleeding stigmata, blood transfusion requirements, or hospitalization periods. Primary hemostasis was achieved in all 26 patients. There was one case of recurrent bleeding in each group; secondary hemostasis was achieved with EBL in one of these patients and by endoscopic epinephrine injection in the other. There were no second episodes of recurrent bleeding, no procedure-related complications, no cases in which surgery was needed, and no bleeding-related deaths in either group. CONCLUSIONS: In this small study, no differences were detected in the efficacy or the safety of EBL vs. EHP in the management of bleeding gastric Dieulafoy's lesions.     

金属钛夹治疗急性消化道出血48例报告

目的 观察金属钛夹治疗急性消化道出血的疗效。方法 2001年6月-2003年9月随机急性消化道出血行急诊胃镜检查发现出血灶和内镜下治疗后即时大出血患者共计48例。其中男38例，女10例。上消化道出血30例，下消化道出血18例，发现出血灶后立即行钛夹止血，最多7枚，最少2枚，平均枚3．5枚。结果 48例共使用金属钛夹163枚，48h后再出血1例(金属钛夹已脱落)，再经内镜下钛夹止血成功。总有效率100％。结论 金属钛夹对急性血管性消化道出血是一种有效的止血方法，值得临床推广应用。     

内镜注射在治疗Dieulafoy病活动性出血的应用

目的观察内镜下黏膜内注射硬化剂治疗Dieulafoy病活动性出血的治疗效果。方法经胃镜检查而确诊的Dieulafoy病合并活动性出血的病人23例，在内镜下用注射针经内镜活检孔至出血部位，在出血部位周围1，2mm处注射3～5点，每点5为5．00％鱼肝油酸钠或1．00％乙氧硬化醇0．5～1．0ml，其中用5．00％鱼肝油酸钠11例，1．00％乙氧硬化醇12例。结果止血成功率达95．65％(22／23)。需要第二次内镜治疗成功者3例(0．13％)治疗失败者1例(占0．04％)。结论内镜下注射治疗可作为Dieulafoy病活动性出血的首选治疗方法之一进行推广应用。     

Dieulafoy's lesion of the esophagus correctly diagnosed and successfully treated by the endoscopic injection of N-butyl-2-cyanoacrylate

Dieulafoy's lesion is an arterial malformation in the subumucosal layer of the gastrointestinal tract that can cause massive bleeding. The esophagus is not a common location for this lesion. We present here a first report of Dieulafoy's lesion of the esophagus correctly diagnosed and successfully treated by the endoscopic injection of N-butyl-2-cyanoacrylate.