Dieulafoy病临床特点及内镜下诊治研究

目的 总结Dieulafoy病的临床特点、内镜表现及治疗预后,提高对该病的诊治水平.方法 调查1995～2009年非静脉曲张上消化道大出血患者,分析确诊为Dieulafoy病12例的临床表现及内镜诊治情况.结果 （1）患者近期无上腹痛病史,出血前均有诱因;（2）发病急,呕血便血量大,有休克或血容量不足的表现;（3）病变部位胃内占75%,内镜下表现为喷血、滴血、血凝块附着、病变中央呈火柴头样血管显露,周同微小黏膜缺损;（4）内镜下硬化治疗安全有效,手术治疗效果明确.结论 无症状突发上消化道大出血患者,要考虑Dieulafoy病的可能,急诊胃镜检查可确诊,内镜下硬化治疗为首选,复发出血者应手术治疗.

Clinical and endoscopic study of Dieulafoy's disease

Objective To study the clinical and endoscopic characteristics and treatment of Dieulafoy＇s disease and improve its diagnosis and therapy. Methods Patients with massive upper gastrointestinal （UGI） bleeding of the non-variees were investigated from 1995 to 2009. Diagnnsis was confirmed as Dieulafoy＇s disease in 12 patients. Medical histories, symptoms, endoscopic features , therapeutic methods and outcomes were analyzed. Results They all had cause before bleeding ,but no abdominal pain recently. Massive hemalemcsis, inch;ha and shock wcrc the principal clinical symptoms. The endoscopic manifestations were active arterial blood ejection , blond drop, clots and 0.2 -0. 5cm mucnsa defect with ecnter vessel. Endoscopic injection sclerotherapy was an effective and safe therapeutic mcthod. Conclusions Massive UG1 bleeding may be due to Dieulafoy＇s disease. Emergent endoscopy and injection sclcrotherapy at the same time are first choice. Surgery should be performed when recurrent bleeding oceurrs.