Dieulafoy病的诊断及治疗(附12例报告)

目的：探讨Dieulafoy病的诊断和治疗方法，提高人们对本病的认识。方法：对本院10年来收治的12例Dieulafoy病的临床资料进行回顾性分析。结果：主要临床表现为呕血、便血和休克；急诊胃镜检查11例，确诊10例(占91％)，l例血管造影确诊。误为肠出血，行急诊肠镜检查l例(后为胃镜确诊)。其中3例手术后病理证实；位于胃体近端至贪门部有7例(占58％)，球部4例(33％)，胃角1例(8．3％，)。镜下表现为病变中心小动脉喷血或血管断端渗血；7例患者胃镜下治疗。2例病灶位于胃底，内镜止血困难，行病灶局部楔形切除术。l例行血管结扎术。l例包括病灶在内的胃大部分切除术。l例动脉造影后行血管栓塞术。所有患者均治愈出院。结论：急诊目镜检查是确诊本病的首选方法，胃镜怀疑本病时可行血管造影检查等。胃镜下治疗是本病的首选治疗方式，病灶位于胃底者可转手术治疗。病灶局部楔形切除宜作为首选的手术方式。血管造影确诊后动脉栓塞术亦不失为一种行之有效的治疗方法。

The Diagnosis and Treatment of Dieulafoy Lesion(with a report of 12 cases)

Objective:To investigate the diagnostic and treatment procedures of Dieulafoy lesion and increase the knowledge of the lesion.Method:12 cases of Dieulafoy lesion during the present 10 years were analysed retrospectively.Results:The most common clinical symptoms were hematemesis,melena and shock;11 patients were examined by emergency endoscopy,10 of which were diagnosed (91%).1 case was admited by angiography.One was taken for intestinal bleeding (verified by endoscopy ).3 of them were verified by postoperative pathology;In 7 patients hemorrhagic lesions were located in the body of stomach to cardial part (58%),4 in duodenal bulb (33%),1 in the angle of stomach (8.3%).The lesions presented as a protruding vessel with active bleeding including oozing and sourting of blood;7 underwent therapy of endoscopic hemostasis.2 patients whose lesions were located in the fundus of stomach were transferred to surgery,and local wedge resection were performed.In one,angiorrhaphy of the lesion was performed,one underwent subtotal gastrectomy including the lesion,one underwent angiemphraxis of the lesion.All of them were cured.Conclusion:Emergency endoscopy is the first choice to diagnose Dieulafoy lesion.Angiography is another choice when it is difficult to diagnose by endoscopy.Endoscopic hemostasis is the first choice of Dieulafoy lesion treatment.The lesion located in the fundus of the stomach should resort to surgery in time.In surgical procedure,local wedge resection of the lesion is recommended.It is also effective to treat the lesion by angiemphraxis after angiography.