Dieulafoy病致消化道大出血的介入治疗

Interventional therapy for gastrointestinal hemorrhage induced by Dieulafoy disease

目的探讨介入治疗Dieulafoy病所致的消化道大出血的效果及应用价值。方法10例Dieulafoy病所致急性消化道大出血患者常规行腹腔动脉和胃左动脉造影,发现有胃左动脉出血征象和(或)血管异常者8例,6例使用明胶海绵栓塞,2例血管瘤样扩张者使用明胶海绵+弹簧钢圈栓塞;另2例无明显出血征象者中1例给予垂体后叶素灌注,另1例未予介入治疗。结果本组病例术中均无严重并发症。栓塞的8例患者中,1例明胶海绵栓塞术后第3天再呕血,后行外科手术治疗,其余7例均未再出血;1例垂体后叶素灌注患者1周后症状消失出院。结论介入疗法安全、快捷、见效快,是急诊处理Dieulafoy病所致消化道大出血较为理想的治疗手段。

Objective To investigate and assess the efficiency and clinical value of interventional therapy for gastrointestinal hemorrhage induced by Dieulafoy disease. Methods Ten patients definitely diagnosed with Dieulafoy disease suffering from massive acute gastrointestinal hemorrhage received celiac arterial and left gastric arterial angiography, outcoming with 8 positively and 2 negative cases. Among them, 6 were embolized with geffoam particles and the other two with aneurismal dilatation received geffoam particles and spring steel coils ; and one of the negtive cases was given hypophysin and without intervention to the other. Results Among the 8 intra-arterial embolized cases, only 1 case rebleeded on the third day after geffoam embolization,and then treated by surgical operation, and the rest 7 showed no rebleeding. One case with hypophysin treatment rehabilitated after one week. Conclusions Interventional therapeutics is a safe and effective emergency management for gastrointestinal hemorrhage induced by Dieulafoy disease.