腹部手术后腹腔内出血的诊断和治疗

目的：总结腹部手术后腹腔内出血的诊断和治疗经验。方法：回顾性分析1981年1月至2000年12月腹部手术后24h内腹腔内出血超过300ml的病人15例，均为男性，脾切除加断流术5例，肝癌切除术4例，腹膜后肿瘤切除术3例，胰头十二指肠切除术2例，直肠癌Miles手术1例。结果：7例再手术治疗，8例非手术治疗。死亡5例。结论：提出腹部手术后腹腔内出血的概念和再手术适应证。生命体征稳定，可在严密监测下非手术治疗，术后24h内出血量＜600ml或累计出血量＜1000ml可作为非手术治疗的参考指标。创面广泛渗血或不能清楚显示出血部位,长国压迫止血是有效的方法。

The diagnosis and treatment of abdominal postoperative intra-abdominal bleeding

Objective: To summarize the experiences in diagnosis and treatment of abdominal postoperative intra-abdominal bleeding.Methods: From Jan 1981 to Dec 2000, 15 cases of abdominal postoperative bleeding over 300 ml within the first 24 hours after operation were analyzed retrospectively. All patients were male.The initial operations were splenectomy and devascularization of portal hypertention in 5 patients, resection of hepatic cancer in 4, resection of retroperitoneal tumour in 3, pancreatoduodenectomy in 2 and Miles operation for rectal cancer in 1.Results: Seven cases were relaparotomized.8 cases were treated non-operatively. Five cases died.Conclusion: The definition of postoperative intra-abdominal bleeding is not clear. The possible concept and indication for relaparotomy were discussed.Patients with stable life signs could be nonoperatively treated under intensive monitoring .The blood loss less than 600 ml within 24 hours after operation or the accumulative blood loss less than 1000 ml could be the indication for nonoperative treatment.Long ribbon gauze plugging could be effective hemostatic method for patients with diffuse blood oozing and bleeding site that could not be revealed clearly.