胃Dieulafoy病内镜下特点及临床诊治心得

Endoscopic gastric Dieulafoy disease characteristics and clinical experience

目的探讨胃Dieulafoy病的内镜及临床诊治特点。方法搜集1998年1月至2009年1月我院1012例上消化道出血患者的临床资料，对确诊的20例胃Dieulafoy病患者临床资料进行回顾性分析。结果Dieulafoy病好发于男性，男：女为3．5：1，平均年龄41．3岁；本病以反复发作性上消化道出血为主要症状，出血前无明显腹部不适或疼痛；内镜检查及治疗为本病主要诊疗手段；镜下表现特点为t片状黏膜糜烂，中央有血管断端显露（3／11），胃底见喷射样出血点（3／11）；胃体上部前壁见点状血痂（2／11）；胃体上部后壁见红疹样隆起（2／11），胃体上部前壁有浅小溃疡（1／11）。内镜治疗以内镜下电凝止血为主（7／11）。病变部位局部楔形切除在基层医院也应受到重视。结论急诊科、消化科医师尤其是内镜医师应提高对本病的认识，对患者进行细致、反复的内镜检查以及及时有效的镜下治疗。

Objective To investigate the features of endoscopic diagnosis and therapy of Dieulafoy disease. Methods Out of 1012 patients with gastrointestinal bleeding, the data of 20 patients with Dieulafoy disease diagnosed by endoscopy from January 1998 through January 2009 were reviewed. Results Males were inlarger proportion than females（ 3.5：1 ）. Most of the patients were 41.3 years old. Recurrent upper gastrointestinal bleeding without abdominal discomfort or pain was an important clinical manifestation. Endoscopy was the choice for diagnosis and treatment of this disease. The eappearance of the lesion consisted of a vascular stump which protrudes from mucosa through a small erosion, an isolated vascular stump, and anisolated thrombus or blood clot. In endoscopic therapy give priority to electrocoagulation. Conclusion The clinician, especially the endoscopist,should enhance the understanding of this disease. It is important to do endoscopy carefully and repearly and do endoscopic treatment timely and effectively.