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。     

内镜下金属夹和注射硬化剂治疗消化性溃疡大出血

目的：探讨经内镜金属夹和注射硬化剂治疗消化性溃疡出血的临床价值。方法：对2005年1月-2008年1月89例经内镜金属夹和注射硬化剂治疗的消化性溃疡出血患者的临床资料进行回顾分析。结果：89例患者止血成功81例，初次治疗成功率为91．0％（81／89）。再出血8例，再次内镜下止血5例成功，3例治疗无效转外科手术治疗，总有效率为96．6％（86／89）。结论：内镜下金属夹和注射硬化剂治疗消化性溃疡出血是一种安全、有效的方法，可作为首选方法在临床上推广应用。     

Dieulafoy病致消化道出血18例临床特点和诊疗分析

[目的]探讨Dieulafoy病致消化道出血的临床特点及诊疗方法.[方法]分析2010年1月至2016年1月本院收治的18例Dieulafoy病患者的临床资料.[结果]18例患者均表现为消化道出血,其中以呕血和黑便为首发症状6例,呕血和暗红色血便2例,仅呕血6例,仅黑便4例.出血病灶位于胃体11例,胃窦2例,胃底1例,十二指肠球降交界处2例,十二指肠降部憩室内1例,十二指肠球部前壁1例.采用内镜下治疗15例,其中金属钛夹钳夹止血12例,硬化剂(聚桂醇)注射2例,金属钛夹联合硬化剂注射1例;15例中有12例止血成功,止血率为80％,3例治疗失败转外科手术治疗;单纯药物治疗2例,1例未行内镜治疗直接手术治疗.经以上治疗,18例中有17例治愈.[结论]Dieulafoy病以消化道大出血为主要表现,金属钛夹钳夹止血及硬化剂注射是首选治疗方法,对于内镜治疗失败患者,外科手术是重要的治疗手段.     

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病的内镜诊断和治疗

目的：探讨胃Dieulafoy病的内镜诊断和治疗方法。方法：回顾性分析作者自1994年1月～2002年6月经内镜诊断和治疗胃Dieulafoy病的临床资料。结果：12例均在入院后2h之内行急诊内镜检查，经一次检查确诊10例．二次检查确诊2例。经内镜局部喷洒0．1％去甲肾上腺素治疗博动性出血3例，仅1例暂时止血约12h后再出血。电凝治疗11例均止血成功。结论：急诊内镜是诊断胃Dieulafoy病的最佳手段，浅表溃烂伴博动性或喷射状出血是内镜诊断的主要依据，单独的暗红色血痂或黑褐小隆起是内镜诊断的重要线索。经内镜局部喷洒止血药疗效不佳，电凝是治疗该病的有效手段。     

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。     

内镜下HLE注射治疗Dieulafoy病

目的：介绍并探讨内镜下HLE治疗Dieulafoy病的方法。总结，分析该方法的临床效果。方法：采用内镜下注射高渗盐水 利多卡因 肾上腺素（HLE）治疗Dieulafoy病。结果：我院消化科自1997年3月-2001年10月对107例上消化道出血患者进行内镜下HLE注射治疗。其中Dieulafoy病18例，占16.82%，达到了满意的止血效果。结论：内镜下HLE注射是治疗Dieulafoy病的有效手段。     

内镜下注射止血联合氩离子凝固术治疗Dieulafoy病的护理

目的探讨内镜下注射止血联合氩离子凝固术治疗Dieulafoy病致上消化道出血的护理方法。方法2004年1月至2009年4月,对28例因Dieulafoy病变致上消化道出血的患者进行内镜下注射止血联合氩离子凝固术治疗及其相关护理配合。结果28例患者中,27例急诊止血成功（仅其中1例在术后第3大再出血转外科手术）,1例因出血凶猛直接急转外科手术治疗,治疗成功率为92．8％。结论内镜下注射止血联合氩离子凝固术治疗Dieulafoy病是一种简便易行、止血成功率高、并发症少的治疗方法,在治疗术前、术中、术后给予娴熟有效的护理配合。是治疗成功的重要保证。     

Endoscopic management and follow up of Dieulafoy lesion in the upper gastrointestinal tract

BACKGROUND AND STUDY AIMS: Dieulafoy's lesion is an important cause of upper gastrointestinal bleeding, and the safety and efficacy of endoscopic treatment have been widely accepted. The aim of this study was to evaluate the effectiveness of endoscopic management, including hemoclipping and injection methods, for bleeding Dieulafoy lesions in the upper gastrointestinal tract. PATIENTS AND METHODS: Between 1995 and 2003, 61 patients with bleeding Dieulafoy lesions underwent endoscopic treatment. The available hemostatic methods were hemoclipping, hypertonic saline-epinephrine injection, and pure ethanol injection. Clinical data, endoscopic features, and treatment outcome were analyzed retrospectively. RESULTS: Comorbid conditions were present in 39 patients (64 %). Active bleeding was noted in 20 patients (33 %). Hemoclipping was a selected treatment in 48 patients (79 %). Initial hemostasis was achieved in 61 patients (100 %). One patient had rebleeding 6 days after the initial procedure but was successfully treated endoscopically. The 30-day mortality was 0 %. During follow-up, for a mean of 47 months, 15 patients (25 %) died of causes unrelated to the Dieulafoy lesion. Two patients had recurrent bleeding due to non-Dieulafoy gastric ulcer, and responded to endoscopic therapy. We encountered no patients who required surgery. CONCLUSIONS: Dieulafoy lesion can be successfully managed by endoscopic treatment. The long-term outcome is acceptable.     

The usefulness of endoscopic hemoclipping for bleeding Dieulafoy lesions

BACKGROUND AND STUDY AIMS: Dieulafoy lesion is a rare cause of massive gastrointestinal hemorrhage, most commonly from the proximal stomach. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. However, the effectiveness of various endoscopic modalities in treating bleeding Dieulafoy lesion has been little studied. This study was therefore done to compare the hemostatic efficacy of endoscopic hemoclipping and epinephrine injection therapy. PATIENTS AND METHODS: Between January 1998 and December 2001, a consecutive series of 32 patients with bleeding Dieulafoy lesion underwent endoscopic treatment. They were randomly treated either by endoscopic epinephrine injection therapy (n = 16) or by hemoclipping (n = 16). We compared mortality rate, primary hemostasis rate, and rebleeding rate between two groups. RESULTS: There was no bleeding-related death in either group. There was no significant difference in primary hemostasis rates between the hemoclipping group (93.8 %) and epinephrine injection group (87.5 %, P = 1.00). There was a trend toward a lower rate of need for multiple endoscopic sessions to achieve permanent hemostasis in the hemoclipping group compared with the epinephrine injection group (6.3 % vs. 31.3 %, P = 0.086). Hemoclipping was significantly more effective in preventing recurrent bleeding than epinephrine injection therapy (0 % vs. 35.7 %, P < 0.05). With regard to lesion site, hemoclipping was significantly more effective in preventing recurrent bleeding of gastric body Dieulafoy lesion than epinephrine injection therapy (0 % vs. 50 %, P < 0.05). CONCLUSIONS: Bleeding from Dieulafoy lesion was well controlled by therapeutic endoscopic procedures. Hemoclipping was more effective for Dieulafoy lesion than epinephrine injection therapy, with less need for subsequent endoscopy.     

短期内反复内镜治疗难治性食管静脉曲张破裂大出血

目的：探讨食管静脉曲张破裂大出血急诊硬化治疗术后仍持续出血的再次内镜下处理。方法：52例食管静脉曲张破裂大出血首次硬化术后仍出血不止或于1周内再次大出血患者,插入二腔一囊管后牵拉,再次进行硬化或（和）组织黏合剂黏堵治疗。结果：再次硬化治疗41例,黏堵加硬化治疗11例,无效转外科手术1例,死亡2例。急诊止血率为94.2%。发生较重并发症7例。结论：内镜下反复硬化或（和）黏堵治疗是控制难治性食管静脉曲张破裂大出血的首选抢救措施。     

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。     

胃镜下金属钛夹治疗Dieulafoy病变出血的临床研究

目的探讨胃镜下金属钛夹治疗Dieulafoy病变出血的临床效果。方法 34例Dieulafoy病变出血患者随机分为两组,观察组采用胃镜下放置金属钛夹治疗,对照组采用硬化剂注射治疗,比较观两组患者的治疗效果。结果两组患者在早期止血率、远期止血率、转外科手术率以及住院时间方面差异均无显著性(P>0.05),观察组再出血率明显低于对照组,差异具有统计学意义(P<0.05)。结论胃镜下放置金属钛夹治疗Dieulafoy病变出血是一种积极有效地方法,对预防再出血具有较大的优势。     

Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis

BACKGROUND AND STUDY AIMS: Endoscopic injection sclerotherapy (EIS) using cyanoacrylate and balloon-occluded retrograde transvenous obliteration (B-RTO) are the main procedures used to treat gastric varices. However, neither technique is free of problems. EIS for gastric varices may cause embolism in other organs; B-RTO requires a gastrorenal shunt and may aggravate esophageal varices. We have developed a combined form of endoscopic therapy involving band ligation and sclerotherapy which is an effective and safe procedure for treating gastric varices. PATIENTS AND METHODS: Fifty-six patients with gastric varices and liver cirrhosis were treated at Almeida Memorial Hospital from June 1997 to May 2002 using the combined procedure. Each gastric varix was tightly ligated with O-rings, and 1 % polidocanol was injected into the submucosa around the ligated varix. If necessary, additional sclerotherapy was carried out after the initial treatment. RESULTS: The rate of hemostasis for variceal bleeding was 100 %, and no critical complications were noted. Complete disappearance of the gastric varices was observed endoscopically in all cases. Computed tomography showed that collateral vessels outside the gastric wall were not occluded by the treatment. Endoscopic follow-up examinations were carried out, and gastric varices recurred in seven patients (12.5 %). Only two of the patients (3.6 %) had a small amount of oozing bleeding. Additional endoscopic variceal ligation (EVL) and/or EIS were performed in these seven cases, and none of the patients died as a result of a bleeding gastric varix. CONCLUSIONS: The combined procedure was easily performed immediately after endoscopic examination, and required no special apparatus. It was found to be a safe and effective method of treating gastric varices.     

上消化道Dieulafoy病诊断治疗13例分析

目的　探讨上消化道 Dieulafoy病的诊断和治疗方法。方法　回顾性分析自 1993- 0 1～ 2 0 0 2 - 0 1收治的 13例 Dieulafoy病的临床资料。结果　 Dieulafoy病发生于胃底 7例 ,胃体近贲门小弯侧 3例 ,大弯侧 1例 ,十二指肠球部 1例 ,十二指肠降部 1例。主要表现为突发间歇性大量呕血、黑便和休克。 13例均通过急诊胃镜检查确诊 ,其中术后病理证实 2例。13例均行内镜下止血治疗 ,止血 11例 ,2例胃底 Dieulafoy病镜下止血失败转外科手术。结论　出血后尽快急诊胃镜检查是确诊本病的首选方法。治疗上可先行内镜下止血治疗 ,内镜止血后仍反复出血 ,特别是病灶位于胃底者 ,应及时转外科手术