肝硬化失代偿期并胃窦血管扩张症1例

A case of decompensated liver cirrhosis complicated with gastric antral vascular ectasia

目的探讨胃窦血管扩张综合征(GAVE)临床表现、内镜特征、诊治要点,提高对GAVE的认识,减少误诊。方法回顾性分析十堰市太和医院1例误诊GAVE病人临床表现、内镜、实验室检查结果及治疗过程,并行文献回顾。结果病人66岁,男,肝硬化失代偿期,临床表现为长期贫血、反复黑便,检查胃镜提示胃窦可见散在糜烂及出血点,病情活动时可见多处点状渗血灶,病人误诊为门脉高压性胃病,行抑酸、降门脉压、输血及止血等治疗,并行经颈静脉肝内门体分流术(TIPS)治疗,最终死于多器官功能衰竭。结合病人病史及多次内镜检查结果,诊断考虑为GAVE。结论GAVE发病率低,易误诊,病史及内镜检查是诊断的重要依据,确诊需要结合病理检查,内镜治疗是重要措施,TIPS治疗可能无效,外科手术是重要治疗手段。

Objective To investigate the clinical manifestations,endoscopic features,diagnosis and treatment of gastric antral vas⁃cular ectasia(GAVE),improve the understanding of GAVE and reduce misdiagnosis.Methods The clinical manifestations,endosco⁃py,laboratory examination results and treatment process of a patient with misdiagnosed GAVE in Taihe Hospital were retrospectively analyzed,and the literature was reviewed.Results A 66-year-old male patient with decompensated liver cirrhosis showed clinical manifestations of long-term anemia and repeated melena.Gastroscopy revealed scattered erosions and bleeding points in the gastric an⁃trum and multiple punctate blood oozing foci when the disease was active.The patient was misdiagnosed with portal hypertensive gas⁃tropathy;received acid suppression,lowering portal pressure,blood transfusion and hemostasis;was treated with transjugular intrahe⁃patic portosystemic shunt(TIPS);and eventually died of multiple organ failure.Combined with the patient's medical history and multi⁃ple endoscopy results,the diagnosis was considered to be GAVE.Conclusions The incidence of GAVE is low,and it is easily misdiag⁃nosed.Medical history and endoscopy are important bases for diagnosis based on pathological examination.Endoscopic treatment is an important measure.TIPS treatment may be ineffective,and surgery is an important treatment method.