胃窦血管扩张症的临床分析

摘要

目的 探讨胃窦血管扩张症(gastric antral vascular ectasia,GAVE)的临床特征、诊断要点及治疗方法,提高对本病的认识.方法 对我院2008年4月-2012年5月收治的15例GAVE患者的临床资料进行系统的回顾性分析.结果 15例患者均经内镜诊断为GAVE,男7例,女8例,年龄39～91岁,平均年龄(59.53±13.86)岁.12例表现为大便潜血持续阳性、间断黑便或呕血并伴有不同程度失血性贫血,15例患者血红蛋白平均(82.53±10.25)g/L,其中6例血红蛋白含量< 80 g/L,2例患者有上腹部疼痛.8例伴有肝硬化,6例伴有萎缩性胃炎;3例无症状的患者未进行任何治疗,4例患者在内科保守治疗后出血暂时控制,但均有复发.6 例行内镜下氩离子凝固术(argon plasma coagulation,APC) 治疗,2例行内镜下血管靶向光动力疗法(vascular targeted photodynamic therapy,V-PDT).结论 GAVE具有典型的内镜下表现,是其确诊的主要方法,此病多见于老年人,常伴有肝硬化,长期的消化道隐性出血及贫血是其主要临床表现,APC是治疗该病的一种安全、有效方法.%Objective To investigate the clinical features of gastric antral vascular ectasia (GAVE) , diagnostic criteria and treatment in order to improve the understanding of the disease. Methods The clinical data including initial symptoms or signs, endoscopic findings and treatments were analyzed retrospectively. Results There were 7 males and 8 females, age ranging from 39 to 91 years old, with mean age of ( 59. 53 ± 13. 86) years old. 12 cases manifested as positive fecal occult blood persistently, intermittent melena or hematemesis and with varying degrees of blood loss anemia, in which 6 cases of hemoglobin content < 80 g/L, an average of ( 82. 53 ± 10. 25 ) g/L, 2 cases of patients with upper abdominal pain; 8 cases associated with cirrhosis of the liver, 6 cases associated with atrophic gastritis; 3 cases of a-symptomatic patients did not carry out any treatment, bleeding could be controlled in 4 patients after drug treatment, 6 patients were treated with endoscopic argon plasma coagulation ( APC ) , 2 patients were treated with endoscopic vascular targeted photodynamic therapy ( V-PDT) . Conclusion Endoscopy is a good choice for diagnosis of GAVE which commonly disturbed the elders, especially accompany with cirrhosis, persistent gastrointestinal occult blood and anemia are the main clinical manifestations, APC is a safe and effective treatment for the disease.