|
杜氏病伴上消化道大出血1例并文献复习
|
Abstract:
杜氏病作为上消化道出血来源的报告发病率范围为0.28%至6.7%,是胃肠道出血里非常少见的一种类型,但由于其出血往往是大量且反复发生的,在不明原因胃肠道出血中是最危及生命的原因之一。杜氏病的防治重点在于早发现,尤其是早诊断、早治疗,由于其症状无明显特异性,因此临床上难以及时发现和做出正确诊断是这种疾病仍具有高死亡率的重要原因。现汇报1例行胃肠镜检查后确诊为杜氏病引起消化道出血的病例,并结合相关文献探讨其诊断与治疗。
Dieulafoy’s Disease, reported as the source of upper gastrointestinal bleeding in 0.28% to 6.7% of cases, is a rare cause of gastrointestinal hemorrhage. However, due to its propensity for massive and recurrent bleeding, it is one of the most life-threatening etiologies of obscure gastrointestinal bleeding. The cornerstone of managing Dieulafoy’s Disease lies in early detection, particularly prompt diagnosis and treatment. Nonetheless, the lack of specific clinical symptoms often leads to delayed recognition and misdiagnosis, which significantly contributes to its high mortality rate. This article presents a case of gastrointestinal bleeding caused by Dieulafoy’s Disease, diagnosed following gastroscopy, and discusses its diagnosis and management in conjunction with a review of the relevant literature.
[1] | Lee, Y.T., Walmsley, R.S., Leong, R.W.L. and Sung, J.J.Y. (2003) Dieulafoy’s Lesion. Gastrointestinal Endoscopy, 58, 236-243. https://doi.org/10.1067/mge.2003.328 |
[2] | Chaer, R.A. and Helton, S.W. (2003) Dieulafoy’s Disease. Journal of the American College of Surgeons, 196, 290-296. https://doi.org/10.1016/s1072-7515(02)01801-x |
[3] | Jeon, H.K. and Kim, G.H. (2015) Endoscopic Management of Dieulafoy’s Lesion. Clinical Endoscopy, 48, 112-120. https://doi.org/10.5946/ce.2015.48.2.112 |
[4] | Lara, L.F., Sreenarasimhaiah, J., Tang, S., Afonso, B.B. and Rockey, D.C. (2010) Dieulafoy Lesions of the GI Tract: Localization and Therapeutic Outcomes. Digestive Diseases and Sciences, 55, 3436-3441. https://doi.org/10.1007/s10620-010-1385-0 |
[5] | Baxter, M. and Aly, E. (2010) Dieulafoy’s Lesion: Current Trends in Diagnosis and Management. The Annals of The Royal College of Surgeons of England, 92, 548-554. https://doi.org/10.1308/003588410x12699663905311 |
[6] | 梁政, 刘海燕, 陈均忠. 内镜治疗杜氏溃疡并活动性动脉出血的临床观察[J]. 医学理论与实践, 2014, 27(6): 755-756. |
[7] | Jensen, D.M., Kovacs, T.O.G., Ohning, G.V., Ghassemi, K., Machicado, G.A., Dulai, G.S., et al. (2017) Doppler Endoscopic Probe Monitoring of Blood Flow Improves Risk Stratification and Outcomes of Patients with Severe Nonvariceal Upper Gastrointestinal Hemorrhage. Gastroenterology, 152, 1310-1318.e1. https://doi.org/10.1053/j.gastro.2017.01.042 |
[8] | Schmidt, A., Gölder, S., Goetz, M., Meining, A., Lau, J., von Delius, S., et al. (2018) Over-the-Scope Clips Are More Effective than Standard Endoscopic Therapy for Patients with Recurrent Bleeding of Peptic Ulcers. Gastroenterology, 155, 674-686.e6. https://doi.org/10.1053/j.gastro.2018.05.037 |
[9] | Jensen, D.M., Kovacs, T., Ghassemi, K.A., Kaneshiro, M. and Gornbein, J. (2021) Randomized Controlled Trial of Over-The-Scope Clip as Initial Treatment of Severe Nonvariceal Upper Gastrointestinal Bleeding. Clinical Gastroenterology and Hepatology, 19, 2315-2323.e2. https://doi.org/10.1016/j.cgh.2020.08.046 |
[10] | Park, J.J., Jung, Y., Kim, J.H., et al. (2021) Role of Enhanced CT in Detecting Dieulafoy’s Lesion. Clinical Endoscopy, 54, 653-659. |
[11] | Lee, Y.T., Walmsley, R.S., Leong, R.W.L. and Sung, J.J.Y. (2003) Dieulafoy’s Lesion. Gastrointestinal Endoscopy, 58, 218-224. |
[12] | 中华医学会消化内镜学分会. 急性非静脉曲张性上消化道出血诊治指南(2023) [J]. 中华消化内镜杂志, 2023, 40(5): 321-335. |