陈小伍 戎祯祥 冯家宁 广东省顺德市第一人民医院外二科(顺德.528300) 中国胃肠外科杂志 1999 0 2 1


    关键词：Dieulafoy病；内镜；诊断；治疗 期刊 zgwcwkzz 0 论著 fur -->


    

摘要 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。

The diagnosis and treatment of Dieulafoy lesion of upper gastrointestinal tract:A report of 14 cases

Chen Xiaowu, Rong Zhenxiang, Feng Jianing.

    Dpartment of General Surgery, The First People's Hospital of Shunde. Shunde 528300

Abstract Objective To investigate the diagnostic and treatment p r ocedures of Dieulafoy Lesion of upper gastrointestinal tract. Method The clinical data of 14 patients with Dieulafoy lesion, admited and treated during the present 6 years, were analysed retrospectively. Results In 2 patients hemorrhagic lesions were located in esophagus, 4 in the fundus of stomach, 7 in the body of stomach close to cardial part and lesser curvature , One in duodenal bulb. The main manifestations were abrupt, intermittent hemate mesis, melena and shock. All of the 14 cases were diagnosed by emergency endosco py,3 of wh ich were verified by postoperative pathology; All of them underwent therapy of e ndoscopic hemostasis, and the success rate of temporary hemastatis was 100%. 10 patients (71.4%) were hemostasised continually. 3 patients which lesion were lo cated in the fundus of stomach, re-bled after endoscopic hemostasis, were trans ferred to surgery, and local wedge resection were performed. One patients relinq uished treatment and died. Conclusion Emergency endoscopy is the first choice to diagnose this disease. Endoscopic hemestasis should be taken ini tially. If re-bleeding, especially the lesion in the fundus of the stomach, sho uld resort to surgery in time. Local wedge resection after intra-operative endo scopic localization is the first choice of surgical procedure for Dieulafoy lesi on in the fundus of the stomach.

     Key words Dieulafoy lesion Endoscopy Diagnosis Treatment

Dieulafoy病是上消化道大出血的少见病因之一 ......