摘要
分析2017年1月—2019年6月武汉大学人民医院消化内科诊治的食管裂孔疝继发贫血患者40例的临床资料,其中男17例,女23例,平均年龄(70.6±12.0)岁,病程4天~3年。主要临床表现为腹痛20例(50.00%),头昏、乏力11例(27.50%),腹胀7例(17.50%),恶心、呕吐7例(17.50%),黑便5例(12.50%),胸闷、胸痛5例(12.50%)。误诊为冠心病3例,消化道恶性肿瘤2例,小肠出血1例。患者均不同程度贫血,重度、中度、轻度贫血分别为3例、15例、22例,血红蛋白平均为(89.8±20.8)g/L;大便隐血阳性15例(37.50%);内镜发现Cameron病变19例,其中Cameron溃疡4例,Cameron糜烂15例。因严重贫血行输血治疗6例,选择食管裂孔疝修复术21例,选择药物治疗18例,拒绝治疗1例;随访6个月,手术治疗者食管裂孔疝复发1例,贫血治愈20例,症状好转19例;药物治疗失访1例,贫血治愈13例,贫血较前好转2例,贫血加重2例,症状好转10例;手术/药物治疗在贫血治愈、症状缓解、并发症方面比较差异无统计学意义(P>0.05)。总之,食管裂孔疝继发贫血临床表现无特异性,以消化道隐性出血为主,少数可发生急性消化道出血,Cameron病变是其主要病因,但内镜下发病率低,需与肿瘤、冠心病等进行鉴别,治疗方式应根据患者具体情况选择。
Objective To analyze the clinical characteristics,endoscopic manifestations,treatment and prognosis of patients with secondary anemia due to hiatal hernia.Methods The clinical data of 40 patients with secondary anemia of hiatal hernia were collected from January 2017 to June 2019 in the Department of Gastroenterology,Wuhan University People's Hospital.The clinical data were analyzed,and they were divided into surgical groups according to the different treatment methods.And drug group to analyze its anemia cure,symptom relief,and complications.Results Among the 40 patients,17 were male and 23 were female.The average age was(70.6±12.0)years,and the course of the disease was 4 days to 3 years.The main clinical manifestations were abdominal pain in 20 cases(50.00%),dizziness and fatigue in 11 cases(27.50%),abdominal distension in 7 cases(17.5%),malignancy and vomiting in 7 cases(17.50%),and melena in 5 cases(12.50%).Chest tightness and chest pain were found in 5 cases(12.50%).Three patients were misdiagnosed as coronary heart disease,two were misdiagnosed as malignant tumors of the digestive tract,and one was misdiagnosed as small bowel hemorrhage.All patients had varying degrees of anemia,with severe,moderate,and mild anemia in 3,15,and 22 cases,with average hemoglobin of(89.8±20.8)g/L;positive stool occult blood of 37.5%;and 19 cases of Cameron lesions were found by endoscopy.Among them,4 cases had Cameron ulcer and 15 cases had Cameron erosion.6 cases were treated for blood transfusions due to anemia,21 cases were repaired with esophageal hiatal hernia,18 were treated with medicine,1 patient was discharged after the refusal of treatment;follow-up for 6 months,1 case had a recurrence of esophageal hiatal hernia in operation group,20 cases were cured with anemia,19 cases Symptoms improved;1 case was lost to follow-up in the drug group,13 cases of anemia were cured,2 cases of anemia improved,2 cases of anemia worsened,and 10 cases of symptoms improved;the two groups were not statistically significant in terms of anemia cure,symptom relief,and complications(P>0.05).Conclusion The clinical manifestation of esophageal hiatal hernia secondary to anemia is nonspecific.It is dominated by hidden gastrointestinal bleeding.A few can occur with acute gastrointestinal bleeding.Cameron disease is the main cause,but the incidence is low under endoscopy.And so on,the treatment should be selected according to the specific circumstances of the patient.
作者
程书平
李明
田甜
谭诗云
Cheng Shuping;Li Ming;Tian Tian;Tan Shiyun(Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China)
出处
《疑难病杂志》
CAS
2020年第5期472-475,共4页
Chinese Journal of Difficult and Complicated Cases
基金
湖北省自然科学基金资助项目(2019CFB142)。
