胃癌出血合并失血性休克的治疗体会(附47例报告)

Clinical observation of treatment in gastric carcinoma hemorrhage with hemorrhagic shock: Report of 47 cases

目的分析胃癌出血合并失血性休克的临床特点,探讨救治方法。方法回顾性分析1994年1月-2004年1月收治的47例胃癌出血合并失血性休克的临床资料。结果7例内科保守治疗有效,有效率14.9%(7/47)。21例进行血管内介入栓塞治疗,止血成功19例,有效率90.5%(19/21)。止血成功26例选择限期手术,失败21例选择急诊手术。急诊手术组和限期手术组的死亡率分别为23.8%和3.8%(P<0.05);并发症发生率分别为76.2%和38.5%(P<0.01)。结论内科保守治疗难于奏效。选择经导管动脉栓塞治疗具有止血效果迅速可靠的特点,且可进行动脉输血抗休克,弥补了胃镜的不足。限期手术在手术的安全性及术式的选择方面更趋合理,力争行根治性胃切除术、减少术后并发症是提高术后生存期的关键。

Objective To investigate the clinical characteristics and treatment of gastric carcinoma hemorrhage with hemorrhagic shock. Methods The clinic data of 47 gastric carcinoma hemorrhage patients with hemorrhagic shock were analyed retrospectively. Results Seven cases stopped hemorrhage with medicine expectant treatment, and the response rate was 14.9% （7/47） ; 21 patients underwent TAE （transcatheter arterial embolization） with 19 controled, and the response rate was 90.5% （19/21） Twenty-six controled cases underwent limited operation whereas 21 control failure patients underwent emergency operation. The mortalities in this two groups were 23.8% and 3.8% respectively （P〈0.05）. The occurring rates of complication were 76.2 % and 38.5 % respectively （P〈0.01）. Conclusion Medicine expectant treatment is of little value. Interventional therapy is a considerable method to hematischesis. It antishock by aterial blood transfusion and compensate defect of gastroscopy. The limited operation is more reasonable in aspect of security and modus operandi. The critical factor to prolong life span is radical gastrectomy.