经内镜皮圈套扎治疗Dieulafoy病变出血的临床研究

目的评价经内镜皮圈套扎治疗Dieulafoy病变出血的疗效及安全性.方法对31例Dieulafoy病变出血患者随机采用内镜下皮圈套扎(EBL,n=16)或硬化剂注射治疗(EIS,n=15).其中20例患者病灶位于胃,8例位于胃肠吻合口,3例位于十二指肠球部.EBL组采用多连发套扎设备,通过负压抽吸,使Dieulafoy病变及其周围组织吸入套扎帽内,然后释放弹力皮圈将其结扎.ElS组选用5%鱼肝油酸钠或1%乙氧硬化醇,绕Dieulafoy病变周围注射止血.结果EBL组套扎组织在内镜治疗后3～7 d内脱落;EBL组早期止血率、远期止血率和转外科手术率均与EIS组相似(分别为93.8%比86.7%,100%比86.7%,0比13.3%;均P>0.05),但再出血率显著低于EIS组(6.3%比40%,P<0.05);两组间并发症发生率差异无显著性(EBL组6.3%,EIS组6.7%,P>0.05).结论EBL是内镜治疗Dieulafoy病变出血的一种安全和有效的方法.     

经内镜套扎治疗Dieulafoy病变出血9例分析

Dieulafoy病变是引起上消化道大出血的原因之一，随着急诊内镜检查的普遍开展，其检查率有明显的提高，而内镜下治疗已成为Dieulafoy病变出血的主要治疗手段，包括注射止血、热能止血及机械止血等方法。对我院自2000-05-2005-09采用经内镜皮圈套扎（EBL）治疗Dieulafoy病变出血9例分析如下。     

消化道Dieulafoy病诊治策略的体会

目的 探讨Dieulafoy病治疗方法的变迁及较好的治疗策略.方法 该院近几年采用多种方法治疗Dieulafov病12例.早期治疗方法为外科手术、内镜下电凝、内镜粘膜下注射止血药;后期治疗方法为内镜下止血夹治疗和皮圈套扎治疗.结果 早期2例患者最终采用手术治疗获得成功.后期10例患者内镜下止血夹、皮圈套扎治疗或两者联合治疗均获成功,经1～4年随访并复查胃镜,未再发上消化道出血.结论 内镜下止血夹及皮圈套扎治疗疗效优、创伤小、费用低廉,已成为消化道Dieulafoy病治疗的首选方法.具体方法可根据病灶特点和时机进行选择.     

经内镜钛夹与应用奥曲肽序贯疗法对Dieulafoy病变出血的疗效研究

目的研究内镜下钛夹与应用奥曲肽序贯疗法对Dieulafoy病变出血的疗效。方法对15例Dieulafoy病变患者在内镜下确诊后即行钛夹止血,再连续应用奥曲肽持续静脉泵入0.0125~0.025 mg/h,共用3~5 d。结果 15例患者胃镜下钛夹止血均成功,即时止血率100.00%,再出血率6.67%,全组均未见并发症。结论经内镜钛夹与应用奥曲肽序贯疗法是治疗Dieulafoy病变出血的安全而有效的手段。     

经内镜套扎联合注射组织粘合剂治疗重度食管胃底静脉曲张

目的总结内镜下套扎并联合注射组织粘合剂治疗重度食管胃底静脉曲张破裂出血的疗效。方法对经内镜下连续套扎术治疗的重度食管胃底静脉曲张破裂出血 2 3例 ,及经套扎术后诱发加重的 4例胃底静脉曲张破裂出血者联合内镜下组织粘合剂注射治疗的临床资料进行回顾性分析。结果 2 3例套扎治疗者 ,平均每例套扎 1.8次 ,共行 42例次 198处套扎 ,显效 13例 (5 6.6% ) ,有效 9例(3 9.1% ) ,其中 6例大出血经急诊镜下套扎后即获止血 ,并发大出血失败 1例 (4 .3 % ) ,总有效率 95 .7%。 4例患者分别于食管曲张静脉套扎术后第 4～ 12周出现 ～ 级胃底静脉曲张 (发生率 17.4% ) ,经联合注射组织粘合剂治疗后静脉曲张消失 ,6个月后胃镜复查 ,组织粘合剂完全排出 ,未再出血。结论内镜套扎治疗重度食管静脉曲张破裂出血疗效显著。对套扎后诱发加重的胃底静脉曲张破裂出血 ,联合镜下组织粘合剂注射效果满意     

消化道动脉灶性出血的内镜注射套扎联合治疗

目的探讨内镜注射套扎联合治疗消化道动脉灶性出血的可行性、安全性和临床应用价值。方法对消化道Dieulafoy病、息肉切除术后和消化性溃疡的动脉灶性出血的患者,进行内镜注射套扎联合治疗,首先于出血的动脉及其周围的黏膜下层注射10%高渗钠溶液3～5mL,其后应用单发或双发套扎器,套扎出血的动脉及其周围组织,从而达到止血的目的。结果胃、十二指肠和直肠Dieulafoy病出血12例(ForrestⅠa10例、Ⅱa2例),胃、大肠息肉切除术后出血6例(ForrestⅠa6例),胃、十二指肠球部溃疡出血8例(ForrestⅠa6例、Ⅱa2例),共26例动脉灶性出血的患者,经内镜注射套扎联合治疗后均止血成功,并以瘢痕愈合而治愈,无并发症发生。结论内镜注射套扎联合治疗消化道动脉灶性出血具有明确的理论基础,操作简易,疗效确切,是一种可行的、安全的和有效的治疗方法。     

经内镜硬化与应用奥曲肽序贯治疗Dieulafoy病变出血

【目的】评价内镜下硬化与应用奥曲肽序贯治疗Dieulafoy病变出血的疗效。【方法】16例患者经内镜确诊为Dieulafoy病变所致出血后,先以5%鱼肝油酸钠或1%乙氧硬化醇注射止血,再连续应用奥曲肽7d(0.1mg皮下注射,q8h)。【结果】本组早期止血率93.8%(15/16),长期止血率93.8%(15/16),再出血率12.5%(2/16),转外科手术率6.3%(1/16),1例患者术后有一过性上腹疼痛,并发症发生率6.3%(1/16)。【结论】经内镜硬化与应用奥曲肽序贯疗法是治疗Dieulafoy病变出血的安全而有效的手段。     

急诊内镜下套扎联合组织胶注射治疗食管胃底静脉曲张破裂出血的疗效分析

目的观察急诊内镜下套扎联合组织胶注射液治疗食管胃底静脉曲张破裂出血的效果。方法选择70例急诊肝硬化食管胃底静脉曲张破裂出血的患者,分组治疗方法为内镜下止血治疗33例,单纯内科保守治疗37例,对比两种方法止血的效果及再出血率。结果内镜组止血有效率高达100%,再出血率6%;保守治疗组止血有效率仅为75.7%,再出血率高达28.6%。两组方法止血有效率间的差异有统计学意义(P0.05),内镜止血有效率明显高于保守治疗,且再出血率低。结论急诊内镜下套扎联合组织胶注射治疗肝硬化食管胃底静脉曲张破裂出血安全有效,止血率高,且再出血率低。     

内镜套扎术联合组织胶注射治疗食管胃底静脉曲张破裂出血疗效观察

目的观察内镜套扎术联合组织胶注射治疗食管胃底静脉曲张破裂出血的疗效。方法选择73例食管胃底静脉曲张破裂出血的患者,药物+内镜(生长抑素+内镜套扎术联合组织胶注射)治疗组34例,内科保守治疗(生长抑素+普洛奈尔)组39例,观察两组止血有效率和再出血率。结果药物+内镜治疗组止血有效率94.12%,再出血率5.88%;内科保守治疗止血有效率74.36%,再出血率27.27%。两组止血有效率差异无统计学意义(P>0.05),药物+内镜治疗组再出血率发生率明显低于内科保守治疗组,差异有统计学意义(P<0.05)。结论内镜下套扎术联合组织胶注射治疗食管胃底静脉曲张破裂出血安全有效。     

内镜下金属钛夹联合纤维蛋白胶治疗Dieulafoy病上消化道出血疗效观察

目的:探讨内镜下金属钛夹联合医用生物纤维蛋白胶对Dieulafoy病上消化道出血的止血效果.方法:经内镜检查诊断Dieulafoy 病上消化道出血患者18例,于内镜下应用Olympus金属钛夹直接夹闭出血病灶,并喷洒医用生物纤维蛋白胶止血.观察即时止血率、再出血率.结果:均一次止血成功,即时止血率100%.1例于治疗后2 d再次出血,再行金属钛夹及医用生物纤雏蛋白胶止血,效果不满意,转外科手术治疗,余17例术后随访1 a均未再次出血.结论:内镜下金属钛夹联合医用生物纤维蛋白胶治疗Dieulafoy病上消化道出血疗效满意.     

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.     

Endosonography-guided endoscopic band ligation of Dieulafoy's malformation: a case report

Dieulafoy's vascular malformation may cause serious upper gastrointestinal hemorrhage. The mucosal lesion is usually small, and precise location of the lesion may therefore be difficult. We report a case of Dieulafoy's lesion successfully treated by endoscopic band ligation (EBL) where endoscopic ultrasonography (EUS), including Doppler examination, was applied for accurate diagnosis, guiding EBL and control of treatment.     

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.     

Endoscopic band ligation of Dieulafoy-like lesions in the upper gastrointestinal tract

BACKGROUND AND STUDY AIMS: Endoscopic band ligation (EBL) is currently considered to be the treatment of choice for esophageal variceal bleeding. This study reports on the efficacy and safety of EBL in patients with Dieulafoy-like bleeding lesions in the upper gastrointestinal tract. PATIENTS AND METHODS: Between December 1994 and February 2000, 23 patients with upper gastrointestinal tract hemorrhage (median age 58, range 28-75) were treated using EBL. EBL was used as a rescue therapy in four patients and as the initial treatment in 19 patients. RESULTS: The site of bleeding was the stomach in 10 patients, Billroth II anastomosis in 10, the first part of the duodenum in one, the second part of the duodenum in one, and the jejunum in one patient. Endoscopic band ligation was successful in 22 of the 23 patients. The remaining patient, a young man with a Dieulafoy-like lesion in the jejunum, had recurrent bleeding on day 5 after EBL and underwent elective surgery. CONCLUSIONS: Endoscopic band ligation is an effective and safe endoscopic treatment for Dieulafoy-like lesions. It is easy to use and relatively inexpensive.     

Endoscopic diagnosis and treatment of Dieulafoy's ulcer

Dieulafoy's ulcer often develops unmanageable severe gastrointestinal hemorrhage and sometimes takes a fatal course. In the past surgical operations were considered to be the only life-saving measure for this lesion. Since 1979, 46 lesions of Dieulafoy's ulcer in 45 cases with active bleeding from exposed blood vessels were treated during emergency endoscopy by the hemostatic method of pure ethanol injection. Transient hemostasis was obtained in all cases. Rebleeding occurred in 5 cases (11%) and pure ethanol injection was performed again. Hemostasis was obtained in all cases, but one case again had rebleeding due to an overlooked Dieulafoy's ulcer located in the gastric fundus. Emergent surgical operation was performed in this case. No case required elective surgery and no deaths were attributed to bleeding. Our method achieved complete hemostasis at a rate of 98% (44 cases) for Dieulafoy's ulcer. The pure ethanol injection method is one of the most effective hemostatic methods for the Dieulafoy's ulcer.     

组织黏合剂注射联合套扎治疗食管胃底静脉曲张破裂出血的临床观察

【目的】观察组织黏合剂注射联合套扎治疗食管胃底静脉曲张破裂出血的临床疗效及安全性。【方法】对32例食管胃底静脉曲张破裂出血患者进行内镜下治疗,胃底曲张静脉采用“三明治夹心法”行组织黏合剂注射,对合并的食管曲张静脉同时行套扎治疗。术后观察不良反应、并发症和近期疗效。【结果】组织黏合剂注射量1．0～3．5mL,平均1．8mL,套扎5～12点,平均8．2点。治疗成功率100％。6例出现胸痛（18．8％）,2例出现上腹不适（6．3％）,全组未有异位栓塞的发生,追踪3个月未有再出血病例,28例3个月后复查胃镜,见胃底曲张静脉消失或明显减轻,食管曲张静脉减轻与红色征消失。【结论】组织黏合剂注射联合套扎治疗食管胃底静脉曲张破裂出血安全、有效。     

Effectiveness of a ligating device for endoscopic surgery

A new detachable snare for hemostasis in the removal of large polyps or other elevated lesion was developed by the author (Olympus Ligating Device). It allows ligation to be performed through the channel of an endoscope using a nonconductive loop that can be detached from the ligator. At Sakura National Hospital, endoscopic ligation with this device was performed in 80 patients from May 1989 to January 1994. The purpose of the procedure was preventive hemostasis prior to the endoscopic resection of large elevated lesions in 71 patients and for control of hemorrhage in 9 patients. The elevated lesions were polyps in 69 patients and submucosal tumor in 2, being pedunculated in 36 and semipedunculated in 35. The maximum diameter of these lesions ranged from 15 to 40 mm (mean: 23 mm), being greater than 20 mm in 57 cases. The 9 patients undergoing endoscopic ligation for hemorrhage had bleeding polypectomy stumps (n = 5), bleeding polyps (n = 3), and a bleeding esophageal varix (n = 1). Endoscopic ligation achieved the complete prevention of hemorrhage following the resection of elevated lesion in 63/71 patients (88.7%) and, in combination with a HX-3L clip, allowed endoscopic resection to be performed in 70/71 patients (98.6%). In the 9 patients with bleeding lesions, complete hemostasis was achieved without complications.     

急诊内镜套扎联合奥曲肽治疗肝硬化合并食管静脉曲张出血的疗效分析

[目的]探讨急诊内镜套扎联合奥曲肽治疗肝硬化合并食管静脉曲张出血的疗效.[方法]将121例肝硬化合并食管静脉曲张出血患者分为观察组（n=61）与对照组（n=60）,观察组患者接受急诊内镜套扎联合奥曲肽治疗,对照组患者接受奥曲肽治疗.[结果]①观察组止血成功率显著高于对照组（P＜0.05）,早期再出血发生率显著低于对照组（P＜0.05）;两组患者病死率相比差异无统计学意义（P＞0.05）.②观察组止血时间、奥曲肽治疗天数、输血量、住院时间显著少于对照组（均P＜0.05）.③观察组不良反应发生率显著高于对照组（P＜0.05）.[结论]急诊内镜套扎联合奥曲肽治疗肝硬化合并食管静脉曲张出血的患者的效果显著.     

Endoscopic band ligation for control of acute peptic ulcer bleeding

BACKGROUND AND STUDY AIMS: The use of endoscopic band ligation (EBL) is being extended to treat various causes of upper and lower gastrointestinal bleeding. The aim of this study was to evaluate the usefulness of EBL for control of acute peptic ulcer bleeding and to define the lesions that are most suitable for this technique. PATIENTS AND METHODS: 19 patients with major stigmata of acute peptic ulcer bleeding were treated using EBL; 11 patients had active bleeding and eight patients had a nonbleeding visible vessel. RESULTS: The site of acute peptic ulcer bleeding was the stomach in 12 patients, the duodenum in four patients, and Billroth II anastomosis in three. Initial hemostasis was achieved in 19 patients (100 %) in a single session. There were no rebleeding episodes in any of the patients, and there was no bleeding-related or procedure-related death. During long-term outpatient follow-up, bleeding did not recur. CONCLUSIONS: EBL is an effective and safe endoscopic treatment for small-sized nonfibrotic acute peptic ulcer bleeding. Larger studies in patients with acute peptic ulcer bleeding are needed to confirm these promising results.