Dieulafoy病的诊断与治疗

目的探讨Dieulafoy病的诊断与治疗。方法总结国内近10年来公开报道的389例Dieulafoy病加以综合分析。结果389例患者男女之比为4.2:1,中位年龄45.7岁,主要表现为突发性反复大量呕血、黑便及休克。内镜检查确诊率为87.4%,病灶位于食管10例,胃322例,十二指肠43例,空肠11例,结肠3例。内镜治疗止血率为73.9%,各种治疗的总止血率为95.9%,死亡率4.1%。结论内镜是确诊和治疗本病的首选方法,及时、仔细检查是内镜诊断的关健。     

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病在中国的诊治现状--国内文献分析

Dieulafoy病病灶较隐匿，临床上易漏诊或误诊。目的：分析Dieulafoy病的临床特点等因素，探讨其发病机制、诊断方法和有效治疗措施，以提高对该病的认识。方法：复习1994～2003年国内相关文献41篇，对463例Dieulafoy病例进行回顾分析。结果：463例Dieulafoy病患者的男女比例为3．8：1，发病年龄11～83岁，平均年龄47．4岁。部分文献显示，在同期因上消化道大出血而行内镜检查的患者中，Dieulafoy病的检出率为0．8％～2．6％。86．4％的患者经内镜检查确诊．其余病例经手术或血管造影确诊。病灶分布最多见于贲门周围的胃壁(包括胃体上部和胃底)，病理特征为黏膜下恒径小动脉破损，周围黏膜正常。内镜治疗止血成功率为82.8％，各种治疗的总止血率为97．2％，2．8％的患者因该病而死亡。结论：Dieulafoy病是消化道大出血的少见原因之一，急诊内镜检查是主要的诊断方法．提高对该病的认识和仔细的内镜检查是及时、准确诊断的关键，内镜治疗是首选的有效治疗措施。     

Dieulafoy病四例

Dieulafoy病是临床上引起严重上消化道出血的少见病因之一.我院1994～1996年3年中收住因大量呕血和(或)黑便,经胃镜及手术诊断Dieulafoy病4例.现将临床资料分析如下.     

Dieulafoy病:一种并非罕见的临床难题-结合文献附225例分析

我院于1993～2001年共发现Dieulafoy病4例,均为男性,年龄分别为43岁、48岁、31岁,29岁.诱因不明显,急性起病,反复呕血及黑便,均有失血性休克,2例一次性剖腹探查确诊,1例本院二次剖腹探查未确诊,后在山东省立医院内镜确诊,1例于第二次术中内镜确诊.     

Dieulafoy病11例回顾分析

Dieulafoy病是引起上消化道大出血的一种少见的病因,国内报道的一组上消化道出血的病例中本病约占0.37%[1].由于临床表现无特异性故诊断比较困难,确诊主要依靠急诊胃镜或手术证实.现对我科自1987年以来经胃镜诊断、手术证实的11例Dieulafoy病进行回顾性分析,以期提高对该病的认识和诊断水平.     

Dieulafoy病：一种并非罕见的临床难题一结合文献附225例分析

我院于1993～2001年共发现Dieulafoy病4例,均为男性,年龄分别为43岁、48岁、31岁,29岁。诱因不明显,急性起病,反复呕血及黑便,均有失血性休克,2例一次性剖腹探查确诊,1例本院二次剖腹探查未确诊,后在山东省立医院内镜确诊,1例于第二次术中内镜确诊。术前胃镜均未确诊,均手术治愈,至今无1例复发。Dieulafoy病是一种并非罕见的消化道出血性疾病,由于病灶小,位置特殊,发病突然,病情严重,被认为是威胁生命最严重的消化道出血原因之一,近年来     

无痛性溃疡127例临床分析

消化性溃疡是临床常见病 ,其典型的临床表现是节律性上腹部疼痛 ,部分患者则无疼痛的症状 ,称无痛性溃疡。现总结 1998- 0 1～ 2 0 0 4 - 0 8于我院经电子胃镜诊断的 15 32例良性溃疡和外科急诊手术的胃及十二指肠溃疡穿孔 32例病人中 ,共检出无痛性溃疡 12 7例 ,其溃疡特点及临床表现报道如下。　　临床资料 :12 7例中 ,男 72例 ,女 5 5例 ,年龄 2 4～ 76岁 ,平均年龄 5 4岁 ,其中 <4 0岁 14例 ,占 11% ,4 0～ 5 9岁 4 7例 ,占 38% ,>6 0岁 6 6例 ,占 5 2 %。临床表现 :以呕血或黑便就诊者共 6 6例 ,以单纯呕血或黑便者 4 6例 ,伴肝硬化 8…     

十二指肠良性肿瘤的特点、诊断及治疗

十二指肠良性肿瘤临床少见 ,文献报道较少 ,易被忽视、漏诊或误诊而造成严重后果。现将我院近 15年来经内镜、手术及病理证实的 2 0例报道如下 ,并对其诊断及治疗进行探讨。一、一般资料2 0例病人中 ,男 12例 ,女 8例 ,年龄 18～ 81岁 ,平均 5 7岁。表现为上消化道出血 11例 ,其中 2例表现为突然大量呕血伴休克 ,9例表现为反复黑便伴贫血 ,病程 1～ 18年。中上腹隐痛不适 12例 ,腹块 2例。肿瘤所在部位 :十二指肠球部 4例 (占 2 0 % )、降部 14例 (占 70 % )、横部 1例 (占 5 % )、升部 1例 (占 5 % )。胃镜检查 19例 ,17例获得确诊 ,另 2例…     

克罗恩病２０例临床诊治体会

克罗恩病(Ｃｒｏｈｎ’ｓＤｉｓｅａｓｅ,ＣＤ)是一种病因未明的消化道慢性肉芽肿性炎症性肠病,好发于末段回肠及邻近结肠,临床表现复杂,诊断较为困难,易造成误诊漏诊。现将本院确诊的20例患者的临床资料报道如下。临床资料1.一般情况:20例患者,男性13例,女性7例,年龄20～76岁,平均年龄为40.5岁,入院前病程短者7ｄ,长者3年。确诊时间平均1.76年,半年至1年14例,2年以上6例,手术治疗9例,内科治疗11例。本组20例均经手术、病理、结肠镜及钡剂灌肠明确诊断(手术加病理9例,结肠镜加病理检查16例,Ｘ线造影7例)。住院期间临床痊愈8例(手术切除病变…     

Clinical aspects and endoscopic management of gastrointestinal bleeding from Dieulafoy's lesion]

OBJECTIVE: the aim of the study was to assess the incidence, clinical presentation, location, and response to endoscopic therapy of gastrointestinal bleeding from Dieulafoy's lesion. MATERIAL AND METHOD: ALL consecutive episodes of gastrointestinal bleeding due to Dieulafoy's lesion seen between 2000 and 2006 were retrospectively reviewed. All main clinical and endoscopic data were collected: type and effectiveness of endoscopic therapy, rebleeding, complications, and mortality during hospitalization. RESULTS: WE found 41 patients, 26 males and 15 females, median age of 71.19 years. Dieulafoy's lesion accounted for 1.55% of all gastrointestinal bleeding episodes during the study period. The incidence of Dieulafoy's lesion was 2.2 cases/100.000 inhabitants/year. Active bleeding at endoscopy was present in 85.36%, and comorbidity in 92.68%. The stomach was the most frequent location (60.97%), followed by duodenum (29.26%). Endoscopic therapy achieved initial hemostasis in all cases. Three patients (7.31%) initially treated with epinephrine injection showed rebleeding and properly responded to a second session of endoscopic therapy. No surgery was needed. The mortality rate during hospitalization was 4.87%. CONCLUSIONS: Dieulafoy's lesion is an uncommon, but potentially severe cause of gastrointestinal bleeding. It may be found in any location within the gastrointestinal tract. Endoscopic therapy is effective and safe. Injected epinephrine alone is associated with a higher risk of rebleeding.     

Dieulafoy's lesion

A review of 177 cases of upper gastrointestinal hemorrhage due to Dieulafoy's lesion is reported. Dieulafoy's lesion is frequently responsible for severe and recurrent upper gastrointestinal hemorrhage. The lesion was predominantly found in the proximal stomach. Repeat endoscopies were needed in 33% of the patients in order to make the correct diagnosis. When preoperative diagnosis and localization were made, surgery was an effective therapeutic modality. Therapeutic endoscopy was successful in achieving permanent hemostasis in 85% of the reported cases. Re-treatment was needed in an additional 10% and surgical therapy in 5% of the cases. Therapeutic endoscopy should be considered initially in all patients. Surgical intervention and angiography with embolization may be effective options if endoscopic therapy is unsuccessful.     

Clinical presentation and endoscopic management of Dieulafoy＇s lesions in an urban community hospital

AIM: To identify rates of occurrence, common clinical and endoscopic features, and to review the outcome of endoscopic management of Dieulafoy's lesions in the upper gastrointestinal (GI) tract in an urban community hospital setting. METHODS: Endoscopic data from esophagogastroduodenoscopies (EGDs), done at Wyckoff Heights Medical Center, Brooklyn, NY between 2000 and 2006 were reviewed to identify patients with Dieulafoy's lesions. Demographic data, medical history, examination findings, lab data, endoscopic findings and details of therapy for patients treated for Dieulafoy's lesions were reviewed retrospectively. RESULTS: Dieulafoy's lesions were documented to be the cause of bleeding in approximately 1% of patients presenting with upper gastrointestinal bleeding, while they were detected in only 2 patients when the indications for EGDs were different from active GI bleeding. When we analyzed EGDs performed in patients above age 65 years presenting with gastrointestinal bleeding, prevalence of Dieulafoy's lesions approached 10 percent. The most common location of the lesion was the body of stomach (7), followed by the cardia (4) and the esophagus (2). One patient had this lesion in the fundus and one patient in the duodenal apex. All patients were initially treated endoscopically with epinephrine injection, in eight cases heater probe was applied following epinephrine and endoscopic clips were applied in two cases. All but one of the patients did well in near and intermediate term follow-up (average follow-up period of 18 mo). One patient died of multi-organ failure during the same hospital stay. Average length hospital stay was 7 d. CONCLUSION: Community hospital gastroenterologists and endoscopists should be aware that Dieulafoy's lesions are an uncommon cause of upper GI bleeding among elderly patients. Early accurate diagnosis through emergent endoscopy and endoscopic therapy, especially in patients with multiple co-morbid conditions, can be very effective and life saving.     

Outcomes of endoscopic treatment of gastroduodenal Dieulafoy's lesion with rubber band ligation and thermal/injection therapy

BACKGROUND: Dieulafoy's lesion is a rare but important cause of upper gastrointestinal bleeding. Current endoscopic methods used to treat Dieulafoy's lesion include injection, with or without thermal methods, and mechanical methods. The latter include variceal ligation and hemoclips. There are no studies comparing the outcomes of rubber band ligation and injection with or without thermal therapy. AIM: To report the outcomes of Dieulafoy's lesion treated endoscopically with rubber band ligation and injection with or without thermal therapy at a single institution. METHODS: Patients with the diagnosis of Dieulafoy's lesion treated endoscopically at the Carl T. Hayden VA Medical Center in Phoenix, between August 1994 and August 2002 were analyzed. Demographic data, mode of presentation, risk factors for gastrointestinal bleeding, hemodynamic parameters, blood transfusion requirements, endoscopic findings, details of endoscopic therapy, length of stay in ICU/hospital, complications, recurrence of bleeding, and mortality rates were collected and compared between those receiving endoscopic band ligation (EBL group) and those receiving injection with or without thermal therapy (non-EBL group). RESULTS: Twenty-three patients with Dieulafoy's lesion (14 in the EBL group and nine in the non-EBL group) were studied. All patients were men. The mean age, hemoglobin levels on admission, and the transfusion requirements before therapy were similar in both groups. Fourteen patients (eight in the EBL- and six in the non-EBL groups) presented with hematemesis and the remaining with melena. The majority of Dieulafoy's lesions (91.3%) were located in the stomach and two in the duodenum. Active bleeding at the time of endoscopy was seen in 61% of cases, and immediate hemostasis was achieved with either method in 100% of patients. Early rebleeding (within 72 hours of endoscopic therapy) occurred in only one patient treated with epinephrine plus heater probe therapy. The length of stay in ICU was longer in the non-EBL group (6.7 days) compared with the EBL group (1.8 days) (P = 0.2). There were six deaths (three in the non-EBL group and three in the EBL group) within 30 days of the index hospitalization. The causes of death included infection/sepsis (n = 3), complications of acute myocardial infarction (n = 2), and end-stage liver disease (n = 1). CONCLUSIONS: Endoscopic rubber band ligation is as effective as injection with or without thermal therapy in the treatment of Dieulafoy's lesion.     

Endoscopic injection therapy of bleeding Dieulafoy lesion of the stomach

BACKGROUND/AIMS: Dieulafoy's lesion is a rare cause of upper gastrointestinal bleeding and is potentially life threatening. The aim of this study is to determine the clinical features of these lesions and the efficacy of the endoscopic injection sclerotherapy in patients with Dieulafoy's lesion. METHODOLOGY: Between January 1994 and December 2001, twenty-eight patients with upper gastrointestinal bleeding due to Dieulafoy's lesion were treated by endoscopic injection sclerotherapy. Efficacy of endoscopic therapy and clinical findings of these cases were analyzed. RESULTS: The study group consisted of 22 male (78.5%) and 6 female (21.5%) patients with a mean age of 57 years (range 22-82 years). Significant comorbidity was present in 22 (78.5%) patients. Hemoglobin values of the patients ranged from 5.4-10.3 g/dL at hospitalization. The median transfusion requirement was 5 (range 0-12) units. Dieulafoy's lesion was observed in the proximal half of stomach in 25 cases (89.3%), in the antrum in 2 cases (7.1%) and in the angulus in 1 case (3.5%). Endoscopic injection sclerotherapy was successful in stopping the bleeding in 26 out of 28 patients (92.8%). CONCLUSIONS: Dieulafoy's lesions mostly affect the proximal stomach and cause serious upper gastrointestinal bleeding. Endoscopic injection sclerotherapy is an effective and a safe therapeutic method for Dieulafoy's lesion.     

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.     

Massive Rectal Bleeding from a Dieulafoy''s Type Ulcer of the Rectum: A Review of This Unusual Disease

Dieulafoy's ulcer is an uncommon lesion that usually presents with massive bleeding. Although it has been observed, for the most part, in the stomach, it has also been identified in the small bowel and colon. Both endoscopy and angiography have been used for diagnosis; however, endoscopy has had a high failure rate for localizing colonic disease during active bleeding. Treatment has been primarily surgical, but endoscopic coagulation and sclerotherapy have been recently employed. A 20-year-old male presented with massive lower gastrointestinal bleeding, which was found to be caused by a Dieulafoy's ulcer in the rectum. Observation of Dieulafoy's ulcer in the rectum has not been reported previously. Diagnosis was by rigid sigmoidoscopy. This lesion was treated by widely oversewing the vessel after endoscopic therapy failed. The etiology of this lesion is most likely congenital. Hemorrhage probably occurs as a result of mechanical damage of the mucosa, combined with erosion of the vessel by fecal flow. Unlike colonic Dieulafoy's ulcers, it should be possible to diagnose rectal lesions by rigid sigmoidoscopy. This diagnosis may be difficult with high rectal ulcers, and angiography may have to be employed. Endoscopic therapy failed here, as in other reports on colonic disease. Thus, we would recommend widely oversewing rectal lesions as the primary treatment. Resection should be reserved for cases that have failed this therapy.     

Endoscopic treatment and follow-up of gastrointestinal Dieulafoy＇s lesions

AIM: To investigate retrospectively the clinical and endoscopic features of bleeding Dieulafoy's lesions and to assess the short- and long-term effectiveness of endoscopic treatment. METHODS: Twenty-three patients who had gastrointestinal bleeding from Dieulafoy's lesions underwent endoscopic therapy. Demographic data, mode of presentation, risk factors for gastrointestinal bleeding, blood transfusion requirements, endoscopic findings, details of endoscopic therapy, recurrence of bleeding, and mortality rates were collected and analyzed retrospectively. RESULTS: Hemostasis was attempted by dextrose 50% plus epinephrine in 10 patients, hemoclipping in 8 patients, heater probe in 2 patients and ethanolamine oleate in 2 patients. Comorbid conditions were present in 17 patients (74%). Overall permanent hemostasis was achieved in 18 patients (78%). Initial hemostasis was successful with no recurrent bleeding in patients treated with hemoclipping, heater probe or ethanolamine injection. In the group of patients who received dextrose 50% plus epinephrine injection treatment, four (40%) had recurrent bleeding and one (10%) had unsuccessful initial hemostasis. Of the four patients who had rebleeding, three had unsuccessful hemostasis with similar treatment. Surgical treatment was required in five patients (22%) owing to uncontrolled bleeding, recurrent bleeding with unsuccessful retreatment and inability to approach the lesion. One patient (4.3%) died of sepsis after operation during hospitalization. There were no side-effects related to endoscopic therapy. None of the patients in whom permanent hemostasis was achieved presented with rebleeding from Dieulafoy's lesion over a mean long-term follow-up of 29.8 mo. CONCLUSION: Bleeding from Dieulafoy's lesions can be managed successfully by endoscopic methods, which should be regarded as the first choice. Endoscopic hemoclipping therapy is recommended for bleeding Dieulafoy's lesions.     

Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

AIM： To investigate acute nonvariceal bleeding in the upper gastrointestinal （GI） tract and evaluate the effects of endoscopic hemoclipping. METHODS： Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. RESULTS： The 68 cases （male：female = 42：26, age from 9 to 70 years, average 54.4） presented with hernatemesis in 26 cases （38.2%）, melena in nine cases （13.3%）, and both in 33 cases （48.5%）. The causes of the bleeding included gastric ulcer （29 cases）, duodenal ulcer （11 cases）, Dieulafoy＇s lesion （11 cases）, Mallory-Weiss syndrome （six cases）, post-operative （three cases）, post-polypectomy bleeding （five cases）, and post-sphincterotomy bleeding （three cases）; 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery （three cases had peptic ulcers, one had Dieulafoy＇s lesion, and two were caused by sphincterotomy）; three patients died （two had Dieulafoy＇s lesion and one was caused by sphincterotomy）; and one had recurrent bleeding with Dieulafoy＇s lesion 10 mo later, but in a different location. CONCLUSION： Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.     

Clinical features and endoscopic management of Dieulafoy's disease.

The experience of a specialized management team using urgent endoscopy in the management of acute gastrointestinal bleeding from Dieulafoy's disease is presented. Dieulafoy's disease was found in 19 of 1124 consecutive patients with upper gastrointestinal bleeding. Most patients with Dieulafoy's disease were elderly men with severe acute upper gastrointestinal hemorrhage. Endoscopic diagnosis was possible in all patients, but required multiple endoscopies in 37%. The lesions were in the proximal stomach (79%) and duodenal bulb (21%). Endoscopic therapy included epinephrine injection, then heater probe coagulation in 17 patients, bipolar electrocoagulation in 1, and Nd:YAG laser photocoagulation in 1. Endoscopic therapy was successful in 18 patients (95%); one patient had successful surgery after endoscopic therapy failed. There were no deaths due to bleeding and no endoscopic complications. Dieulafoy's disease is an unusual cause of acute gastrointestinal bleeding. Endoscopic diagnosis is sometimes difficult, but primary endoscopic therapy is safe, successful, and should be attempted.