Dieulafoy病合并上消化道大出血16例诊治体会

Clinic diagnosis and treatment of Dieulafoy with complicated gastrointestinal hemorrhage： a report of 16 cases

目的探讨Dieulafoy病的临床特点、诊断与治疗方法。方法回顾性分析16例Dieulafoy病伴消化道出血患者的临床资料。结果首发症状均为突发上消化道大出血。胃镜检查16例，确诊12例，首次确诊率50％；数字减影血管造影（DSA）检查4例，确诊2例，手术探查确诊2例。胃镜下止血治疗12例，成功10例，失败2例，再出血2例，再行胃镜下止血，1例成功，1例失败行手术治疗。选择性血管栓塞治疗2例均成功，但其中1例2个月后再次出血；手术治疗6例，成功6例，均无复发。结论胃镜检查治疗是Dieulafoy病首选的诊断治疗方法，胃镜检查阴性或治疗失败可行DSA检查或选择性血管栓塞治疗，以上治疗失败或反复出血者应手术治疗，手术是彻底、有效的治疗方法。

Objective To observe the clinic features, diagnosis and treatment of Dieulafoy. Methods Sixteen cases of Dieulafoy complicated with gastrointestinal bleeding were retrospectively analyzed. Results The first occurring symptom was massive gastrointestinal hemorrhage. 12 of 16 cases who received gastroscopy were confirmed of diagnosis. 2 of 4 cases who took digital subtraction angiography （DSA） and 2 cases taking operations also had confirmed diagnosis. 10 of 12 cases who were treated by endoscopy, 2 cases taking embolization through DSA and 4 cases who were operated were cured. Conclusion Gastroscopy examination is the most effective method for Dieulafoy.