胃癌D2根治术后迟发性出血的临床分析及防治  

Analysis and prevention of postoperative delayed hemorrhage associated with radical D2 gastrectomy

作　　者：王君辅[1] 谢勇[2] 胡林[2] 李昌荣[2] 李伟峰[2] 李红浪[2] 

机构地区：[1]南昌大学第三附属医院普外科,南昌市330006 [2]南昌大学第二附属医院胃肠外科

出　　处：《中国肿瘤临床》2016年第6期245-249,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨胃癌D2根治术后迟发性出血的原因、处理方法及预后防治。方法:回顾性分析南昌大学第二附属医院2015年1月至2015年10月294例胃癌D2根治患者的临床资料。结果:15例患者手术后发生迟发性大出血,占同期患者的5.1%(15/294),其中腹腔镜下胃癌根治术9例、开腹胃癌根治术6例;大血管出血7例,吻合口漏、吻合口溃疡致出血3例,十二指肠残端破裂致出血2例,其他部位出血2例,部位不明1例。11例经二次手术,2例经数字减影血管造影(digital subtraction angiography,DSA)+经导管介入下动脉栓塞(transcathete arterial embolization,TAE)止血,1例经内镜下止血,1例经保守治疗,二次手术率73.3%(11/15),死亡率40%(6/15),治愈率60%(9/15)。结论:胃癌D2根治术后迟发性出血二次手术率及死亡率较高,临床中需综合患者出血情况及原因积极采取治疗。重大血管出血、吻合口漏、吻合口溃疡、十二指肠残端破裂是最重要危险因素,腹腔动脉性出血及吻合口漏并发症引起出血是最主要致死原因。对于出血量大,生命体征不稳定患者应及时行二次手术和腹腔引流术为有效的处理方法;对于生命体征平稳,出血量少患者可行保守治疗;对于单纯吻合口溃疡出血患者可采取内镜下止血;对于出血部位不明患者可行DSA明确出血部位,再行TAE治疗。Objective： To investigate the cause, treatment, and prognosis of delayed hemorrhage in patients who underwent radical gastrectomy. Methods： The clinical data of 294 patients who underwent radical gastrectomy in the Second Hospital Affiliated from Nanchang University from January 2015 to October 2015 were retrospectively analyzed. Results： A total of 15 patients suffered from delayed hemorrhage and accounted for 5.1% of the gastric cancer cases in our hospital for the same period of radical gastrectomy. Of the 15 patients,9 underwent laparoscopic radical gastrectomy and 6 received open radical gastrectomy resection. Large vascular hemorrhage was found in 7 cases. Anastomosis and anastomotic ulcer induced hemorrhage were observed in 3 cases. Duodenal stump rupture induced hemorrhage was detected in 2 cases. Hemorrhage was also observed in some parts in 2 cases. Likewise, hemorrhage occurred in 1 case, but the affected parts were unknown. Of the 11 patients who underwent a second operation, 2 were subjected to digital subtraction angiography（DSA）and transcathete arterial embolization（TAE） to stop hemorrhage. Endoscopic hemostasis was performed to stop hemorrhage in 1 case.Conservative treatment was administered to stop hemorrhage in 1 case. The secondary surgery rate was 73.3%（11/15） with mortality and curative rates of 40%（6/15） and 60%（9/15）, respectively. Conclusion： For delayed hemorrhage after D2 of gastric cancer, a second radical surgery and death rates were high. Therefore, patients suffering from hemorrhage should be subjected to comprehensive clinical treatment and positive measures. Major vascular bleeding, anastomotic leakage, anastomotic ulcer, and duodenal stump rupture are relevant risk factors. Anastomotic fistula and celiac artery bleeding complications caused hemorrhage is the leading cause of death. Extensive bleeding and unstable vital signs should be checked. A second operation and abdominal drainage should also be timely conducted to as effective methods. Realistic a

关 键 词：腹腔镜 胃癌根治术 迟发性出血 治疗 预防 

分 类 号：R735.2[医药卫生—肿瘤]