十二指肠杜氏病致上消化道出血5例临床分析

Clinical Analysis of 5 Cases of Upper Gastrointestinal Bleeding Caused by Duodenal Dieulafoy’s Disease

摘要: 目的：探讨发生于十二指肠的杜氏病(Dieulafoy disease)致上消化道出血的临床表现、诊断方法、治疗和预后，以加强对该病的认识，提高其诊治水平。方法：收集临沂市人民医院2020年1月~2023年3月诊断的5例发生在十二指肠的杜氏病致上消化道出血病人的临床资料，分析其临床表现、内镜下特征、治疗方式及预后等特点，并复习相关文献。结果：5例杜氏病患者均因“呕血、黑便”入院。均由胃镜确诊为“杜氏病”。镜下：病灶4例位于十二指肠球部，1例位于十二指肠降部。位于球部的表面可见破裂血管残端及血凝块，伴活动性渗血，其中1例可见“火柴头”样改变；降部的病例胃镜下可见裸露血管残端及血痂。治疗上给予质子泵抑制剂(PPI)针剂、生长抑素、补液等，无效后行急诊内镜检查及治疗：予金属钛夹 + 粘膜下注射1:10,000肾上腺素高渗盐水治疗。预后：经3个月~3年随访，2例病灶复发。结论：杜氏病是上消化道出血少见但重要的病因，多发生于胃，发生于十二指肠和其他部位的较少，但我们分析发现：发生在十二指肠的杜氏病与胃部杜氏病的临床特征并无明显差异。诊断主要依靠电子内镜检查，且内镜下止血治疗是杜氏病的诊治关键，无效时应尽快进行急诊外科手术治疗，此病较为罕见，但因其出血部位隐匿和易反复等特点，必须加强认识，有效降低死亡率。

Abstract: Objective: To investigate the clinical manifestations, diagnostic methods, treatment, and prognosis of Dieulafoy’s disease in the duodenum causing upper gastrointestinal bleeding, in order to enhance understanding of the disease and improve its diagnosis and treatment. Methods: Clinical data of five patients diagnosed with duodenal Dieulafoy’s disease causing upper gastrointestinal bleeding, from January 2020 to March 2023 at Yiyi City People’s Hospital, were collected. The clinical manifesta-tions, endoscopic features, treatment modalities, and prognosis were analyzed, and relevant litera-ture was reviewed. Results: All five patients were admitted with the chief complaints of “hematem-esis and melena”. Diagnosis of “Dieulafoy’s disease” was confirmed by gastroscopy in all cases. Mi-croscopically, four lesions were located in the duodenal bulb, and one lesion was located in the de-scending part of the duodenum. In the bulb region, ruptured vascular remnants and blood clots with active bleeding were observed, with matchstick-like changes seen in one case. In the descend-ing part, exposed vascular remnants and blood scabs were visible. Treatment included proton pump inhibitor (PPI) injections, somatostatin, fluid resuscitation, and blood transfusion. Emergency endoscopy and treatment were performed when conservative management failed, with titanium clips and submucosal injection of 1:10,000 epinephrine saline solution used. Prognosis: Follow-up ranging from 3 months to 3 years revealed lesion recurrence in two cases. Conclusions: Dieulafoy’s disease is a rare but important cause of upper gastrointestinal bleeding, with a higher incidence in the stomach and a lower incidence in the duodenum and other locations. However, our analysis found that there was no clear difference in the clinical features of Duchenne disease in the duode-num and in the stomach. Diagnosis primarily relies on electronic endoscopy, and endoscopic hemo-stasis is crucial for the diagnosis and treatment of Dieulafoy’s disease. In cases of treatment failure, prompt emergency surgical intervention should be considered. Due to its rarity, concealed bleeding sites, significant blood loss, and propensity for recurrence, understanding of this disease should be enhanced to effectively reduce mortality rates.