Cacoub P, Sbaï A, Benhamou Y, Godeau P, Piette J C
Service de Médecine interne, Hôpital La Pitié-Salpêtrière, Paris.
Presse Med. 2000 Jan 29;29(3):139-41.
Vascular abnormalities are being reported with increasing frequency as a cause of major lower gastrointestinal hemorrhage in the elderly. They are occasionally very difficult to treat by conventional means.
A 66-year-old white man with a history of type 2 diabetes mellitus, coronary artery disease, congestive heart failure, severe peripheral arterial occlusion disease and chronic renal insufficiency presented for five years recurrent major bleeding due to gastrointestinal angiodysplasia, requiring repeated transfusions. He was treated with efficacy using ethinyl-estradiol (30 micrograms) and norethisterone acetate (1 mg) given orally once daily. After six months of treatment, transfusion requirements fell to 0 unit and the patient's hemoglobin was stable at 13 g/dl. Attempts to stop hormone therapy (by the patient himself, without complaint of side effects) led to a fall in hemoglobin.
Hormonal therapy should be considered when multiple degenerative mucosal vascular bleeding lesions are beyond the reach of therapeutic endoscopy leading to high transfusion needs and when surgical risk is unacceptably high.
血管异常作为老年人下消化道大出血的一个病因，其报告频率日益增加。它们有时很难用传统方法治疗。
一名66岁白人男性，有2型糖尿病、冠状动脉疾病、充血性心力衰竭、严重外周动脉闭塞性疾病和慢性肾功能不全病史，因胃肠道血管发育异常出现反复严重出血5年，需要反复输血。给予乙炔雌二醇（30微克）和醋酸炔诺酮（1毫克）口服，每日1次，治疗有效。治疗6个月后，输血需求降至0单位，患者血红蛋白稳定在13克/分升。试图停止激素治疗（由患者自行停止，无副作用主诉）导致血红蛋白下降。
当多个退行性黏膜血管出血病变超出治疗性内镜检查范围导致高输血需求且手术风险高得不可接受时，应考虑激素治疗。
