Stark M E, Gostout C J, Balm R K
Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota 55905.
Gastrointest Endosc. 1992 Sep-Oct;38(5):545-50. doi: 10.1016/s0016-5107(92)70513-6.
The experience of a specialized management team using urgent endoscopy in the management of acute gastrointestinal bleeding from Dieulafoy's disease is presented. Dieulafoy's disease was found in 19 of 1124 consecutive patients with upper gastrointestinal bleeding. Most patients with Dieulafoy's disease were elderly men with severe acute upper gastrointestinal hemorrhage. Endoscopic diagnosis was possible in all patients, but required multiple endoscopies in 37%. The lesions were in the proximal stomach (79%) and duodenal bulb (21%). Endoscopic therapy included epinephrine injection, then heater probe coagulation in 17 patients, bipolar electrocoagulation in 1, and Nd:YAG laser photocoagulation in 1. Endoscopic therapy was successful in 18 patients (95%); one patient had successful surgery after endoscopic therapy failed. There were no deaths due to bleeding and no endoscopic complications. Dieulafoy's disease is an unusual cause of acute gastrointestinal bleeding. Endoscopic diagnosis is sometimes difficult, but primary endoscopic therapy is safe, successful, and should be attempted.
本文介绍了一个专业管理团队在使用紧急内镜检查治疗Dieulafoy病所致急性胃肠道出血方面的经验。在1124例连续性上消化道出血患者中，发现19例患有Dieulafoy病。大多数Dieulafoy病患者为老年男性，伴有严重的急性上消化道出血。所有患者均可行内镜诊断，但37%的患者需要多次内镜检查。病变位于胃近端（79%）和十二指肠球部（21%）。内镜治疗包括17例患者先注射肾上腺素，然后用热探头凝固，1例采用双极电凝，1例采用Nd:YAG激光光凝。18例患者内镜治疗成功（95%）；1例患者在内镜治疗失败后手术成功。无出血相关死亡病例，也无内镜并发症。Dieulafoy病是急性胃肠道出血的一种罕见病因。内镜诊断有时困难，但内镜下初始治疗安全、有效，应予以尝试。
