上消化道出血少见病因的临床特点及治疗

摘要

Objective To explore the clinical features and treatment of upper gastrointestinal bleeding with rare etiologies.Methods A total of 45 cases with rare etiologies was selected from a group of 1200 patients with upper gastrointestinal bleeding admitted from January 2012 to December 2015.Results The incidence of gastric stromal tumor (24.4％) and Dieulafoy's lesion (20.0％) was the highest.Among rare etiologies of upper gastrointestinal bleeding were Mallory-Weiss syndrome (17.8％) and stomal ulcer and hemorrhage of efferent loops after subtotal gastrectomy (17.8％),as well as left-side portal hypertension (6.7％),liver cirrhosis complicated with variceal bleeding in the descending part of the duodenum (2.1％),esophageal hematoma (2.1％),esophageal mucosa avulsion (2.1％),P-J syndrome (2.1％),duodenal adenocarcinoma (2.1％),and cutaneous malignant melanoma with duodenal metastasis (2.1％).Conclusions Gastroscopy in early stages played a role in etiologies identification,while etiological treatments could substantially reduce recurrent bleeding rate,thus enhanced cure rate.Analysis on rare etiologies promoted the medical understanding,with clinical diagnosis and treatment improved.%目的 分析和探讨上消化道出血少见病因的临床特点及治疗.方法 回顾性分析2012年1月至2015年12月在本院确诊为上消化道出血的1 200例住院患者,从中筛选出少见病因患者45例.结果 上消化道出血的少见病因患者中,以胃间质瘤、Dieulafoy's病、Mallory-Weiss综合征、胃大部分切除术后吻合口及输出袢溃疡出血为主:分别为24.4％(11/45例)、20.0％(9/45例)、17.8％(8/45例)、17.8％(8/45例);余为左侧门脉高压症3例(6.7％),肝硬化并十二指肠降段静脉曲张破裂出血、食管血肿、P-J综合征、食管黏膜撕脱症、十二指肠腺癌、皮肤恶性黑色素瘤并十二指肠转移各1例(2.1％),其中43例经药物联合内镜、外科手术治疗,上消化道出血治愈.结论 早期胃镜检查能迅速明确出血病因,在治疗出血同时针对病因治疗.而针对病因治疗能有效提高治愈率,降低死亡率和防止再出血.分析和探讨上消化道出血少见病因,能加深医务人员对少见病因的认识,提高临床诊治水平.