食管器械吻合术后上消化道大出血分析及治疗

Clinical Analysis and Treatment on Upper Gastrointestinal Hemorrhea after the Surgery of Gastroesophageal Mechanical Anastomosis

目的分析胃食管器械吻合术后上消化道大出血的原因及诊疗方法。方法2001年12月~2011年12月间我院行食管癌、贲门癌切除术患者2013例，均采用弯管型吻合器行胸内胃食管吻合术。术后26例患者（出血组）出现上消化道出大出血。对比出血组与未出血组的差异性，分析吻合口出血的影响因素。结果18例患者保守治疗后出血停止，8例患者行二次手术止血。多因素logistic回归分析示吻合方式及术中出血量与术后出血的发生率存在明显的相关性。结论胃食管器械吻合术后上消化道大出血多发生于吻合口、胃残端，吻合方式及术中出血量与术后出血相关，大部分病例经保守治疗出血可停止，保守治疗无效者应积极再次手术止血；术中应采取多种措施减少术后出血几率。

Objective To summarize the causes and treatment of patients with upper gastrointestinal hemorrhea after the surgery of gastroesophageal mechanical anastomosis. Methods From December 2001 to December 2011, a total of 2013 patients were enrolled in this research to compared the clinical index of bleeding group（ n = 26 ） and non-bleeding group （n = 1 987 ）. All cases were performed gastroesophageal mechanical anastomosis. Results 26 patients suffered with bleeding after the surgery. The logistic regression revealed that amount of bleeding and operative site were associated with bleeding after the surgery. 18 patients were recovered by conservative therapy, while 8 patients were performed reoperation to stop bleeding. Conclusions Postoperative hemorrhage associated with gastroesophageal mechanical anastomosis frequently happened in the anastomotic and stomach stump, which should be avoided in operation. Most of the bleeding could be cured by conservative therapy, surgery should be performed as early as possible once the conservative therapy inefficient.