Mallory-Weiss综合征59例胃镜治疗效果分析

Effect Analysis of 59 Mallory-Weiss Syndrome Cases Treated by Gastroscope

目的探讨急诊胃镜诊治食管-贲门黏膜撕裂（Mallory-Weiss）综合征的临床疗效。方法回顾性分析2009年1月至2012年12月收治的59例急诊胃镜诊断治疗Mallory-Weiss综合征患者的临床资料,总结其临床特点、胃镜下表现、诊治方法、并发症等。结果 59例患者胃镜下可见不同程度的黏膜和黏膜下层纵行撕裂伤,位于食管下段近贲门处17例,贲门处34例,贲门胃底处8例;位于小弯侧39例,大弯侧7例,前壁8例,后壁5例;撕裂处表面覆有血痂11例,血凝块13例,新鲜血6例,黄白苔7例,活动性出血22例,可见裸露的血管残端17例。撕裂黏膜边界清晰,周围黏膜轻度水肿。撕裂黏膜长度5~60 mm、宽2~5 mm,其中撕裂伤1处31例、2处21例及3处7例。胃镜下行止血夹缝合治疗43例,应用氩气喷凝治疗7例,行注射针注射治疗6例,行套扎治疗3例。术后恢复顺利,无穿孔、纵隔气肿、出血等并发症发生。结论 Mallory-Weiss综合征发生于食管-贲门-胃底黏膜,表现为消化道出血。急诊胃镜诊断、治疗Mallory-Weiss综合征,安全、并发症少、疗效确切,是一种有效的治疗措施。

Objective To investigate the clinical characteristic,gastroscopic manifestation and treatment of Mallory-Weiss syndrome（ MWS）. Methods We retrospectively analyzed the gastroscopic and clinical datas of 59 MWS patients from January 2010 to December 2012 in department of Endoscopy of General Hospital of Shenyang Military Command,and summarized characteristics,approach of gastroscopic diagnosis and therapy. Results Under gastroscope,59 cases with MalloryWeiss syndrome were all found lacerations which were longitudinal and length ranged from 5 to 60 mm,width from 2 to 5mm. 17 cases lacerations were at lower esophagus,34 cases lacerations at cardia,8 cases lacerations at cardia and fundus. 31 cases had single laceration,21 cases had 2 lacerations and 7 cases had 3 lacerations. 39 cases had lacerations in lesser curvature,7 cases in greater curvature,8 cases anterior wall,and 5 cases in posterior wall. 11 cases had blood scab on laceration,13 cases had blood clot on laceration,6 cases had fresh blood on laceration,7 cases had yellow-white moss on laceration,22 cases had active hemorrhage on laceration,and 17 cases had bare stumps of blood vessels on laceration. 43 cases were sutured with metal clip,7 cases were treated with APC,6 cases were treated with injection,and 3 cases were treated with band ligature. No perforation,mediastinal emphysema,hemorrhage. Conclusion Mallory-Weiss syndrome could be found at esophagua cardia-gastri with gastrointestinal hemorrhage. It is a less invasive,safe and effective treatment option for Mallory-Weiss syndrome in emergency by gastroscope.