9例Dieulafoy病的诊治报告及文献复习

Endoscopic diagnosis and treatment of 9 cases with Dieulafoy lesion

目的探讨Dieulafoy病的发病情况、临床特征、诊断与治疗。方法收集我院2000年12月至2007年10月间收治的上消化道出血病人450例,对其中检出的9例Dieulafoy病病例的临床特征、内镜下表现及治疗方法进行回顾性分析。结果Dieulafoy病约占上消化道出血的2%,9例Dieulafoy病中,病灶位于胃底5例,胃体3例,十二指肠球部1例,其中8例均于胃镜下可直接见破裂血管,有2例可见喷射状出血。病灶直径2mm1例,直径2.5～10mm4例。1例于内镜下行病灶粘膜下局部注射肾上腺素;内镜下金属钛夹止血6例,其中2例加局部喷纤维蛋白封闭剂,1例因再出血需手术治疗。结论Dieulafoy病是上消化道大出血的少见而重要的病因,该病诊断主要依靠胃镜检查,通过内镜早期诊断和治疗可以取得好的疗效。

Objective To identify the clinical features and endoscopic management of 9 cases with Dieulafoy＇ s lesion in the upper gastrointestinal （GI） bleeding, and to review the literature related. Methods Data of 9 cases with Dieulafoy＇ s lesion out of 450 patients with the upper GI bleeding were reviewed and analyzed retrospectively from December 2000 to October 2007, including the clinical features, the endoscopic examination and the edoscopic therapies. Results 2% of tile cases with upper GI bleeding were caused by Dieulafoy＇ s lesion. Among the 9 cases of Dieulafoy＇ s lesion, 5 of them were found in the fundus of stomach, 3 in the body of stomach, and 1 was in the duodenum. Broken blood vessel was found directly in 8 cases （89%）, 2 of which were found with blood spurting out of artery. The diameter of the lesion were 2 mm in 1 case, and 2.5 mm-10 mm in 4 other cases. One patient was initially treated by endoscopic injection therapy with epinephrine. 6 cases were treated with endoscopic hemoclip and two of them were applied with insufflation of fibrin sealant, among which one had recurrent bleeding and was treated by surgery. Conclusion Dieulafoy＇ s lesion is an uncommon but major cause for upper gastrointestinal bleeding. Emergent endoscopic examination and therapy in the early stage can be very effective.