内镜在Dieulafoy病诊断与治疗中的价值

目的探讨内镜在Dieulafoy病诊断与治疗中的价值. 方法回顾性分析我院1994年6月～2002年6月21例引起上消化道出血的Dieulafoy病的内镜下特征、治疗方法与效果. 结果 21例中15例(71.4%)为1次检查确诊,6例为2次或2次以上检查确诊.17例经内镜止血成功,首次治疗成功14例(66.7%),3例经2次内镜止血成功(14.3%);4例外科手术治疗(19.0%). 结论 Dieulafoy病的诊断与治疗,内镜为首选方法.     

23例Dieulafoy病的内镜诊断和治疗

目的探讨Dieulafoy病内镜下诊断和治疗的方法。方法回顾分析我科临床诊断明确的23例Dieulafoy病伴消化道出血患者的临床资料。结果急诊胃镜确诊19例,急诊肠镜确诊2例,血管造影检查确诊1例,剖腹探查术确诊1例。19例病变位于近端胃,1例位于胃窦,1例位于十二指肠,2例位于直肠。21例内镜确诊的患者行金属钛夹钳夹成功止血,血管造影确诊的患者经动脉内持续灌注垂体后叶素止血,剖腹探查术确诊的患者行单纯血管缝扎术止血。结论急诊内镜检查是诊断Dieulafoy病的首选方法,内镜下钛夹的合理使用是治疗本病的主要手段。     

内镜下治疗Dieulafoy病出血39例

目的观察内镜下治疗Dieulafoy病出血的疗效及安全性。方法 2004年6月～2009年6月我院对39例Dieulafoy病出血急诊行高张钠-肾上腺素液黏膜内注射联合射频及钛夹治疗。结果 36例经内镜止血成功,首次治疗成功34例(87.2%),2例经2次内镜止血成功(5.1%);3例外科手术治疗(7.7%)。内镜止血术后2～4周再行胃镜检查均未发现溃疡。39例随访0.5～5年,平均2年,均无再发出血。结论高张钠-肾上腺素液黏膜内注射联合射频及钛夹是治疗Dieulafoy病出血的一种较为安全有效的方法 。     

上消化道Dieulafoy病的诊断与治疗（附14例报告）

目的 探讨上消化道Dieulafoy病的诊断和治疗方法。方法 回顾性分析本院6年来收治的14例上消化道Dieulafoy病的临床资料：结果 Dieulafoy病发生于食管2例,胃底4例,胃体近贲门小弯侧7例,十二指肠球部1例。主要表现为突发间歇性的大量呕血、黑便和休克。14例均通过急诊胃镜检查确诊,其中3例术后病理证实。14例均行内镜下止血治疗,暂时止血宰100％。10例(71．4％）持久止血,3例胃底Dieulafoy病镜下止血后再出血,转外科手术,行术中胃镜定位病灶局部楔形切除治愈,1例放弃治疗死亡。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,应适时中转手术。术中胃镜定位,局部楔形切除病灶是胃底Dieulafoy病的首选术式。     

Dieulafoy病的微创诊治

目的 探讨Dieulafoy病的微创诊治方法。方法 分2个阶段回顾性分析1993至2003年收治的20例Dieulafoy病的临床资料。结果 第一阶段(1993至1995年)4例均误诊，采用传统的剖腹切开胃体探查，2例盲目进行胃大部切除术，1例剖腹探查4次，1例死亡。第二阶段(1996至2003年)16例，内镜确诊率100％，内镜临时止血率93．8％(15／16)，内镜硬化治疗持久止血率达91．7％(11／12)。联合术中胃镜指示病灶，行胃壁楔形切除5例，2例使用腹腔镜技术，均治愈。结论 内镜是Dieulafoy病诊断及治疗的首选，若内镜下止血失败，应及时中转手术，联合术中内镜、腹腔镜治疗，手术简单、微创，疗效可靠。     

胃Dieulafoy病15例诊治分析

目的探讨胃Dieulafoy病的微创诊治方法。方法对本组1993年～2003年收治的15例胃Dieulafoy病病人的临床资料进行回顾性分析。结果第一阶段(1993年～1995年,共4例病人)对该病认识不足,确诊率低,采用传统的剖腹切开胃体探查,手术出血多,2例盲目胃大切、1例剖腹4次、1例死亡。第二、第三阶段(1996年～2003年,共11例病人)总结第一阶段的经验,胃镜的确诊率100%,胃镜临时止血率100%,胃镜硬化治疗持久止血率达80%。术中联合胃镜指示病灶,行胃壁楔形切除(2例使用腹腔镜技术),无1例死亡。结论胃镜是胃Dieulafoy病诊断及治疗的首选,若胃镜下止血效果不确切,应及时中转手术。术中联合胃镜、腹腔镜治疗具有手术简单、微创、无污染腹腔、疗效可靠。     

Dieulafoy病21例临床分析

目的探讨Dieulafoy病的病因、临床表现、诊断及治疗。方法回顾性分析笔者所在医院于1998-2014年期间收治的21例Dieulafoy病患A的临床资料。结果 21例Dieulafoy病患者的发病诱因:饮酒6例,长期服用非甾体类抗炎药6例,食辛辣食物刺激5例,精神刺激1例,其余3例无诱闪临床表现:均突发起病,17例表现为呕血及大量黑便,3例表现为大量呕血,1例仅表现为黑便。所有病例入院后行急诊胃镜检查,确诊20例,1例漏诊病变位于胃底部4例,位于胃体近贲门小弯侧13例,位于胃角2例,位于十二指肠球部2例。20例行内镜下止血治疗,15例经内镜下止血成功,5例失败,内镜止血成功的15例患者获访8~20个月,中位数为14个月,随访期间均未再出6例行外科手术治疗,包括胃镜引导下腹腔镜胃楔形切除3例,胃镜引导下腹腔镜单纯血管缝扎1例,开腹胃大部切除术1例,腹腔镜胃大部切除术1例。术后6例患者获访6~14个月,中位数为9个月,随访期间5例未再出血;1例于术后6个月再次出血,但出血量少,经抑酸、止血等保守治疗后出血停止。结论急诊胃镜是诊断Dieulafoy病的首选方法Dieulafoy病的治疗首选内镜下止血,内镜止血不成功者可考虑手术治疗,手术方式首选双镜联合局部楔形切除术     

1例Dieulafoy病的护理

Dieulafoy病是胃粘膜下动脉畸形引起的出血,是上消化道出血的原因之一,其大出血十分危险[1].我院于1999年1月成功诊治了1例Dieulafoy病,通过积极内镜下止血治疗及精心护理,痊愈出院,随诊2个月,病人情况良好.现将护理体会总结如下.     

上消化道Dieulafoy病的诊断与治疗(附14例报告)

目的探讨上消化道Ｄｉｅｕｌａｆｏｙ病的诊断和治疗方法。方法回顾性分析本院６年来收治的１４例上消化道Ｄｉｅｕｌａｆｏｙ病的临床资料。结果Ｄｉｅｕｌａｆｏｙ病发生于食管２例,胃底４例,胃体近贲门小弯侧７例,十二指肠球部１例。主要表现为突发间歇性的大量呕血、黑便和休克。１４例均通过急诊胃镜检查确诊,其中３例术后病理证实。１４例均行内镜下止血治疗,暂时止血率１００％。１０例（７１．４％）持久止血,３例胃底Ｄｉｅｕｌａｆｏｙ病镜下止血后再出血,转外科手术,行术中胃镜定位病灶局部楔形切除治愈,１例放弃治疗死亡。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,应适时中转手术。术中胃镜定位,局部楔形切除病灶是胃底Ｄｉｅｕｌａｆｏｙ病的首选术式     

急诊内镜治疗上消化道动脉性出血

目的评价上消化道动脉性出血的内镜治疗效果。方法回顾性总结1998年以来收治的31例上消化道动脉性出血的临床资料，所有病人均实行急诊内镜下1：10000肾上腺素盐水注射治疗。结果本组内镜止血有效29例(93．5％)，其中2例治疗过程中再次出现搏动性出血，经继续内镜下治疗止血成功；3例止血后再出血，经再次胃镜下注射后止血。止血失败2例(6．5％)，经Billroth Ⅰ式胃大部切除后治愈。10例治疗过程中出现胸痛或腹痛，9例自行缓解，1例给予镇痛剂后缓解，无其他并发症。结论内镜下注射肾上腺素治疗上消化道动脉性出血方法简单、疗效可靠、安全性高，可成为目前首选的治疗方法。     

胃手术后再出血七例临床分析

目的 分析与总结胃手术后再出血的诊断和治疗.方法 对2000年7月至2009年7月胃手术后再出血7例的临床资料作回顾性分析.结果 全部7例中,吻合口出血3例,旷置的溃疡出血2例,应激性溃疡1例,Dieulafoy病1例.全组病人均经积极治疗痊愈.结论 多学科协作的综合诊疗模式已成为当前胃手术后再出血诊治中的迫切需求和发...     

胃平滑肌肉瘤的外科治疗

目的 探讨胃平滑肌肉的诊断,病理学特点及外科治疗。方法 轭生分析１６例胃平滑肌肉瘤的临床资料。结果 术前确诊仪５例（３１．３％）。１６例均于手术治疗并经病理学证实。随访中３例因肿瘤广泛扩散而衰竭死亡,１例于 ３年发生肝转移而予再次手术,再次手术后已存活５年,其余病例情况良好。结论 胃平滑肌肉瘤的诊断要根据病史、多种辅助检查、以及术中、术后病理等综合分析。手术切除肌肉瘤的诊断要根据病史、多种辅助检查     

Total gastrectomy in the surgical treatment of acute massive hemorrhage caused by Dieulafoy lesion of the gastric fundus

GI bleeding caused by Dieulafoy lesion in the gastric fundus: a case report Dieulafoy lesion is a rare cause of massive gastrointestinal (GI) hemorrhage that can be fatal. It arises from an abnormally large eroded submucosal artery and in more than 75% of cases the lesion is mostly found within 6 cm of the cardia. The severity of bleeding and the site of the lesion render the diagnosis sometimes difficult, more than one endoscopic exam is often required. Surgery was regarded as the treatment of choice in the past, but recently endoscopic management has become the standard approach. We report a case of an 42-year-old man presented with upper GI hemorrhage. Repeated upper GI endoscopies revealed a missed diagnosis of subcardial gastric ulcer and Mallory-Weis lesion. Following conservative treatment, the frequency and amount of haemorrhage decreased and totally stop. 48 hours after admission patient developed sudden massive upper GI bleeding and underwent emergency total gastrectomy. The diagnosis of Dieulafoy lesion was made histologically. The patient recovered uneventfully and discharged on the postoperative day 11th. Therefore, Dieulafoy disease represent a diagnostic and therapeutic challenge. Advances in endoscopic technique have greatly assisted in earlier diagnosis and added options to the treatment regimen for this lesion. The relationship of this anomaly to possible exsanguination makes it essential that both endosopical and surgical approach play an important role in the management of this pathology.     

Crohn病的外科治疗

目的 探讨Crohn病(CD)的诊断及外科治疗方法.方法 回顾性分析31例CD的临床资料、治疗方法及随访结果并进行分析.结果 该病临床表现多样,全组术前确诊仅9例,纤维肠镜检查12例中5例诊断为该病.31例患者行1次或2次手术治疗,术后发生并发症7例.1例死亡,术后复发5例.结论 Cmhn病确诊率低,术前误诊率高;可根据术中所见准确判断.治疗宜选择合理的手术方式和系统的药物治疗.     

Is endoscopic band ligation superior to injection therapy for Dieulafoy lesion?

Background  Dieulafoy lesion is a rare but serious cause of gastrointestinal system bleeding. An aberrant submucosal artery, which was described in 1884, causes the bleeding. The lesion can be located anywhere in the gastrointestinal tract but is most commonly found in the proximal stomach up to 6 cm from the gastroesophageal junction. Increased experience in endoscopy has led to an increased frequency of its proper diagnosis. Various methods are used to achieve successful hemostasis by endoscopy in Dieulafoy lesion; however, comparative studies about the success rates of these methods are still needed. In this study, we compared two of these endoscopic hemostatic methods: band ligation, and injection therapy in Dieulafoy lesions. Methods  In this prospective study, 18 patients admitted to the Emergency Surgical Unit between January 2002 and December 2005 with upper gastrointestinal bleeding diagnosed as Dieulafoy lesion were included. Diagnose of Dieulafoy lesion was made at initial or second-look endoscopy. Patients were randomized in two groups according to therapy method: injection therapy and band ligation groups. Therapy was applied immediately after recognizing the lesion at the same endoscopic procedure. Two groups were compared regarding demographical data, presence of comorbid diseases, history of medication and previous gastrointestinal system bleeding, hemodynamic status, laboratory values, need for transfusion, endoscopic findings, success rate of the treatment method, mean hospital stay, complications, and recurrence of bleeding. Results  Of 588 patients admitted with upper gastrointestinal hemorrhage, Dieulafoy lesion was recognized in 18 cases (3.1%) at initial or second-look endoscopy. All patients were men with a mean age of 62.8 (range, 30–80) years. Band ligation was applied to ten patients and the remaining eight were treated by injection therapy. During the follow-up period, rebleeding occurred in six of the patients (75%) with injection therapy, whereas no rebleeding occurred for the patients in the band ligation group. The rebleeding rate and mean hospital stay was significantly higher for the injection therapy group. Conclusions  Our study suggests that of the endoscopic treatment methods, band ligation is superior to injection therapy for the treatment Dieulafoy lesions. Presented at the 15th EAES Congress, July 4–7, 2008 Athens, Greece.     

胰岛素瘤的诊断和治疗：附30例报告

目的:总结探讨胰岛素瘤的诊断和治疗方法。方法:回顾性分析近11年来治疗的30例胰岛素瘤的临床资料。结果:全组30例均表现Whipple三联征。术前B超，CT，MRI诊断的阳性率分别为34.8 %(8/23)， 58.3 %(7/12)，71.4 %(5/7)，术中B超诊断的阳性率为87.5 %(7/8)。单个肿瘤27例，多发性肿瘤3例。单发者，位于胰头8例,胰体7例,胰尾12例;多发者，1例2枚肿块均位于胰体，另2例均为2枚肿块分别位于胰体和胰尾。行肿瘤局部摘除术21例,胰体尾切除术6例，胰体尾切除术＋脾切除术2例，胰十二指肠切除术1例。良性肿瘤29例，恶性1例。术后胰瘘4例,均经充分引流后治愈。30例术后低血糖症状均消失，随访27例，良性肿瘤术后4年复发1例，再次手术切除胰体肿块后治愈，恶性肿瘤术后3年复发，因腹腔转移死亡。结论:Whipple三联征,测定IRI/G比值是定性诊断的主要依据,术中扪诊联合术中B超是最有效的肿瘤定位手段,肿瘤摘除术仍为胰岛素瘤的主要术式。