转外科治疗的难治性消化道出血128例临床分析

目的探讨内科药物治疗无效而转外科治疗的难治性消化道出血的高危因素和有效治疗方法。方法回顾性分析2004～2008年经消化内科治疗无效而转外科进一步治疗的128例难治性消化道出血患者的临床资料。结果老年组胃癌出血居首位,显著高于青年组（χ^2=4.309,P=0.038）和中年组（χ^2=8.611,P=0.003）,青年组食管胃底静脉曲张破裂出血占第一位,显著高于老年组（χ^2=7.559,P=0.006）,有内镜下近期活动性出血征象的患者在消化性溃疡中占61.54%,出血量估计值在中重度的占80.99%;接受手术治疗110例,术后死亡1例;非手术治疗17例,死亡2例,手术组生存率明显高于非手术组（χ^2=7.523,P=0.047）。结论男性、胃癌、食管胃底静脉曲张破裂出血、中重度出血以及消化性溃疡合并内镜下近期活动性出血是内科药物治疗无效的难治性消化道出血的高危因素;手术为治疗难治性消化道出血的较为有效措施。

Clinical analysis of 128 cases of transfer surgical treatment of refractory gastrointestinal bleeding

Objective Prediction of risk factors and effective treatment method of medical drug therapy and it's ineffectiveness requiring surgical treatment of refractory gastrointestinal bleeding.Methods This is a retrospective analysis of a five-year period from 2004 to 2008 in our hospital through the digestive invalid medical treatment,thus the need to transfer for further surgical treatment of 128 cases of clinical data of hospitalized patients in line with refractory gastrointestinal bleeding.Results Gastric cancer bleeding ranks first in the elderly group,significantly higher than the young group(χ2 = 4.309,P = 0.038) and middle-aged group(χ2 = 8.611,P = 0.003),esophageal variceal bleeding accounts for the first one in the young group,significantly higher than the elderly group(χ2 = 7.559,P = 0.006).Peptic ulcer with endoscopic recent active bleeding signs accounts for 61.54%,the preliminary estimate of the value of the amount of bleeding in severe accounts for 80.99%.110 patients received surgical treatment,1 died after operation;non-surgical treatment in 17 cases,2 deaths,and surgical survival rate was significantly higher than non-surgical group(χ2= 7.523,P = 0.047).Conclusion Male,gastric cancer,esophageal variceal bleeding,moderate to severe bleeding and peptic ulcer with endoscopic recent active bleeding signs is the risk factors of medicine ineffective drug treatment of refractory gastrointestinal bleeding.Surgery for the treatment of refractory gastrointestinal bleeding is a more effective measure.