急诊绿色通道内镜联合选择性动脉造影诊治消化道大出血12例临床应用

目的探讨急诊绿色通道内镜联合选择性动脉造影在消化道大出血诊治中的临床价值。方法对我院消化内科2008年1月1日-2011年12月31日经急诊绿色通道,急诊内镜联合选择性动脉造影救治的消化道大出血12例患者进行临床分析,分别观察出血部位、病因的诊断情况以及止血效果。结果急诊内镜明确出血部位和病因者7例,其中十二指肠球部溃疡3例。Dieulafoy病4例．内镜下给予钛夹止血或药物喷洒止血治疗仍有活动性出血随即选择性动脉造影血管栓塞治疗;3例急诊内镜检查后初步确定为小肠出血,随后选择性动脉造影证实而转外科择期手术。术后证实其中2例为小肠憩室,1例为小肠间质瘤;另2例无法完善内镜检查,行血管造影栓塞止血后,内镜进一步诊治,其中1例为急性出血性直肠溃疡综合征,1例为贲门黏膜撕裂综合征,底部深溃疡。选择性动脉造影显示典型造影剂溢出征9例。异常血管分支增粗紊乱间接征象3例。本组12例在选择性动脉造影同时结合内镜检查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。结论急诊绿色通道并内镜联合选择性动脉造影诊治消化道大出血,协同互补,是一种及时。安全、有效的诊治方法,亦能为手术做好定位准备。     

急诊内镜联合选择性动脉造影诊治上消化道大出血：7例临床分析

背景：上消化道大出血属急危重症,联合多种诊治手段有助于提高救治效果。目的：探讨急诊内镜联合选择性动脉造影在上消化道大出血诊治中的应用价值。方法：选取2009年1月～2010年12月北京军区总医院经急诊内镜止血失败或止血成功后再次大出血的7例患者并给予选择性动脉造影和栓塞治疗。观察急诊内镜联合选择性动脉造影对明确病因诊断和止血效果的价值。结果：7例患者行急诊内镜检查确诊为上消化道大出血．并经镜下止血治疗后仍有严重活动性出血．行选择性动脉造影和栓塞治疗。7例患者就诊后行急诊内镜的平均时间为4．4h．选择性动脉造影平均时间为8．4h。4例患者表现为造影剂外溢的出血直接征象．其余3例表现为异常血管分支增粗紊乱的间接征象;给予弹簧圈栓塞或明胶海绵栓塞治疗后均成功止血。结论：急诊内镜联合选择性动脉造影是一种及时、安全、有效的诊治上消化道大出血的方法。     

胰十二指肠动静脉畸形合并Dieulafoy病1例

Dieulafoy病与内脏动静脉畸形都是罕见的血管畸形病变,并且两者均为消化道出血的少见病因。1例上消化道大出血的病例经内镜检查和动脉造影检查明确诊断胰十二指肠动静脉畸形合并Dieulafoy病,在进行相应的内镜下止血和动脉造影介入栓塞治疗后出血停止,现报告其诊治情况。     

内镜下钛夹钳夹治疗Dieulafoy病出血的体会

目的观察Dieulafoy病内镜下钛夹止血的临床效果。方法对11例Dieulafoy病患者在内镜下确诊后即行钛夹止血,其中胃大部切除毕氏II术后吻合口4例,胃底1例,胃窦1例,胃底体交界2例,十二指肠球部2例,回肠末段1例。其中1例肝癌晚期合并重度食管静脉曲张。结果所有病例均在内镜下行钛夹止血,一次成功11例,其中1例第2天,1例第25d再次出血,行急诊胃镜见钛夹脱落再行钛夹止血成功。平均随访90d,未见复发。结论内镜下钛夹止血治疗Dieulafoy病疗效确切,组织损伤小,复发率低,值得开展推广应用。     

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.     

消化道大出血的急诊血管造影与介入治疗

目的:探讨消化道大出血的急诊血管造影与介入治疗的临床价值。方法:收集29 例消化道大出血患者,采用Seldinger技术经股动脉穿刺插管行选择性血管造影,根据出血病因及出血部位分别行出血动脉的栓塞或缩血管药物局部灌注治疗,对不能明确出血病因及出血部位者行试验性栓塞和/或灌注治疗。结果:本组血管造影有阳性发现21 例,主要表现为肿瘤性病变5 例、血管性病变5例、造影剂外溢和滞留11例。栓塞治疗18例,即刻止血率94.4%(17/18);灌注缩血管药物6例,即刻止血4 例;试验性栓塞和/或灌注治疗5 例,即刻止血2 例。结论:消化道大出血在急诊血管造影的基础上行选择性出血动脉栓塞或缩血管药物灌注治疗是安全有效的止血措施,血管造影对出血病因及出血部位的检出具有重要意义。     

16例Dieulafoy病的急诊胃镜诊疗分析

目的:分析急诊胃镜在Dieulafoy病诊疗方面的作用。方法:回顾性分析16例Dieulafoy病患者的临床资料及急诊胃镜诊疗结果。结果:15例首次急诊胃镜明确诊断并给予止血夹、注射或联合止血治疗,其中14例一次性成功止血,1例2次内镜成功止血,另1例经急诊胃镜治疗后仍有少量出血转外科行贲门下病灶楔形切除术后止血,未出现相关并发症。结论:对Dieulafoy病诊断治疗,急诊胃镜是简便、安全、有效的方法。     

内镜下治疗22例Dieulafoy病操作体会

Dieulafoy病又名胃黏膜下恒径动脉破裂出血.本病因动脉突出于黏膜破损处,出血量大,药物治疗效果差,常危及患者生命.本病发病率较低,近年来随着对本病的认识及内镜技术的提高,报道逐渐增多.我院近5年来对22例:Dieulafoy病行内镜下金属钛夹联合氩离子凝固术(APC)治疗,取得了满意的止血效果.     

内镜下钛夹联合氯化钠、利多卡因和肾上腺素注射治疗Dieulafoy病临床分析

Dieulafoy病伴出血的处理首选内镜下止血,而内镜下操作技术较多,药物注射最为简单廉价,钛夹的应用近年来发展较快[1].本研究回顾我院58例Dieulafoy病的内镜下治疗的临床资料,并进一步分析钛夹联合氯化钠、利多卡因和肾上腺素注射治疗的临床意义.     

16例Dieulafoy病的急诊胃镜诊疗分析福建医科大学附属漳州市医院消化内科 赖亚栋 陈俊杰 许秋泳 林淑惠 刘麒樱 陈雪芬

目的：分析急诊胃镜在Dieulafoy病诊疗方面的作用。方法：回顾性分析2004年1月-2014年12月,求诊我科的16例Dieulafoy病的临床特点,急诊胃镜诊疗成功率等。结果：15/16例首次急诊胃镜明确诊断并给予止血夹、注射或联合止血治疗,1/16例经二次内镜得到诊疗,14例一次性成功止血,1例二次内镜成功止血,1例急诊胃镜经注射后转外科追加手术后无再出血,未出现相关并发症。结论：对 Dieulafoy病诊断治疗,急诊胃镜是简便、安全、有效的方法。 关键词： Dieulafoy病,急诊胃镜诊疗,分析     

急性小肠大出血5例诊治临床分析

目的通过对5例小肠急性大出血诊治过程的分析,探讨急诊消化内镜、选择性动脉造影、外科手术紧密协作的临床价值。方法我院消化内科2011年1月1日-2011年12月31日共收治不明原因消化道出血20例,对其中5例小肠急性大出血病例的救治过程进行分析、总结。结果 5例患者经常规胃镜及结肠镜检查均未见出血性病灶,4例经小肠镜检查发现病变后行手术治疗,其中2例在小肠镜检查过程中再发大出血,经急诊选择性动脉造影栓塞止血后,外科手术成功切除病变;1例大量便血患者经急诊结肠镜和急诊胃镜检查排除上消化道及结肠出血后,因患者失血量较大,无法耐受小肠镜检查,遂行紧急选择性动脉造影明确病变部位及大致性质后行手术治疗。5例小肠急性大出血中2例间质瘤、2例憩室病、1例血管畸形,均救治成功。结论急诊内镜、选择性动脉造影和外科手术的紧密协作,能够安全有效地救治小肠急性大出血,另外内外科紧密配合是患者得以成功救治的关键。     

Dieulafoy病大出血内镜治疗效果比较(附152例分析)

目的比较Dieulafoy病大出血的内镜治疗效果。方法对国内15家医院自1992~2002年报告的经内镜确诊的152例Dieulafoy病进行分析,并对内镜治疗的2种主要方法———注射治疗和电凝治疗进行比较。结果152例Dieulafoy病患者经内镜治疗144例次,手术治疗29例。内镜治疗包括注射治疗88例,成功72例,止血率81.82%(72/88);电凝治疗32例,止血28例,止血率87.5%(28/32)。结论经内镜治疗现已为一线疗法,主要常用有注射疗法和电凝治疗,2者对本病治疗效果无显著性差异(P>0.05)。     

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.     

Endoscopic treatment of Dieulafoy's disease

The "exulceratio simplex Dieulafoy" is an uncommon and dangerous cause of upper gastrointestinal hemorrhage. In all patients admitted to our hospital with signs of acute gastrointestinal hemorrhage in whom Dieulafoy's disease was diagnosed at emergency endoscopy, an attempt was made to stop the bleeding or to prevent further hemorrhage by local injection of polidocanol, or by bipolar electrocoagulation, or by a combination of both. Since 1979 an exulceratio simplex has been diagnosed in 22 patients. All patients were treated endoscopically, 18 of them with satisfactory results. Four patients had to be operated on after emergency endoscopy had failed. Knowing the location of the bleeding site, the operations could be planned exactly and performed quickly. All patients, whether they had undergone endoscopic or surgical treatment, made an uncomplicated recovery and none had a further bleeding episode after discharge from the hospital.     

Dieulafoy lesions: a review of 6 years of experience at a tertiary referral center

Dieulafoy lesions are uncommon sources of GI hemorrhage and predominantly occur in the proximal stomach. At one time a pathological diagnosis made postoperatively, Dieulafoy lesions are now routinely diagnosed and treated endoscopically. Their true incidence is unclear as quiescent Dieulafoy lesions are easily overlooked on endoscopy and bleeding lesions are occasionally misidentified. Over 6 yr (June 1993-November 1999), 40 Dieulafoy lesions were identified on upper endoscopy at our institution, of which seven were located in the duodenum and one in the right colon. Forty-seven percent of patients were hospitalized for other causes before onset of bleeding, and 17 of 40 were found to have other abnormal findings at endoscopy. In 90% of the cases, endoscopic treatment was successful. Seven patients died, but none as a result of hemorrhage. In 24 endoscopically-treated patients in whom follow-up data are available, Dieulafoy bleeding recurred in one patient. Dieulafoy lesions are rare and often difficult to diagnose, but must be considered in the evaluation of upper and lower GI tract hemorrhage, as they can usually be managed endoscopically.     

急性非静脉曲张性上消化道出血临床分析

目的分析非静脉曲张性上消化道出血的临床特征。方法回顾分析我院消化内科2009年1月-2011年12月期间收治的经胃镜证实的301例非静脉曲张性上消化道出血病例,分析总结非静脉曲张性上消化道出血的常见病因及临床诊治情况。结果非静脉曲张性上消化道出血的常见病因依次为消化性溃疡、消化道肿瘤、急性胃黏膜病变,内科保守治疗的有效率为96.35%(290/301),内镜下止血成功率93.55%(58/62)。结论消化性溃疡是非静脉曲张性上消化道出血最常见的病因。在消化道出血的救治中,急诊内镜、选择性血管造影以及内外科的紧密配合与协作发挥着重要作用。     

杜氏病的诊断及治疗

对我院10年来收治的15例杜氏病（Dieulafoy disease）进行回顾性分析。结果显示11例内镜下治疗成功止血,3例行DSA治疗,1例手术治疗。急诊内镜检查是杜氏病主要的诊断手段,内镜下治疗是目前杜氏病首选的治疗方法。     

Dieulafoy's lesion of the small bowel causing massive gastrointestinal bleeding: two case reports and literature review

Dieulafoy's lesions are an often unrecognized cause of obscure, massive GI hemorrhage. Their diagnosis may elude conventional investigations, including upper and lower endoscopy, arteriography, and even laparotomy. In this paper, we report two cases of small-bowel Dieulafoy lesions. The first, a jejunal lesion, occurred in a young patient and was discovered at laparotomy. The second was an ileal Dieulafoy's malformation in an older patient. An intraoperative endoscopy with surgical guidance may be needed for definitive localization of this lesion.     

支气管Dieulafoy病1例并文献复习

目的 介绍1例支气管Dieulafoy病并复习国内外文献,以提高对这一少见病的认识.方法 对1例确诊为支气管Dieulafoy病患者的临床表现及检查结果进行分析,并结合文献讨论其临床特点、诊断及治疗.结果 支气管Dieulafoy病是一种病因尚未明确的以支气管黏膜下畸形动脉破裂出血为病理特征的罕见疾病,临床常见表现为反...