胃Dieukafoy病的诊治(2)
3.5.2 栓塞治疗栓塞治疗需选择将插管进入支配动脉，血管造影明确病灶和出血点，在无侧支血管且生命体征平稳的情况下可行此项治疗，特别适用内镜无法深达部位的Dieulafoy病。但技术难度高，临床成功病例报告不多。
3.5.3手术治疗对内镜治疗和血管栓塞治疗失败者需进行手术治疗。治疗Dieulafoy病的手术方式包括近端胃大部切除、楔形胃壁切除或缝扎异常血管等。以往多主张行近端胃大部切除，可以切除病变血管，从根本上防止再出血发生，彻底治疗Dieulafoy病。近几年随着微创观念的深化，手术方式趋于简化。由于单纯缝扎血管有一定的复发率，目前多主张行楔形胃壁切除术，或在内镜引导下行限制性楔形胃壁切除术。传统的开腹手术创伤大，在一定程度上可增加患者的病死率，有主张内镜和腹腔镜联合行限制性楔形胃壁切除术。
[参考文献]
[1]Chaer R, Helton WS. Dieulafoy's disease[J]. J Am Coll Surg，2003，196:290-296.
[2]Dieulafoy G.Exuleeratio simplex.L' intervention chimrgieale dans les hematemes foudroyaqntes consecutives a I' exuceration simplex de l' estomae[J]. Bull Acad Med,1898,49:49-84.
[3]Avian D,Nayci A,Altintas E,et al.An unusual cause for massive upper gastrointestinal bleeding in children:dieulafoy's lesion[J].Pediatric Surg International,2005,21(5):417-418.
[4]时淑舫,张长淮,黄受方.Dieulafoy's病五例临床及病理观察[J].临床和实验医学杂志,2003,2:234-335.
[5]Ertekin C,Barbaros U,Taviloglu K,et al.Dieulafoy's lesion of esophagus[J].Surg Endosc 2002;16:219.
[6]Ribeiro A,Vazquez-Sequeiros E,Wiersema MJ. Doppler EUS guided treatment of gastric Dieulafoy's lesion[J].Gastrointes Endosc 2001;53:807-809.
[7]Penner RM,Owen RJ,Williams CN.Diagnosis of a bleeding Dieulafoy lesion on compute tomography and its subsequent embolization[J].Gastroenterology,2004,18:525-527.
[8]Park CH,Joo YEA.Kim HS,et a1.Prospective.randomized trial of endoscopic band ligation versus endoscopic hemoclip placement for bleeding gastric Dieulafoy's lesions[J].Endoscopy,2004,36:677-681.
(收稿日期：2007-11-20), 百拇医药(张韶光 郭世洲 原禄双)
3.5.3手术治疗对内镜治疗和血管栓塞治疗失败者需进行手术治疗。治疗Dieulafoy病的手术方式包括近端胃大部切除、楔形胃壁切除或缝扎异常血管等。以往多主张行近端胃大部切除，可以切除病变血管，从根本上防止再出血发生，彻底治疗Dieulafoy病。近几年随着微创观念的深化，手术方式趋于简化。由于单纯缝扎血管有一定的复发率，目前多主张行楔形胃壁切除术，或在内镜引导下行限制性楔形胃壁切除术。传统的开腹手术创伤大，在一定程度上可增加患者的病死率，有主张内镜和腹腔镜联合行限制性楔形胃壁切除术。
[参考文献]
[1]Chaer R, Helton WS. Dieulafoy's disease[J]. J Am Coll Surg，2003，196:290-296.
[2]Dieulafoy G.Exuleeratio simplex.L' intervention chimrgieale dans les hematemes foudroyaqntes consecutives a I' exuceration simplex de l' estomae[J]. Bull Acad Med,1898,49:49-84.
[3]Avian D,Nayci A,Altintas E,et al.An unusual cause for massive upper gastrointestinal bleeding in children:dieulafoy's lesion[J].Pediatric Surg International,2005,21(5):417-418.
[4]时淑舫,张长淮,黄受方.Dieulafoy's病五例临床及病理观察[J].临床和实验医学杂志,2003,2:234-335.
[5]Ertekin C,Barbaros U,Taviloglu K,et al.Dieulafoy's lesion of esophagus[J].Surg Endosc 2002;16:219.
[6]Ribeiro A,Vazquez-Sequeiros E,Wiersema MJ. Doppler EUS guided treatment of gastric Dieulafoy's lesion[J].Gastrointes Endosc 2001;53:807-809.
[7]Penner RM,Owen RJ,Williams CN.Diagnosis of a bleeding Dieulafoy lesion on compute tomography and its subsequent embolization[J].Gastroenterology,2004,18:525-527.
[8]Park CH,Joo YEA.Kim HS,et a1.Prospective.randomized trial of endoscopic band ligation versus endoscopic hemoclip placement for bleeding gastric Dieulafoy's lesions[J].Endoscopy,2004,36:677-681.
(收稿日期：2007-11-20), 百拇医药(张韶光 郭世洲 原禄双)