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目的观察内镜下放置止血夹与注射疗法在治疗Dieulafoy病出血中的疗效。方法回顾分析自2001年至2009年我院诊治的Dieulafoy病内镜下特点及治疗结局,比较内镜下止血夹与注射疗法的止血的疗效差异,分析治疗失败的原因。结果①21例Dieulafoy病中男16例,女5例,平均年龄56.6岁,分别有11例行内镜下止血夹治疗,10例行注射治疗止血,两组间患者年龄、病变Forrest分级、平均输血量均有可比性;②采用止血夹治疗组止血成功率、再发出血率、转手术治疗比例分别为72.7%、27.3%、18.2%,注射治疗组分别为60.0%、40.0%、20.0%,两组间止血疗效比较差异无统计学意义(P>0.05);无内镜治疗相关的并发症发生;③内镜治疗后再次出血的时间均在48h内。注射治疗组有2例再出血患者死亡。结论内镜下放置止血夹及注射治疗均是治疗Dieulafoy病的有效方法再出血多见于内镜治疗后48h内;死亡的患者存在高龄、合并慢性病等因素。
Objective To observe the efficacy of endoscopic placement of hemostatic clips and injection therapy in the treatment of Dieulafoy’s disease. Methods The characteristics of endoscopic diagnosis and treatment of Dieulafoy ’s disease in our hospital from 2001 to 2009 were analyzed retrospectively. The difference of hemostasis between endoscopic clamp and injection therapy was compared. The causes of treatment failure were analyzed. Results ① There were 16 males and 5 females in 21 Dieulafoy’s disease patients with a mean age of 56.6 years. Of them, 11 were treated with endoscopic hemostasis and 10 were treated with injection. The age, lesion grade, and blood transfusion (2) The success rate of hemostasis and recurrence of hemostasis in the treatment group with hemostatic clip were 72.7%, 27.3% and 18.2%, respectively, and those in the treated group were 60.0%, 40.0% and 20.0% respectively, There was no significant difference between the two groups in the curative effect of hemostasis (P> 0.05). The complications related to endoscopic treatment were not found. The bleeding time after endoscopic treatment was within 48 hours. Two patients with rebleeding died in the injection group. Conclusion Endoscopic placement of the hemostatic clip and injection therapy are effective methods of treatment of Dieulafoy disease rebleeding more common within 48h after endoscopic treatment; death of patients with advanced age, combined with chronic diseases and other factors.