CAJ | 학술논문

目的探讨Dieulafoy病变致急性消化道大出血的多学科综合治疗及外科治疗方式的选择.方法回顾性分析2007年4月至2012年4月48例Dieulafoy病变合并消化道大出血患者的临床资料.结果本组最常见的出血部位是胃体(40例),其次是贲门(4例)、十二指肠(2例)和空肠(2例),且多发生在胃上部胃食管交界处6 cm以内.胃镜明确诊断有46例,急诊剖腹探查确诊2例.18例胃镜明确诊断的患者首先行局部肾上腺素注射和止血夹治疗；6例胃镜明确诊断的患者仅用止血夹治疗；2例十二指肠降部Dieulafoy病变出血内镜治疗失败的患者,行血管X线造影检查并栓塞,结果均成功.23例行手术治疗.47例治愈,1例死于低血容量性休克及多器官功能衰竭,平均住院时间是(10.8±2.5)d.结论 Dieulafoy病变发生率低但易导致凶险出血,可首先尝试内镜下肾上腺素局部注射联合止血夹治疗及介入治疗,多数患者最终需要外科治疗.
목적 탐토Dieulafoy병변치급성소화도대출혈적다학과종합치료급외과치료방식적선택.방법 회고성분석2007년4월지2012년4월48례Dieulafoy병변합병소화도대출혈환자적림상자료.결과 본조최상견적출혈부위시위체(40례),기차시분문(4례)、십이지장(2례)화공장(2례),차다발생재위상부위식관교계처6 cm이내.위경명학진단유46례,급진부복탐사학진2례.18례위경명학진단적환자수선행국부신상선소주사화지혈협치료；6례위경명학진단적환자부용지혈협치료；2례십이지장강부Dieulafoy병변출혈내경치료실패적환자,행혈관X선조영검사병전새,결과균성공.23례행수술치료.47례치유,1례사우저혈용량성휴극급다기관공능쇠갈,평균주원시간시(10.8±2.5)d.결론 Dieulafoy병변발생솔저단역도치흉험출혈,가수선상시내경하신상선소국부주사연합지혈협치료급개입치료,다수환자최종수요외과치료.
Objective To explore the multidisciplinary treatment for acute massive gastrointestinal (GI) bleeding caused by Dieulafoy's lesion.Methods The clinical data of 48 patients with Dieulafoy's lesions treated at our hospital from April 2007 to April 2012 were retrospectively analyzed.Of the 48 patients,40 were males and 8 were females,with a mean age of 46.7 years (range 21 -52 years).Accurate diagnosis was established by emergency upper gastrointestinal endoscopy, angiography and emergency laparotomy.Results The most common location of the bleeding Dieulafoy's lesion was at the body of stomach (40 cases),followed by the cardia (4 cases),the duodenum (2 cases) and the jejunum (2 cases ),with most lesions being located in the upper part of the stomach within 6 cm of the gastroesophageal junction.Correct diagnosis was made by endoscopy in 46 patients and by emergency laparotomy in 2 cases.Of the 18 patients initially treated endoscopically epinephrine injection and endoscopic hemoclips,2 cases needed angiography to identify the source of bleeding and were cured by transcatheter arterial embolization.23 patients underwent surgical therapy.In this series,47 cases were cured,1 patient died of hypovolaemic shock and multi-organ failure during the hospital stay.Average length hospital stay was (10.8 ± 2.5 ) d.Conclusions Dieulafoy' s lesion is less common cause of gastrointestinal bleeding.Endoscopy plays a key role in the diagnosis and treatment.Topical epinephrine injection and haemoclipping may cure the patients,if it fails angiography and embolization provides a therapy.Most patients may need a laparotomy and surgery as a decisive measure.