国内312例dieulafoy病临床分析

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1、国内312例Dieulafoy病临床分析作者：郭俊雄郑永平杨壁辉【关键词】国内摘要：目的：为探讨Dieulafoy病的发病情况及临床特点。方法：无选择地收集国内近12年公开报道的301例及含本例确诊的11例，共312例Dieulafoy病加以综合分析。结果：全组312例中男：女=7：1，中位年龄50.3岁。诱因以饮酒、药物及刺激性食物多见，临床常见呕血、黑便、失血性休克、腹痛及腹胀。首次内镜检查确诊率为53%，部分经2～4次确诊其余病例均经手术证实，病变部位以胃部（269/312）多见，绝大部分位于食管与胃连

2、接部以下6cm范围（218/269），死亡原因多为失血性休克及伴发疾病。结论：Dieulafoy病临床表现缺乏特异性，对于中年男性无明显先兆的突发消化道出血又无相关病史，应高度怀疑本病。并尽可能及早进行内镜检查及治疗。关键词：Dieulafoy；诱因；内镜检查TheClinicalAnalysisof312PatientswithDieulafoyLesioninChinaAbstract：Objective:Toinvestigatetheincidenceof7Dieulafoylesionanditsc

3、linicalfeatures.Method:Total312casesofDieulafoylesionwith301casesreportedopenlyinrecent12yearsnational-wideand11casesfinallydiagnosedinourhospitalhavebeenenrolledunselectivelyinourstudytobeanalyzed.Result:In312cases,theratioofmaletofemaleis7to1aswellastheme

4、dianageis50.3.Themostcommoninducementscanbefoundinalcoholintake,drugsandincentivefoods.Haematemesis,melena,hemorrhagicshock,diarrheaandabdominalpainoftenmanifestsinclinic.Theconfirmeddiagnosisbyfirstendoscopesexaminationis53%,thefinaldiagnosisofpartialcases

5、wasobtainedafter2to4timesexaminationandtherestcaseswereconfirmedbysurgery.Thelesionmostlylocatedingastriccorpus(269/312),especiallyintherangeof6cmbelowgastroesophagealjunction(218/269).Therapeuticalmeasuresincludeendoscopichemostasiaandsurgerytreatment.Tota

6、lsuccessrateofendoscopichemostasiareaches80%(91/127).Hemorrhagicshockandaccompaniedlesionsarethemostcauseofdeath.Conclusion:Dieulafoylesionislackofclinicalspecificity,soinMiddle-Agepatientswithsuddenuppergastrointestinalhemorrhageofnoobviousprecursorandnore

7、latedlesions,Dieulafoylesionshouldbehighlysuspected,whichmustbeunderwentendoscopicexaminationandtreatment7asquicklyaspossible.Keywords:Dieulafoy；Inducements；EndoscopicexaminationDieulafoy病是上消化道出血的少见病因之一。其病情凶猛，临床医师如对该病缺乏足够认识，诊断及处理不当，往往导致病情恶化甚至死亡。为加深对本病的认识及对诊

8、断、治疗的全面了解，本文结合含本院确诊的11例并综合国内近5年公开报道的301例，共312例Dieulafoy病加以综合分析。1临床资料1．1一般资料：全组312例中男性273例，女性39例，男：女=7：1，发病年龄11～89岁，中位年龄50.3岁。全组中有212例描述诱因（212/312），其中饮酒109例，药物41例，刺激性食物11例，应激8例，诱因不明43例。1.27临床表现：全组中呕血303