内镜诊治十二指肠静脉曲张破裂出血5例的临床分析

Clinical analysis of endoscopic diagnosis and treatment for 5 cases of duodenal variceal bleeding

摘要:

探讨内镜诊治十二指肠静脉曲张破裂出血患者的临床转归，回顾性分析2011年8月至2024年12月首都医科大学附属北京友谊医院消化分中心内镜诊治十二指肠异位静脉曲张破裂出血患者的临床资料。共纳入5例患者，均为男性，平均年龄50.4岁，其中1例为酒精性肝硬化、2例为乙肝相关肝硬化、1例为自身免疫病相关门静脉高压、1例为易栓症相关门静脉高压。5例内镜下止血均获得成功，其中1例酒精性肝硬化和1例乙肝肝硬化患者术后血红蛋白仍有下降趋势，予序贯介入治疗后好转出院；余3例患者止血术后好转出院。由此可见，十二指肠静脉曲张破裂出血少见但凶险，多学科协作治疗尤为重要，如情况允许可优先考虑尝试内镜下止血治疗。

Abstract:

To investigate the clinical outcomes of endoscopic diagnosis and treatment in patients with duodenal variceal bleeding, a retrospective analysis was conducted on clinical data of patients with ectopic duodenal variceal bleeding diagnosed and treated endoscopically at the Digestive Endoscopy Center of Beijing Friendship Hospital, Capital Medical University, from August 2011 to December 2024. Five male patients (mean age 50.4 years) were included. Etiologies included alcohol-related cirrhosis (1 case), hepatitis B virus-related cirrhosis (2 cases), autoimmune disease-associated portal hypertension (1 case), and thrombophilia-related portal hypertension (1 case). Immediate hemostasis was achieved endoscopically in all cases. Two patients (1 alcohol-related and 1 hepatitis B virus-related cirrhosis) exhibited persistent decline in hemoglobin levels post-procedure and received sequential interventional therapy before discharge. The remaining 3 patients recovered uneventfully. Duodenal variceal bleeding, though rare and life-threatening, can be effectively managed through multidisciplinary collaboration. Endoscopic hemostasis should be prioritized when technically feasible.