胃大部分切除后并大出血再手术治疗分析

目的分析胃大部分切除后并大出血再手术治疗的疗效，为临床工作提供参考。方法选择我院2006年2月-2011年1月收治的胃大部分切除后并大出血患者50例，均进行再次手术治疗，包括原吻合口切除后再吻合23例，残胃切除后食道空肠吻合15例，十二指肠溃疡血管缝扎后残端造瘘7例，十二指肠溃疡腔外置后残端造瘘5例。术后随访6个月，观察并分析患者再次手术的效果和预后情况。结果全部患者再次手术后出血均停止，术后发生切口感染2例，肠梗阻1例，近期并发症发生率为6．00％，经对症治疗后均痊愈出院。术后随访6个月，1例患者死于癌细胞广泛转移，1例患者死于心肌梗死，死亡率为4．00％；其余患者预后良好，未出现再次出血现象。结论再次手术是治疗胃大部分切除后并大出血的有效方法，在临床工作中可根据具体情况考虑使用。

Repeat surgical treatment for massive hemorrhage after subtotal gastreetomy

Objective To provide reference for clinical practice by analyzing the efficacy of repeat surgical treatment for massive hemorrhage after subtotal gastrectomy. Methods 50 patients with hemorrhage after subtotal gastrectomy who had received repeat surgical treatment during the period of February 2006 to January 2011 were included in this study. 23 patients received repeated anastomosis after resection of the original anastomotic sites,5 received esophagus-jejunum anastomosis, 7 received artifi- cial stump fistula after duodenal vascular suture, and 15 received artificial stump fistula after external placement of duodenal ulcer cavity. All the patients were followed up for 6 months to observe and analyze the efficacy of treatment and the prognosis in patients. Results Hemorrhage were terminated in all the patients after repeat surgery. Postoperative infection of incision sites occurred in two patients and intestinal obstruction in one, with a short-term rate of complications of 6.00%. During a 6-month follow-up, one patient died of widespread metastases of cancer ceils and one died of myocardial infarction, with a mortality rate of 4.00%. The remaining patients had good prognosis and had no repeated bleeding. Conclusions Repeat surgical treatment is a effective method for massive hemorrhage after subtotal gastrectomy.