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目的探讨急诊内镜联合选择性动脉造影诊治Dieulafoy病的临床价值。方法我院消化内科2009年1月1日~2010年12月31日共收治Dieulafoy病18例,对其中急诊内镜联合选择性动脉造影救治Dieulafoy病所致上消化道大出血4例进行临床分析,通过急诊内镜联合选择性动脉造影的协同应用,观察对出血部位、病因的诊断价值和止血效果。结果 4例患者均在就诊1~24h内胃镜检查确诊Dieulafoy病,其中3例给予镜下钛夹止血或药物喷洒止血后仍有活动性出血随即行选择性动脉造影血管栓塞治疗,1例因镜下出血表现为喷射样,并血压下降,给予病灶旁钛夹标记后随即行选择性动脉造影血管栓塞治疗。本组4例在选择性动脉造影同时结合内镜所见均给予相应病变血管弹簧栓或明胶海绵栓塞止血治疗并成功止血。结论急诊内镜联合选择性动脉造影血管栓塞术协同诊治Dieulafoy病所致消化道出血,两者互为补充,是一种安全、有效、可靠的诊治方法。
Objective To investigate the clinical value of emergency endoscopy combined with selective arteriography in diagnosis and treatment of Dieulafoy’s disease. Methods Gastroenterology in our hospital from January 1, 2009 ~ December 31, 2010 were treated 18 cases of Dieulafoy disease, which emergency endoscopy combined with selective arteriography for the treatment of Dieulafoy disease caused by upper gastrointestinal bleeding in 4 cases clinical analysis, Through the emergency endoscopic combined with selective angiography synergistic application to observe the bleeding site, the cause of the diagnosis and hemostasis effect. Results All 4 patients were diagnosed with Dieulafoy’s disease by gastroscopy during the first 24 hours of treatment. Among them, 3 cases were treated with titanium clips to stop the bleeding or active hemorrhage after drug spraying, followed by selective angiography and embolization. Under the performance of jet-like hemorrhage-like, and decreased blood pressure, given lesions adjacent titanium clip mark immediately after the line selective angiography embolization. This group of 4 cases of selective angiography combined with endoscopic findings are given to the corresponding lesion vascular bolt or gelatin sponge embolization hemostasis and successful hemostasis. Conclusion Emergency endoscopic combined with selective arteriography and angiography embolization combined with diagnosis and treatment of gastrointestinal bleeding caused by Dieulafoy disease are complementary, which is a safe, effective and reliable diagnosis and treatment method.