论文部分内容阅读
目的探讨急诊胃镜诊治食管-贲门黏膜撕裂(Mallory-Weiss)综合征的临床疗效。方法回顾性分析2009年1月至2012年12月收治的59例急诊胃镜诊断治疗Mallory-Weiss综合征患者的临床资料,总结其临床特点、胃镜下表现、诊治方法、并发症等。结果 59例患者胃镜下可见不同程度的黏膜和黏膜下层纵行撕裂伤,位于食管下段近贲门处17例,贲门处34例,贲门胃底处8例;位于小弯侧39例,大弯侧7例,前壁8例,后壁5例;撕裂处表面覆有血痂11例,血凝块13例,新鲜血6例,黄白苔7例,活动性出血22例,可见裸露的血管残端17例。撕裂黏膜边界清晰,周围黏膜轻度水肿。撕裂黏膜长度5~60 mm、宽2~5 mm,其中撕裂伤1处31例、2处21例及3处7例。胃镜下行止血夹缝合治疗43例,应用氩气喷凝治疗7例,行注射针注射治疗6例,行套扎治疗3例。术后恢复顺利,无穿孔、纵隔气肿、出血等并发症发生。结论 Mallory-Weiss综合征发生于食管-贲门-胃底黏膜,表现为消化道出血。急诊胃镜诊断、治疗Mallory-Weiss综合征,安全、并发症少、疗效确切,是一种有效的治疗措施。
Objective To investigate the clinical efficacy of emergency endoscopy in the diagnosis and treatment of Mallory-Weiss syndrome. Methods The clinical data of 59 patients with Mallory-Weiss syndrome diagnosed by endoscopy in our hospital from January 2009 to December 2012 were retrospectively analyzed. The clinical features, performance under endoscopy, diagnosis and treatment methods, complications and so on were summarized. Results Fifty-nine patients were treated with endoscopic rupture of mucosa and submucosa under endoscopy, 17 cases were located near the cardia in the lower esophagus, 34 cases were in the cardia and 8 cases were in the cardiac fundus. There were 39 cases located in the lesser curvature, 7 cases in the anterior wall, 8 anterior wall and 5 posterior wall. There were 11 blood clots on the surface of the tear, 13 blood clots, 6 fresh blood, 7 yellow-white moss and 22 active bleeding. 17 cases of vascular stump. Clear tear mucosal border, mild mucosal edema around. Tearing mucosa length of 5 ~ 60 mm, width 2 ~ 5 mm, including laceration in 1 case 31 cases, 2 cases 21 cases and 3 cases 7 cases. Forty-three cases underwent endoscopic stenosis with gastroscope. Seven cases were treated with argon sparging, 6 cases were injected with injection needle and 3 cases were treated with ligation. Postoperative recovery was smooth, no perforation, mediastinal emphysema, bleeding and other complications. Conclusion Mallory-Weiss syndrome occurs in the esophagus - cardia - gastric mucosa, showing gastrointestinal bleeding. Emergency diagnosis of gastroscopy, the treatment of Mallory-Weiss syndrome, safety, fewer complications, the exact effect, is an effective treatment.