心血管介入和手术后食管贲门黏膜撕裂的临床及内镜特点

Clinical and Endoscopic Features of Mallory-Weiss Syndrome Associated With Cardiovascular Intervention and Surgical Treatment

目的探讨心血管介入和手术后食管贲门黏膜撕裂的临床特点。方法回顾性分析2015年3月~2019年3月经电子胃镜检查诊断为食管贲门黏膜撕裂综合征并出血,且发病前1周内有心脏及大血管介入或手术史24例的临床、内镜资料。发病前均有呕吐的症状,继而出现呕血或胃管内抽出暗红色血。结果内镜下均为纵行撕裂,好发生于贲门部(14例,58. 3%),多见于左侧壁(10例,41. 7%)、后壁(8例,33. 3%),单处撕裂多见(19例,79. 2%)。75. 0%(18/24)有活动性出血(Chung分级Ⅰ级3例,Ⅱ级15例)。2例Chung分级Ⅳ级者无需止血治疗;余22例采用以金属钛夹为基础的联合止血方式,止血成功20例,2例内镜下止血失败者行腹主动脉和腹腔干造影联合胃左动脉栓塞止血。结论心血管介入治疗和手术后出现呕血或胃管内抽出暗红色血的患者应考虑到食管贲门黏膜撕裂并出血的可能,胃镜下止血是有效的治疗方法。

Objective To investigate the clinical characteristics of Mallory-Weiss syndrome (MWS) associated with cardiovascular intervention and surgical treatment. Methods A retrospective study was performed on 24 patients in our hospital from March 2015 to March 2019, who were diagnosed as MWS with bleeding by gastroscopy and had a history (within 1 week) of cardiovascular intervention and surgical treatment before the onset of MWS.All the patients had the symptom of vomiting before the onset of MWS, followed by hematemesis or dark red blood drawn from the stomach tube. Results Under gastroscope, all the tears were longitudinal. The lesions were mainly in cardia (14 cases, 58.3%), common in the left wall (10 cases, 41.7%) and back wall (8 cases, 33.3%). There were 19 cases (79.2%) of single tear. Active hemorrhage was seen in 75.0% of patients (18/24), including Chung grade Ⅰ in 3 cases and grade Ⅱ in 15 cases. Two patients with Chung grade Ⅳ did not need hemostasis treatment. The remaining 22 patients received combined hemostasis based on titanium clipping. And 20 patients succeeded in hemostasis, while 2 patients with failed endoscopic hemostasis underwent abdominal aortography and celiac trunk angiography combined with left gastric artery embolization. Conclusions Patients with hematemesis or dark red blood drawn out of the gastric tube after cardiovascular intervention and surgical treatment should be considered the possibility of MWS. Hemostasis under gastroscopy is an effective treatment.