肝源性溃疡出血的临床及内镜分析

Clinical and endoscopic analysis of hepatogenic ulcer hemorrhage

目的总结肝源性溃疡出血的临床及内镜特点。方法对2000年1月至2005年5月收治的肝源性溃疡出血病例资料进行回顾性分析。结果42例患者临床表现为黑便42例(100%)、呕血30例(71.4%)、腹胀35例(83.3%)、腹痛9例(21.4%)、反酸18例(42.9%)。急诊内镜检查可见胃或十二指肠有活动性出血和(或)有血痂附着的溃疡病灶,溃疡形态多呈圆形或椭圆形。镜下分期均为A1期,17例合并门脉高压性胃病。35例予内科保守治疗获得止血,有效率为83.3%,7例需行外科手术。结论肝源性溃疡出血是肝硬化上消化道出血的重要原因之一,急诊内镜检查能够及时确诊以指导选择最佳的治疗方案。

Objective To summarize the clinical symptoms and endoscopic features of hepatogenic ulcer hemorrhage so as to strengthen the recognition of this disease. Methods The clinical data of 49 patients with hepatogenic ulcer hemorrhage from January 9000 to May 9005 were analyzed retrospectively. Results The clinical symptoms were muhiple, including melena in 42 cases（ 100 % ）, hematemesis in 30 cases（71.4 % ）, abdominal distention in 35 cases（83.3 % ）, abdominal pain in 9 cases（21.4 % ） and acid regurgitation in 18 cases（42.9 % ）. Emergency endoscopy could find active hemorrhage of stomach or duodenum and ulcer lesions with blood scab; The ulcer shape was round or ellipse. The stage under endoscopy all was At, 17 patients combined with portal hypertensive gastropathy. 35 patients was homeostasis after medical conservative treatment, the effective rate was 83.3 % ,7 patients needed surgical operation. Conclusion Hepatogenie ulcer hemorrhage is not rare,it is an important factor of upper gastrointestinal bleeding in liver cirrhosis. Emergency endoscopy can make a correct diagnosis in time and guide to choose the best treatment planning.