摘要
目的:探讨食管贲门黏膜撕裂综合症(MalloryWeiss syndrome,MWS)的临床和内镜特点;对该综合症提出新型临床分类方法,有助于对病情的了解.方法:回顾分析华中科技大学附属同济医院2010-01/2014-03经胃镜检查发现的64例MWS的临床及内镜特点.结果:64例MWS患者中,男女比例约3.3∶1,平均年龄50.2岁.51.6%患者呕吐诱因为不当饮食,其中绝大部分为饮酒,39.1%患者是因上消化道基础疾病诱发呕吐,比如消化性溃疡,胃癌或胃恒径动脉出血,少数患者是由内镜操作引起患者呕吐导致MWS.内镜发现食管和/或贲门交界处黏膜有纵行撕裂伤,平均为1.7处撕裂伤.通过观察内镜下表现,我们建议将MWS分为4级:A级为撕裂并活动性出血;B级为撕裂并血管裸露或新鲜血痂;C级为撕裂并陈旧性血痂;D级撕裂无出血表现.结论:对于上消化道出血患者,在内镜检查发现MWS引起出血后,还应特别注意寻找有无其他基础疾病出血引起呕吐导致MWS,如胃恒径动脉出血,很容易漏诊,应特别予以重视;新型的分类方法对MWS评估可能具有更好的临床使用价值.
AIM：To explore the diagnosis and treatment of Mallory-Weiss syndrome（MWS）.METHODS：A retrospective analysis was performed of 64 MWS patients treated at our hospital from January 2010 to March 2014.The causes,endoscopic findings,treatment and prognosis were evaluated according to a new type of clinical classification.RESULTS：The male to female ratio was 3.3：1and the average age was 50.2 years old.Approximately 53.1%of MWS cases were caused by over-drinking or inappropriate diet occasionally,37.5%caused by underlying gastric diseases such as peptic ulcer（26.6%）,gastric cancer（6.3%） or Dieulafoy’s disease（4.7%）,and 9.4%by endoscopic examination or treatment.62.5%of MWS cases developed only one lesion of the cardia and/or lower esophagus and 29.7%developed two to three lesions.The lesions may occur in any location of the wall of the cardia and/or lower esophagus,with the right wall being a relatively common location（32.5%）.According to a new type of clinical classification introduced here based on endoscopic examination,17.2%of MWS cases were found to have active bleeding（type A） such as spouting,pulsating or oozing,21.9%with a fresh blood clot（type B） and32.8%with an old blood clot（type C）.The rest（28.1%） was found to have linear ulcer or scar（type D）.All type A patients were treated by endoscopic clipping,and some patients additionally underwent noradrenalin spraying.Some type B patients were treated by clipping or noradrenalin spraying.Only one type A patient died because of suspected underlying intestinal bleeding,and all other patients were cured.CONCLUSION：Underlying gastric diseases are important causes of MWS and easy to be ignored,especially Dieulafoy’s disease.Endoscopic clipping is the first choice of treatment for MWS,and the new type of clinical classification is useful for disease evaluation.
出处
《世界华人消化杂志》
CAS
2015年第5期772-776,共5页
World Chinese Journal of Digestology
关键词
食管贲门黏膜撕裂综合症
上消化道出血
内镜治疗
消化系基础疾病
临床分级
Mallory-Weiss syndrome
Upper gastrointestinal bleeding
Endoscopic therapy
Underlying gastric diseases
Clinical classification
