消化道大出血行胃大部切除术后再出血原因分析

目的 :总结如何提高上消化道大出血的诊断水平 ,改善处理对策 ,避免误诊误治。方法 :回顾性分析 1988～ 2 0 0 3年 16例上消化道大出血行胃大部切除术后再出血的临床资料。结果 :16例均于胃大部切除术后 72小时内再出血 ,11例急诊胃镜检查或再次剖腹探查确诊 ,5例再次手术中联合胃镜检查明确诊断。发生再出血后 ,3例保守治疗 ,13例再次手术治疗 ,死亡3例 ,病死率 18.75 % ( 3 /16)。结论 :上消化道大出血病因较复杂 ,常易误诊误治。选择手术或非手术治疗有赖正确的诊断 ,因此强调术前胃镜检查或术中联合胃镜检查的重要性 ,避免手术盲目性 ,审慎行胃大部切除术

Re-bleeding after Subtotal Gastrectomy for Hemorrhage of Upper Digestive Tract

Objective:To summarize the ways of improving the diagnosis and treatment of hemorrhage in upper digestive tract so as to avoid them.Methods:A retrospective analysis was performed on the clinical data about 16 patients with re-bleeding following subtotal gastrectomy for hemorrhage of upper digestive tract between 1988 and 2003. Results:Re-bleeding occurred within 72 hours following subtotal gastrectomy to all of the 16 cases.The right diagnosis in 11 cases was confirmed by emergency gastroscopy or by the second laparotomy;the correct diagnosis was made in the other 5 cases on the second operation plus gastroscopy. For the re-bleeding,3 cases received conservative treatment;13 cases were operated on surgically for the second time.Of the 16 cases,3 died with a fatality rate of 18 75% (3/16).Conclusions:The causes of upper digestive tract hemorrhage were very complicated.So misdiagnosis and mistreatment would be easily encountered in.A right option of treatment depended on the correct diagnosis.Therefore,emphasis must be placed on preoperative gastrectomy or combination of laparotomy with gastroscopy.Blind operation should be avoided and subtotal gastrectomy should be cautiously undertaken.