Dieulafoy病的内镜治疗及临床特点

Endoscopic Therapy and Clinical Characteristic of Dieulafoy Lesion

为探讨Dieulafoy病所致消化道出血的临床特征 ,回顾分析比较了Dieulafoy病组 (n =3 7)和消化性溃疡组(n =40 )的临床特点及治疗差异。结果 :Dieulafoy病组内镜注射止血成功 3 6例 ( 97.3 % ) ;1例内镜治疗失败后成功进行了外科手术。年龄平均 ( 61 .1 4± 9.1 8)岁 ,出血凶猛。发现 :Dieulafoy组和消化性溃疡组患者的发病年龄 (P <0 .0 1 )、出血量 (P <0 .0 1 )、病变部位 (P <0 .0 1 )、基础病 (P <0 .0 1 )、内镜治疗 (P <0 .0 5 )和输血次数 (P <0 .0 1 )有显著性差异。无出血死亡及内镜操作并发症。Dieulafoy病多发生在老年男性 ,常合并有心血管疾病、高血压和糖尿病 ,出血急骤凶猛。结果提示 :内镜下注射止血安全、有效、经济 。

The aim was to investigate clinical characteristic of the Dieulafoy lesion and causation of gastrointestinal bleeding and. Patients were divided into 2 groups according to initial endoscopic treatment method. Thirty-seven cases of Dieulafoy lesion were endoscopic injection groups. Forty cases of upper GI bleeding from a peptic ulcer were control groups. Data were analyzed with respect to clinical and endoscopic characteristics as well as outcome. Endoscopic injection therapy was successful in 36 patients(97.3%). One patient had successful surgery after endoscopic therapy failed. Most patients with Dieulafoy lesion were elderly men 〔average (61.14±9.18) years〕 with severe acute upper gastrointestinal hemorrhage. There were significant differences between the 2 groups with respect to age ( P<0.01), hemorrhage values (P<0.01), localization of lesion ( P< 0.01), number of therapeutic endoscopic sessions (P<0.01), delitescent time (P<0.01), and number of units transfused (P< 0.01). There were no deaths due to bleeding and no endoscopic complications. Dieulafoy lesion occurs most frequently in elderly males with severe acute upper bleed gastroiatestinal hemorrhage. Many patients in this series (81.1%) had significant comorbidity, in particular, cardiovascular disease, hypertension, and diabetes. Endoscopic injection therapy of Dieulafoy lesion is safe, economical, effective, successful, and should be performed. There are no deaths due to bleeding and no endoscopic complications.