内镜下钛夹闭合联合局部注射肾上腺素治疗上消化道Dieulafoy病42例临床分析

目的探讨内镜下钛夹闭合联合局部注射肾上腺素治疗上消化道Dieulafoy病的临床效果。方法 42例因呕血和（或）解黑便病人行急诊内镜检查,明确诊断为上消化道Dieulafoy病,病灶位于食管下端8例、胃底14例、胃体5例、胃窦3例、十二指肠球部4例、十二指肠球部降部交接3例,十二指肠降部5例。对Dieulafoy病灶进行内镜下钛夹闭合联合局部注射1∶10000肾上腺素治疗,内镜治疗后再次出血的病人进行第二次内镜下钛夹闭合联合局部注射1∶10000肾上腺素治疗。结果内镜下止血术后即时止血42例（100%）,5例病人（11.9%）72h内因再次出血进行第二次内镜下钛夹闭合联合局部注射1∶10000肾上腺素治疗,2例病人出血停止,72h总的止血有效率为（92.85%）,3例（7.15%）病人因效果欠佳转外科手术治疗。结论内镜下钛夹闭合联合局部注射1∶10000肾上腺素治疗上消化道Dieulafoy病止血率为（92.85%）,是一种安全、有效,创伤小的治疗上消化道Dieulafoy病的首选方法。

Endoscopic titanium clips closure combined with local injection of adrenalin to treat Dieulafoy disease on upper digestive tract

Objective To explore the clinical effect of endoscopic titanium clips closure combined with local injection of adrenalin to treat Dieulafoy disease on upper digestive tract.Methods 42 cases of patients suffering from hematemesis and/or roiding melema,were diagnosed surely as Dieulafoy disease on upper digestive tract after emergency endoscopic examination,of which 8 cases on the lower part of esophagus ,4 cases fundus of stomach ,5 cases body of stomach,3 cases antrum of stomach,4 cases bulbus of duodenum,3cases connection of bulbus and descending part of duodenum,5 cases descending part of duodenum. Dieulafoy lesions were treated with endoscopic titanium clips closure combined with local injection of 1：10 000 adrenalin. The patients re-bleeding after endoscopic treatment were repeated the above method. Surgical treatment was used on the patients who bleed after endoscopic treatment twice.Results 42 cases stopped bleeding immediately after endoscopic hemostasis （100%）,of which 5 cases （11.9%） were conducted second time,and 2 cases stopped bleeding. The total effectiveness rate was 92.85%. 3 cases （7.15%） were transformed to surgical department for surgical operation because of lacking effect.Conclusion Endoscopic titanium clips closure combined with local injection of adrenalin is a safety and effective methods to treat Dieulafoy disease on upper digestive tract with minimal trauma.