Dieulafoy病19例临床分析

目的:探讨Dieulafoy病发病情况、诊断及治疗方法。方法:回顾性分析19例Dieulafoy病的临床表现、诊断、治疗方法及疗效。结果:全部病例均表现突发上消化道大出血。初次胃镜检查确诊12例（63.2%），第2次检查确诊4例（21.1%），术中探查确诊3例（15.8%）；14例经一次内镜下止血成功，1例经二次内镜下止血成功，4例行外科手术止血（包括1例内镜下止血后72h再出血者）。结论:急诊胃镜是诊断Dieulafoy病首选方法；治疗首选内镜下止血，内镜下止血不成功者，应立刻手术治疗。     

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 。     

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     

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。     

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病变致急性消化道大出血的综合治疗

目的 探讨Dieulafoy病变致急性消化道大出血的多学科综合治疗及外科治疗方式的选择.方法 回顾性分析2007年4月至2012年4月48例Dieulafoy病变合并消化道大出血患者的临床资料.结果 本组最常见的出血部位是胃体(40例),其次是贲门(4例)、十二指肠(2例)和空肠(2例),且多发生在胃上部胃食管交界处6 cm以内.胃镜明确诊断有46例,急诊剖腹探查确诊2例.18例胃镜明确诊断的患者首先行局部肾上腺素注射和止血夹治疗;6例胃镜明确诊断的患者仅用止血夹治疗;2例十二指肠降部Dieulafoy病变出血内镜治疗失败的患者,行血管X线造影检查并栓塞,结果均成功.23例行手术治疗.47例治愈,1例死于低血容量性休克及多器官功能衰竭,平均住院时间是(10.8±2.5)d.结论 Dieulafoy病变发生率低但易导致凶险出血,可首先尝试内镜下肾上腺素局部注射联合止血夹治疗及介入治疗,多数患者最终需要外科治疗.     

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。     

胃肠道血管畸形的诊断与治疗

目的探讨胃肠道血管畸形引起消化道大出血的发病机制、临床特点和诊断治疗方法。方法回顾性分析经内镜、消化道造影等辅助检查和/或手术、病理确诊的17例胃肠道血管畸形病人的临床资料。结果15例行急诊胃镜检查,阳性7例,其中2例为胃镜复查阳性;结肠镜检查9例,阳性6例;血管造影检查2例,阳性1例;胶囊内镜检查1例阳性。2例未行内镜者急诊手术,确诊为胃血管畸形;另2例小肠血管畸形亦行手术治疗。内镜下止血治疗均一次成功。所有病人出血停止出院。结论消化道大出血是胃肠道血管畸形的主要临床表现,其诊断主要依靠内镜检查和血管造影。内镜诊断和治疗是胃肠道血管畸形诊治的首选方法,安全方便,创伤小。手术对胃肠道血管畸形的治疗仅适用于多次内镜治疗无效、小肠血管畸形以及诊断未明而大量反复出血病人。     

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.     

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.     

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     

胃Dieulafoy病的腹腔镜联合胃镜治疗进展

胃Dieulafoy病是恒径动脉破裂引起的一种少见的上消化道出血。胃镜作为该病首选诊断方法,外科手术是根治胃Dieulafoy病的首选治疗方法,而腹腔镜联合胃镜治疗胃Dieulafoy病能够优势互补,具有创伤小、污染小、再出血率低等优点,成为目前根治胃Dieulafoy病的最有效手术方式之一。     

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.     

Dieulafoy lesion: endoscopic and surgical management

Dieulafoy lesion is characterized by exteriorization of a large pulsatile arterial vessel through a minimal mucosal tear surrounded by normal mucosa, causing massive and recurrent upper digestive bleeding in previously healthy patients. More frequently presented than diagnosed, with the increase of its knowledge among endoscopists, a large number of cases are expected in the literature. Data from patients with upper gastrointestinal bleeding submitted to endoscopy at the Federal University of S?o Paulo, Gastrointestinal Endoscopy Unit from 1991 through 2002 were reviewed for Dieulafoy lesion. We found 15 patients with typical Dieulafoy gastric lesion. Their ages ranged from 18 to 78 years (mean age 49.9); 5 patients were female and 10 were male. Bleeding presented as hematemesis and melena in 7 cases (46.6%), hematemesis alone in 4 cases (26.6%), and melena alone in the other 4 cases (26.6%). Initial hemostatic approaches employed were: alcoholization (2 cases), epinephrine associated with alcohol injection (5 cases), sclerosis in 7 cases and surgery in 1 case. Dieulafoy lesion is a distinct nosologic entity that must be suspected in patients with massive digestive bleeding. Endoscopy became the procedure of choice for diagnosis and treatment of this disease.     

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...     

Massive bleeding from a rectal dieulafoy lesion: combined multidetector-row CT diagnosis and endoscopic therapy

Dieulafoy lesion is an uncommon cause of acute gastrointestinal bleeding. The diagnosis is usually carried out endoscopically. We report a 77-year-old woman with rectal Dieulafoy lesion. A recent endoscopic examination missed the lesion because it was small and the bleeding was intermittent. In our case, prompt colonoscopic therapy was allowed after locating the bleeder by multidetector-row computed tomography. On the basis of the success of this procedure, we suggest that an emergent multidetector-row computed tomography could have a role in the management of patients with massive lower gastrointestinal bleeding.