急性上消化道大出血手术治疗体会(附117例报告)

目的探讨急性上消化道大出血手术时机和手术方式的选择.方法本组对自1998年4月-2003年12月的117例经手术治疗的急性上消化道大出血的临床资料进行回顾性分析.结果行胃大部分切除术69例,贲门周围血管离断术36例,胃癌根治术3例,胃癌姑息切除5例,十二指肠憩室切除4例.本组治愈111例,术后并发症20例,死亡6例.结论胃十二指肠溃疡及门脉高压症是上消化道大出血的主要原因,术前胃镜是重要的诊断手段.掌握好手术时机和术式的合理选择,是提高手术疗效的关键.

Experience of operative treatment for acute massive hemorrhage of upper gastrointestinal tract(A report of 117 cases)

Objective To investigate the choice of the operative timing and procedures of acute massive hemorrhage of upper gastrointestinal tract.Methods From April 1998 to December 2003,117 cases with acute massive hemorrhage of upper gastrointestinal tract received operative treatment were analyzed retrospectively.Results Subtotal gastrectomy was performed in 69 cases,Pericardial disconnection(divascularization)36 cases. Radical operation for gastric cancer 3 cases,palliative gastrectomy for cancer 5 cases,duodenal diverticulectomy 4 cases.111cases were cure in this group. Postoperative complications were occurred in 20cases,6 cases died.Conclusion Gastroduodenal ulcer and portal hypertension are main causes of acute massive hemorrhage of upper gastrointestinal tract. Preoperative gastroscopy is an important diagnostic measure.Controlling a good operative timing and selecting a reasonable procedure are keys to improve the operative efficacy.