胃癌二次手术10例分析  

Analysis of ten patients with gastric cancer undergoing reoperation for complications after gastrectomy

作　　者：马军[1] 张亚铭[1] 周潮平[1] 汪大田[1] 高斌[1] 汤代彬[1] 袁建伟[1] 蒋鹏[1] 

机构地区：[1]安徽省安庆市立医院肿瘤外科,安庆246000

出　　处：《国际外科学杂志》2016年第1期26-29,共4页International Journal of Surgery

摘　　要：目的 探讨胃癌行二次手术的原因及防治措施.方法 回顾性分析安徽省安庆市立医院肿瘤外科2010年1月-2015年2月单一手术组完成的667例胃癌患者的临床资料,其中有10例患者因术后严重并发症行二次手术,归纳总结这10例患者的临床特点和治疗经过.10例二次手术患者中,因术后腹腔内出血行止血术3例,因术后肠梗阻行单纯肠粘连松解术3例、行空肠侧侧吻合及空肠造瘘术1例,因术后黄疸再次手术2例,其中1例梗阻性黄疸,行粘连松解＋穿孔修补＋腹腔引流术;而另1例行剖腹探查术,术中未见胆管及肠管扩张,考虑淤胆.因引流管与肠系膜粘连,行腹腔引流管拔出术1例.结果 1例淤胆病例因肝功能衰竭而死亡;1例胃十二指肠动脉出血病例,行二次手术止血,术后再次出血,经介入予以成功止血.其余8例患者全部治愈,无再次并发症发生.结论 胃癌术后二次手术的常见原因主要是肠梗阻和出血;由于腹腔引流技术的进步,绝大多数术后消化道瘘无需再次手术处理.Objective To investigate the cause and manangement of treatment and prenvention of reoperation after gastrectomy.Methods Clinical date of 667 cases with gastric cancer undergoing gastrectomy from January 2010 to Februry 2015 by the same surgical team in Anqing municipal hospital were retrospectively analyzed,Among them,10 patients underwent reoperation after gastrectomy because of serious complications.Clinical feature and treatment course were summarized.The induction and procedure of reoperation incuded laparotomy for hemorrhage （n =3）,enterolysis for bowel obstruction （n =3）,the small intestine side-to-side anastomosis and jejunostomy for bowel abstruction （n =1）,enterolysis and bowel perforation repair and drainage of abdominal cavity for obstructive jaundice （n =1）,exploratory laparotomy for cholestatic jaundice （n =1）,laparotomy for removing drainage tube （n =1）.Results One patient finally died of live failure,another patient was not successfully cured by hemostasis operation and accepted interventional therapy at last,other patients were successfully cured without perioperative compliations.Conclusion The common reason of reoperation after gastrectomy incude postoperative ileus and bleeding;thanks to the development of abdominal drainage,most of patients with postoperative alimentary fistula will successfully cured in conservative treatment.

关 键 词：胃肿瘤 再手术 术后并发症 

分 类 号：R735.2[医药卫生—肿瘤]