Fockens P, Tytgat G N
Department of Gastroenterology-Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands.
Gastrointest Endosc Clin N Am. 1996 Oct;6(4):739-52.
Brisk bleeding from a Dieulafoy's gastric vascular anomaly is not an uncommon cause of upper gastrointestinal bleeding. The lesion in Dieulafoy's disease consists of a normal caliber artery that runs very close to the epithelial layers and is therefore relatively large compared with the vessels normally in that area. Meticulous inspection of the gastric mucosa, especially in the well-distended upper part of the stomach, is essential for an adequate diagnosis. Quite often multiple endoscopies are necessary before the lesion is recognized. In the past 10 years Dieulafoy's disease has also been described in almost every other part of the gastrointestinal tract, although less frequently than in the stomach. Endoscopy is the primary diagnostic technique but in some patients ES has been described to be of major help in identifying the vascular anomalies and in guiding local therapy aimed at occlusion of the abnormal vessel. Successful hemostasis has been reported with many different endoscopic techniques, with a success rate between 80% and 90% in expert hands. Alternatively, wedge resection or vascular ligation is required in cases of endoscopic failure at hemostasis. With further improvement of our diagnostic techniques, it is expected that even more patients will be diagnosed with Dieulafoy's disease in the future.
Dieulafoy胃血管异常引起的急性出血是上消化道出血的常见原因之一。Dieulafoy病的病变由一条管径正常的动脉组成，该动脉紧贴上皮层走行，因此与该区域正常血管相比相对较粗。对胃黏膜进行细致检查，尤其是胃充分扩张的上部，对于做出准确诊断至关重要。很多时候，在识别病变之前需要多次进行内镜检查。在过去10年中，Dieulafoy病在胃肠道的几乎其他各个部位也有报道，尽管其发生率低于胃部。内镜检查是主要的诊断技术，但在一些患者中，内镜超声被描述为在识别血管异常以及指导针对异常血管闭塞的局部治疗方面有很大帮助。多种不同的内镜技术都报道有成功止血的案例，在专家手中成功率在80%至90%之间。另外，在内镜止血失败的情况下需要进行楔形切除术或血管结扎术。随着我们诊断技术的进一步改进，预计未来会有更多患者被诊断为Dieulafoy病。
