23例Dieulafoy病的内镜诊断和治疗

Endoscopic diagnosis and treatment of Dieulafoy＇s disease： a report of 23 cases

目的探讨Dieulafoy病内镜下诊断和治疗的方法。方法回顾分析我科临床诊断明确的23例Dieulafoy病伴消化道出血患者的临床资料。结果急诊胃镜确诊19例，急诊肠镜确诊2例，血管造影检查确诊1例，剖腹探查术确诊1例。19例病变位于近端胃，1例位于胃窦，1例位于十二指肠，2例位于直肠。21例内镜确诊的患者行金属钛夹钳夹成功止血，血管造影确诊的患者经动脉内持续灌注垂体后叶素止血，剖腹探查术确诊的患者行单纯血管缝扎术止血。结论急诊内镜检查是诊断Dieulafoy病的首选方法，内镜下钛夹的合理使用是治疗本病的主要手段。

Objective To investigate the endoscopic diagnosis and therapy of Dieulafoy＇s disease. Methods The clinical data of 23 patients clinically diagnosed with gastrointestinal bleeding combined with Dieulafoy＇s disease were retrospectively analyzed. Results Nineteen patients were diagnosed by emergency gastroscopy ,2 by emergency colonoscopy, 1 by selective angiography,and 1 by exploratory laparotomy. The focus were located in proximal stomach （ 19 patients）, antrum of stomach （ 1 patient）, duodenum（ ! patient） ,and rectum（2 patients）. The 21 patients diagnosed by endoscopy were cured by titanium clips, the patient diagnosed by selective angiography was controlled by intra - arterial infusion of vasopressin, and the remaining patient was stanched by surgery. Conclusion Emergency endoscopy is the first choice for diagnosis of Dieulafoy;s disease, and appropriate use of endoscopic clips under endoscope is the primary therapy.