| 摘要: |
| 目的 探讨胃切除术后出血的原因及防治策略。方法 回顾性分析2014年1月至2018年12月我院收治的36例胃癌根治术后出血二次手术患者的临床资料。记录患者的性别、年龄、体质量指数（BMI）、第一次手术时间、切除范围、重建方式、联合脏器切除情况、出血间隔时间、出血部位、出血原因、术中处理方案、其他并发症及二次手术后住院时间等资料。根据术后出血部位将患者分为腹腔内出血和消化道内出血2组，对比2组患者上述临床特征的差异。结果 36例患者出血发生于术后1~247 h，其中29例立即再手术，7例保守治疗无效再手术。术中探查明确血管活动性出血18例，予血管结扎或缝扎；脾脏出血1例，予脾脏切除；腹腔积血10例，予积血清除、充分引流处理；消化道内出血7例，予加固、缝扎处理。1例患者二次手术后2 d因并发恶性心律失常死亡；1例并发十二指肠残端瘘，1例并发胰瘘，1例并发肺炎，该3例患者经对症治疗后均好转出院；1例术后伤口裂开重新缝合后愈合出院；其余患者二术手术治疗后均无继续出血表现，顺利出院。腹腔内出血组（29例）和消化道内出血组（7例）患者在年龄、BMI、性别、第1次手术时间、重建方式、二次手术后住院时间、联合脏器切除、出血间隔时间等方面差异均无统计学意义（P均>0.05）；在切除范围方面，腹腔内出血组2例（6.9%）行近端胃大部分切除、5例（17.2%）行远端胃大部分切除、17例（58.6%）行全胃切除、5例（17.2%）行残胃切除，消化道内出血组分别为0例、5例（71.4%）、2例（28.6%）、0例，2组差异有统计学意义（P=0.035）。结论 胃切除术后出血可表现为消化道内出血、腹腔内出血，积极再手术是有效的治疗手段。 |
| 关键词: 胃切除术 出血 再手术 出血原因 切除范围 |
| DOI：10.16781/j.0258-879x.2019.12.1303 |
| 投稿时间：2019-08-20修订日期：2019-11-18 |
| 基金项目:国家自然科学基金（81372048，81671886）. |
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| Reoperation due to bleeding after gastrectomy: a clinical analysis of 36 cases |
| YIN Xiao-yi△,CUI Hang-tian△,LUO Tian-hang,XUE Xu-chao,FANG Guo-en* |
(Department of Gastrointestinal Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the causes, and prevention and treatment strategies of postoperative bleeding after gastrectomy. Methods We retrospectively analyzed the clinical data of 36 reoperation patients with bleeding after radical gastrectomy in our hospital from Jan. 2014 to Dec. 2018. The gender, age, body mass index (BMI), first operation time, resection scope, reconstruction way, combined organ resection, bleeding interval, bleeding site, bleeding cause, intraoperative treatment, complications and hospital stay after second operation were recorded. According to the location of bleeding after operation, the patients were divided into intraperitoneal bleeding group and gastrointestinal bleeding group. Aforementioned clinical features were compared between the two groups. Results Thirty-six cases of bleeding occurred 1-247 h after operation. Totally, 29 cases underwent second operation immediately and 7 cases underwent second operation after conservative treatment. During the reoperation, 18 cases of active bleeding of blood vessels were identified and ligated or sutured; 1 case of bleeding of spleen was diagnosed and the spleen was resected; 10 cases of hemoperitoneum were found, removed fully drained; and 7 cases of gastrointestinal bleeding were identified, strengthened and sutured. One patient died of malignant arrhythmia 2 d after reoperation. One patient had duodenal stump fistula, 1 patient had pancreatic fistula, and 1 patient had pneumonia; all the 3 patients were discharged after symptomatic treatment. One patient was complicated with postoperative wound disruption and was discharged after resewing treatment. The rest patients were discharged smoothly without continuous bleeding after reoperation. There were no significant differences in age, BMI, gender, first operation time, reconstruction way, hospital stay after reoperation, combined organ resection or bleeding interval between the intraperitoneal bleeding group (29 cases) and gastrointestinal bleeding group (7 cases) (all P>0.05). In the intraperitoneal bleeding group, there were 2 cases (6.9%) receiving proximal gastrectomy, 5 cases (17.2%) distal gastrectomy, 17 cases (58.6%) total gastrectomy, and 5 cases (17.2%) residual gastrectomy, which was significantly different from the gastrointestinal bleeding group (0, 5[71.4%], 2[28.6%] and 0, respectively) (P=0.035). Conclusion Postoperative bleeding can be manifested as intraperitoneal bleeding and gastrointestinal bleeding, and active reoperation is an effective treatment. |
| Key words: gastrectomy bleeding reoperation causes of bleeding resection scope |
