减重手术后出血特征及影响因素分析  

Analysis of bleeding characteristics and influencing factors after bariatric surgery

作　　者：林睿[1] 林士波[1] 梁辉[1] 杨宁琍[1] 花红霞 刘瑞萍 Lin Rui;Lin Shibo;Liang Hui;Yang Ningli;Hua Hongxia;Liu Ruiping(Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院普通外科,南京210029

出　　处：《中华消化外科杂志》2022年第11期1440-1445,共6页Chinese Journal of Digestive Surgery

基　　金：白求恩基金会(HZB‑20190528‑1);吴阶平基金会(320.2710.1831)。

摘　　要：目的探讨减重手术后出血特征及影响因素。方法采用回顾性病例对照研究方法。收集2010年5月至2021年8月南京医科大学第一附属医院收治的3371例肥胖症行减重手术患者的临床资料;男903例,女2468例;年龄为31(16~65)岁。观察指标:(1)减重手术后出血发生情况及诊断与治疗。(2)减重手术后出血的影响因素分析。(3)随访情况。采用门诊、电话或微信方式进行随访,了解减重手术后出血患者总体质量减少率、高血压和2型糖尿病缓解情况。随访时间截至2021年8月。正态分布的计量资料以x±s表示。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验。等级资料比较采用非参数秩和检验。单因素分析根据资料类型选择对应的统计学方法。多因素分析采用二元Logistic回归模型。结果(1)减重手术后出血发生情况及诊断与治疗。3371例患者中,27例确诊术后出血,其中男13例,女14例;腹腔出血18例,消化道出血9例;8例手术当天确诊,13例术后第1天确诊,4例术后第2天确诊,2例术后第3天及以后确诊。27例术后出血患者中,24例主要临床表现为心动过速;11例为腹腔引流异常,引流量为300(100~600)mL;6例为便血,便血量为500(120~1000)mL;5例低血压;3例呕血,呕血量为300(50~800)mL;2例术后第1天血红蛋白显著降低。同一患者可合并多种临床表现。27例术后出血患者中,6例腹腔出血患者因腹腔引流液持续增多或失血性休克再次急诊手术探查,术后心力衰竭死亡1例;再次手术距首次手术结束时间为13.5(2.0~45.0)h,腹腔积血量为1000(600~7000)mL。6例患者中,5例术中明确出血部位,分别为袖状胃切缘出血2例,胃旁路小网膜囊出血、胃短血管及穿刺孔出血各1例;1例探查未见明显活动性出血。其余12例腹腔出血及9例消化道出血患者均经保守治疗治愈,患者出血持续时间为(2.1±0.7)d。(2)Objective To investigate the bleeding characteristic and influencing factors after bariatric surgery.Methods The retrospective case-control study was conducted.The clinical data of 3371 patients with obesity who underwent bariatric surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to August 2021 were collected.There were 903 males and 2468 females,aged 31(16‒65)years.Observation indicators:(1)occurrence,diagnosis and treatment of bleeding after bariatric surgery;(2)analysis of influencing factors for bleeding after bariatric surgery.(3)Follow-up.Follow-up was conducted through outpatient examinations,telephone interview or WeChat to detect total weight loss rate,resolution of hypertension and remission of type 2 diabetes of the patients with bleeding after bariatric surgery.The follow-up was up to August 2021.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M(range).Count data were represented as absolute numbers or percentages,and comparison between groups was analyzed by the chi-square test.Ordinal data were analzyed by the non-parametric rank sum test.Univariate analysis was conducted using the corresponding statistical methods based on data type.The binary Logistic regression was used for multivariate analysis.Results(1)Occurrence,diagnosis and treatment of bleeding after bariatric surgery.There were 27 of 3371 patients diagnosed with postoperative bleeding,including 13 males and 14 females.There were 18 cases of abdominal bleeding and 9 cases of gastrointestinal bleeding.Among the 27 patients with postoperative bleeding,8 cases were diagnosed with bleeding on the day after operation,13 cases were diagnosed on the first day after operation,4 casess were diagnosed on the second day,and 2 cases were diagnosed on the third day or later.Among the 27 patients with postoperative bleeding,24 cases had tachycardia as the main clinical manifestation,11 patients had abnormal abdominal drainage with t

关 键 词：肥胖症 减重手术 出血 危险因素 诊断 治疗 

分 类 号：R656.61[医药卫生—外科学]