Dieulafoy病的诊断与治疗13例

目的:探讨Dieulafoy病的临床特点、诊断及治疗.方法:回顾性分析总结13例Dieulafoy病的临床特点、诊断与治疗方法和疗效.结果:13例患者临床表现为单纯呕血者6例,呕血伴黑便者5例,单纯黑便者2例,所有病例入院后均行内镜检查:其中11例经内镜确诊(11/13,85%),首次内镜治疗成功率为91%(10/11).4例经手术治疗(4/13,31%),其中2例内镜治疗失败者在内镜钛夹指引下实施确定性手术,另2例内镜漏诊者靠手术探查或术后病理确诊.10例随访患者无1例复发.结论:掌握本病的临床表现和病理特征是提高诊断率,减少误诊和漏诊的关键;内镜为该病诊断和治疗的首选方法,具有良好的安全性、有效性和远期效果.

Diagnosis and treatment of Dieulafoy's lesion: an analysis of 13 cases

AIM:To explore the clinical features,diagnosis and treatment of Dieulafoy's lesion. METHODS:Thirteen cases of Dieulafoy's lesion were reviewed and analyzed on the basis of clinical features,diagnosis,treatment and effect. RESULTS:In this series,6 cases showed he- matemesis,2 showed melena and 5 showed both symptoms.All cases underwent endoscopic examination after being hospitalized;11 cases re- ceived a positive diagnosis by endoscopy(11/13, 85%),the success rate of first endoscopic therapy was 91%(10/11),and 4 cases were treated by laparotomic surgery(4/13,31%).Among them, definitive surgery was performed under the guid- ance of endoscopic hemoclipping in 2 patients who failed to be treated by endoscopy.In another 2 cases,diagnosis was missed by endoscopy and definite diagnosis was made only following ex- ploratory operation or on the basis of pathology after the operation.None of 10 patients showed recrudescence by follow-up study. CONCLUSION:It is necessary to understand the clinical pattern and pathological characteris- tics of Dieulafoy's lesion in order to improve the diagnosis rate.Endoscopic therapy is the first- choice method for diagnosis,with good security, validity and long-term results.