上消化道出血的内外科综合处理

Internal and surgical combined therapy of upper gastrointestinal hemorrhage

目的探讨提高上消化道出血诊疗效果的方法。方法回顾分析经过内外科治疗的上消化道出血病例52例,其中消化性溃疡占53.8%,胃肿瘤占25%,食管胃底静脉曲张破裂占7.7%,急性糜烂性出血性胃炎占7.7%。结果手术治疗35例,均治愈;未手术17例,15例通过继续保守治疗而获痊愈,2例拒绝手术自动出院。初诊漏误诊8例,最后诊断为胃肿瘤6例,食管胃底静脉曲张破裂2例。结论上消化道出血病例中胃肿瘤容易被误漏诊;对凶险出血病例先用生长抑素药物及其他止血药有效控制出血可大大降低外科手术风险;对再出血及死亡危险性高的患者及时转入外科观察处理较为安全。

Objective To research the method to improve the therapy effect of upper gastrointestinal hemorrhage. Methods 52 cases of upper gastrointestinal hemorrhage were reviewed retrospectively, including peptic ulcer （53.8 % ）, gastric tumor （ 25 % ）, varicosis rupture of esophagus and stomach fundus （7.7 % ）, acute erosive hemorrhagic gastritis（7.7 % ）. Results 35 cases received operation and all had been cured, 15 cases were cured through conservative therapy and the other 2 cases rejected operation and were discharged. There were 8 cases of missed diagnosis or disdiagnosis in its first visiting. The last diagnosis included 6 cases of gastric tumor and 2 cases of varicosis rupture of esophagus and stomach fundus. Conclusions In cases of upper gastrointestinal hemorrhage,gastric tumor is easily missed or disdiagnosed. Somatostadin and hemostatics can significantly reduce the risk of operation in patients with hazardous bleeding. It is suggested the high-risk cases be observed in surgical ICU on time.