上消化道大出血诊疗分析

目的提高上消化道大出血的诊疗水平。方法回顾分析162例上消化道大出血病人的病因诊断、急症手术指征，剖腹探查原则、术式及治疗结果。结果本组治愈150例，死亡12，治愈率92．6％、死亡率7．4％．主要死于失血性休克、肝功能衰竭。主要并发症为再出血、肝昏迷、肠粘连、腹腔脓肿、切口裂开。结论在积极抗休克非手术止血的同时，尽快初步确定出血的病因和部位，早期掌握急症手术指征，切除出血病灶，合理选择术式是提高治愈率减少死亡率的关键。

Analysis in the diagnosis and treatment of massive bleeding from the upper alimentary tract

Objective To improve the levels of diagnosis and treatment of massive bleeding of upper alimentary tract. Methods From January 1987 to October 2006, the clinical date of 162 cases with massive bleeding of upper alication of emergercy, principle of exploratory laparotomy, surgical procedures and therapeutic outcome were analyzed retrospectively. Results 150 cases were cured, the cure rate was 92.6%. 12 cases died, these patients died from hemorrhagic shock (4 cases), liver function failure(5), myocardiac(1) and MODS(2). The mortality was 7.4%. Postoperative complications were re-bleeding in 9 case intestinal adhesion 6 cases, abdominal abscess 5, liver coma 5, in-sisional adhesion 6 cases, abdminal abscess 5, liver coma 5,in-cisional partial laceration 7,pulmonary infection 4 and MODS 2 cases. Conclusion Aggresive anti-shock and non-surgical hemostasis are performed at the same time and the cause and site of bleeding shouled be initially confirmed as early as possible. Grasping opertive indication and timing, resecting bleeding lesions and choosing reasonable surgieal procedures are keys to improve the cure rate and reduce the martality rate.