- 期刊
Observation of the Development of Gastric Ulcer beside a Dieulafoy's Ulcer-One Case Report
觀察在Dieulafoy潰瘍旁之胃潰瘍發生過程－一例報告
摘要
胃潰瘍之發生過程，在人類少有機會觀察得到，一般都需要利用動物模式來觀察，現在報告一例利用胃鏡觀察胃潰瘍發生在Dieulafoy潰瘍的旁邊。而Dieulafoy潰瘍是一少見的胃部大出血的原因，大多需要手術治療，近年來已有使用內視鏡止血法如局部注射純酒精或腎止腺素及高張鹽水混合液及雷射止血，本例則只用保守療法即已止血。 一位74歲女病人因解黑便及吐血來本院急診，2日後胃鏡發現在胃角部有一血管露出並伴有血塊及徐徐出血，診斷爲Dieulafoy潰瘍，75分鍾後，胃角部可見血塊伴徐徐出血，在其旁有一片粘膜變白，由於雷射機器故障，故使用0.025%腎上腺20ml局部噴灑在血塊及週圍之粘膜，隔一又二分之一小時後血塊不再出血，它的旁邊又多一片粘膜變白，變白的粘膜看起來有一點浮腫的樣子，再隔一又二分之一小時後，變白的粘膜變成糜爛，1日後胃角部只見一潰瘍伴有出血痕跡，病人繼續以Cimetidine及制酸劑治療，56日後胃鏡只見胃角部有紅色瘢痕。 一般胃糜爛及潰瘍之發生都經粘膜出血後，才可觀察到糜爛及潰瘍，本例糜爛發生前並未見粘膜出血之現象，可能潰瘍發生之原因與Dieulafoy潰瘍有關，推測乃因粘膜下畸形之動脈發生血栓，阻斷粘膜血流而導致糜爛及潰瘍，由於粘膜沒有血流，故不見粘膜出血現象。本例未經侵入性療法卽已止血，但畸形的動脈可能還存在，仍有可能再出血，故需長期觀察才可決定Dieulafoy潰瘍可否採保守性療法。
並列摘要
A 74 year-old female patient presented with tarry stool and hematemesis. Panendoscopic examination revealed a Dieulafoy's lesion with blood oozing in the angle. Seventy five minutes later a patch of gastric mucosa beside Dieulafoy's lesion became pale. Twenty ml of 0.025% epinephrine solution was sprayed locally around the lesion. One and a half hours later the bleeding stopped, and another patch of pale mucosa occurred beside Dieulafoy's lesion. Another one and one quarters two hours later the pale mucosa became an erosion. One day later only an ulcer with stigma of hemorrhage was found in the angle. Fifty six days later a red scar was seen in the angle. In this case the development of gastric ulcer without the stage of mucosal hemorrhage is probably related to thrombosis formation in submucosal arterial malformation.