急性上消化道出血的诊断及治疗

Diagnosis and treatment of upper digestive tract massive hemorrhage

目的探讨急性上消化道大出血病人的诊断及治疗。方法本组326例急性上消化道大出血病例,其中211例采用了内科药物保守治疗,全身静脉用药+局部用药;115例采用外科手术治疗。胃大部切除及全胃切除83例,胃癌姑息切除16例,肝硬化门奇断流术12例,分流术2例,胆囊切除、胆道取石术2例。结果326例病人,19例胃癌中16例死亡,手术死亡2例,其余14例分别于术后6～12个月后死亡;39例肝硬化门脉高压食道胃底静脉曲张破裂出血,12例门奇断流手术后,1例于3年后再次行了断流术,1例术后并发胃瘘死亡;2例分流术后1例于1年后因肝昏迷死亡;8例肝癌于出院后6～8个月死亡;211例经内科药物保守治疗治愈出院。结论急性上消化道大出血是胃肠道疾病的严重危及生命的合并症,因其病因复杂,出血程度和部位的不同,其治疗方法和治疗途径各异。要按不同的年龄、病情行内科抢救,保守治疗无效者要果断采用外科手术治疗才能获得较好效果。

Objective To discuss diagnosis and treatment of acute upper digestive tract massive hemorrhage. Methods Among 326 patients with upper digestive tract massive hemorrhage, 311 received conservative treatment with intravenous and local medication, 115 received surgery. Eighty-three received subtotal gastrectomy and total gastrectomy, 16 palliative gastrectomy for gastric cancer, 12 portal-azygous disconnection and 2 bypass for hepatocirrhosis, 2 cholecystectomy and choledocholithotomy. Results Among the 326 pat/ents, 16 out of 19 gastric cancer patients died, 2 of which died immediately after opera- tion, 14 died 6-12 months after operation; 39 hemorrhage caused by hepatocirrhosis, portal hypertension combined esophageal and fundal varice; 12 received portal-azygous disconnection, 1 of them received re-disconnection 3 years later, 1 died due to gastric leakage; 1 of 2 who received bypass died 1 year later because of hepatic coma; 8 hepatocarcinoma patients died 6-8 months after discharge; 211 cured by conservative treatment. Conclusions The upper digestive tract massive hemorrhage is a vital complication of gastrointestinal diseases. The treatment of the disease varies according degree and site of hemorrhage. Surgery is needed for those who failed conservative treatment.