梗阻性黄疸术后并发消化道出血的预防和治疗

PREVENTION AND TREATMENT OF HEMORRHAGE OF DIGESTIVE TRACT AFTER OPERATION FOR OBSTRUCTIVE JAUNDICE.

目的 探讨梗阻性黄疸 (简称梗黄 )术后并发消化道出血的防治措施。方法 回顾性总结分析 2 0年间 5 45例梗黄术后并发症状况和防治消化道出血的经验。结果 5 45例术后并发消化道少量出血占 2 9.5 % ( 16 1/5 45 ) ,大出血 5 .3% ( 2 9/5 45 ) ,死亡 1.7% ( 9/5 45 )。1989年以前并发少量出血占 36 % ( 10 2 /2 84) ,大量出血占 6 .7% ( 19/2 84)、死亡 2 .5 % ( 7/2 84)。1990年后采取了有力的防治措施 ,明显减少发生率和病死率 ,分别为 2 2 .6 % ( 5 9/2 16 )、3.8% ( 10 /2 6 1)、0 .8% ( 2 /2 6 1)结论 梗黄术后并消化道出血的主要原因是应激性消化道粘膜病变。良好的术前准备、术中维持生命体征稳定和充足供氧 。

Objective To discuss the prevent and treat the hemorrhage of digestive tract after the operation for obstructive jaundice.Methods 545 cases with obstructive jaundice during last 20 years were reviewed,especially the complications after the exploration of biliary tract and the experiences of treatment and prevention to the hemorrhage of digestive tract.Results 29.5%(161/545) patients who underwent the exploration of biliary tract for obstructive jaundice had minor hemorrhage of digestive tract after the operation.5.3%(29/545) of these had massive hemorrhage.Death occurred in 1.7%(9/545) patients.The incidence of hemorrhage of digestive tract,minor hemorrhage of digestive tract,massive hemorrhage of digestive tract and mortality rate of it after operation was 36%(102/284),6.7%(19/284),2.5%(7/284)respectively before 1989.After 1990,the rate was were reduced to 22.69%(59/261),3.8%(10/261),0.8%(2/261) by the potent preventive measure.Conclusion The main reasons of hemorrhage of digestive tract after the operation for obstructive jaundice were the stress ulcer of digsesive tract.Its incidence and mortality could be reduced by good preoperative preparations,sufficient oxygen supply during the operation,anti-infection treatment and inhibiting gastric acid secretion after operation