病历简介:男性,42岁,因“酗酒后大量呕血”于2004年2月8日入院,呕血量约800 ml,既往无乙肝病史及消化性溃疡病史,嗜烟酒。查体:神清,贫血貌,无黄染,心肺(-),腹平软,无反跳痛,肝脾不大,未扪及包块,腹部移动性浊音(-),肠鸣音活跃。血常规:RBC 9.8×10~(12)/L,Hbg 59g/L,MVH 20%,PLT 110×10~9/L。入我院内科抗休克、止血治疗。急诊胃镜检查见胃底黏膜一溃疡,可见搏动性出血。即用肾上腺素高渗盐水(HSE)喷洒止血,出血停止,未取病检,疑诊为 Dieulafoy 病。行保守治疗。2d 后又出血,量约1000 ml,急转外科治疗。经连续硬膜外麻醉,术中用胃镜确定出血部位,经上腹部正中切口进腹,按胃镜的冷光源指示后钳夹胃壁,纵行切开约5cm,见位于贲门下5cm 胃底处一1.5cm 的浅表溃疡,其中央有一破溃小动脉出血,余黏膜正常。沿血管走向楔行切除4cm 胃壁,缝扎止血后见无出血,缝合胃壁,手术顺利。常规送病检。术后3d Medical history Description: Male, 42 years old, due to “” a lot of bloody vomiting after alcoholism "was admitted on February 8, 2004, hematemesis amount of about 800 ml, no previous history of hepatitis B and history of peptic ulcer, alcohol and tobacco. Physical examination: Shen Qing, anemia appearance, no yellow dye, cardiopulmonary (-), abdominal soft, no rebound pain, liver and spleen not, palpable mass, abdominal dullness (-), bowel sounds active . Blood routine: RBC 9.8 × 10-12 / L, Hbg 59g / L, MVH 20%, PLT 110 × 10-9 / L. Into our hospital internal medicine anti-shock, hemostatic treatment. Emergency gastroscopy see an ulcer gastric mucosa, showing pulsatile bleeding. Namely adrenaline hypertonic saline (HSE) to stop bleeding, stop bleeding, did not take sick, suspected Dieulafoy disease. Line conservative treatment. After 2d hemorrhage, the amount of about 1000 ml, acute surgical treatment. After continuous epidural anesthesia, intraoperative gastroscopy to determine the bleeding site, the median abdominal incision into the abdomen, cold gas source according to the instructions of the gastroscope after clamping the stomach wall, longitudinal incision about 5cm, see the stomach at the bottom of the stomach 5cm 1.5cm superficial ulcer, the central ulcerated small artery bleeding, mucosal normal. Along the vascular wedge resection 4cm gastric wall, suture bleeding to see no bleeding, stitching the stomach, the operation goes well. Regular sent sick examination. 3d after surgery