Dieulafoy病在中国的诊治现状——国内文献分析

Current Status of Diagnosis and Treatment of Dieulafoy's Disease in China: Review of Domestic Literature

背景:Dieulafoy病病灶较隐匿,临床上易漏诊或误诊。目的:分析Dieulafoy病的临床特点等因素,探讨其发病机制、诊断方法和有效治疗措施,以提高对该病的认识。方法:复习1994～2003年国内相关文献41篇,对463例Dieulafoy病例进行回顾分析。结果:463例Dieulafoy病患者的男女比例为3.8:1,发病年龄11～83岁,平均年龄47.岁。部分文献显示,在同期因上消化道大出血而行内镜检查的患者中,Dieulafoy病的检出率为0.8%～2.6%。86.4%的患者经内镜检查确诊,其余病例经手术或血管造影确诊。病灶分布最多见于贲门周围的胃壁(包括胃体上部和胃底),病理特征为黏膜下恒径小动脉破损,周围黏膜正常。内镜治疗止血成功率为82.8%,各种治疗的总止血率为97.2%,2.8%的患者因该病而死亡。结论:Dieulafoy病是消化道大出血的少见原因之一,急诊内镜检查是主要的诊断方法,提高对该病的认识和仔细的内镜检查是及时、准确诊断的关键,内镜治疗是首选的有效治疗措施。

Dieulafoy's lesion is concealed and difficult to recognize, it may easily be missed or misdiagnosed by the clinicians. Aims: To analyze the clinical characteristics of Dieulafoy's disease, and appraise its pathogenesis, diagnosis and effective treatment for improvement in cognition of the disease. Methods: A retrospective analysis of the data of 463 cases of Dieulafoy's disease was performed from 41 papers published in Chinese literature from 1994～2003. Results: Among the 463 patients with Dieulafoy's disease, it was more common in males (male:female=3.8:1) with an average age of 47.4 years (11～83 years). Some papers reported that Dieulafoy's disease was the cause of bleeding in 0.8%～2.6% of the bleeders receiving endoscopy for upper gastrointestinal hemorrhage. 86.4% of the patients were diagnosed by endoscopy, the others were diagnosed during operation or by angiography. Most of the lesions were distributed in the mucosa nearby the gastric cardia (including proximal body and fundus of stomach). The major histological feature was presence of an eroded submucosal calibre-persistent artery whereas the surrounding mucosa being normal. Endoscopic therapy was successful in achieving permanent hemostasis in 82.8% of the patients. 97.2% of the patients survived after receiving various treatments, and 2.8% died of bleeding Dieulafoy's lesion. Conclusions: Dieulafoy's disease is one of the uncommon causes of gastrointestinal hemorrhage. Emergency endoscopy is the main diagnostic method and awareness of this lesion at endoscopy is the key point to arrive at a prompt and accurate diagnosis. Therapeutic endoscopy is the first treatment of choice.