胃癌根治术后出血的原因分析及处理

Causes and management for hemorrhage after radical gastrectomy

目的分析胃癌根治术后出血的病因、诊断及治疗方案的选择。方法对浙江省肿瘤医院2015年8月至2017年8月胃癌根治术后发生出血的20例病人进行回顾性研究。结果 20例病人中有14例为术后早期出血,其中消化道出血4例,腹腔内出血10例;3例经保守治疗无效后行手术止血,1例经数字减影血管造影技术(digital subtraction angiography,DSA)下栓塞止血,其余10例均经内科保守治疗止血,所有病人均痊愈出院。有6例病人出现术后迟发性出血,均为腹腔内出血;其中1例为胃十二指肠动脉假性动脉瘤形成破裂出血,经血管介入栓塞治疗后止血;有3例为术后吻合口漏引起出血,经手术止血后2例痊愈出院,1例死亡;1例病人为血管夹在拔除腹腔引流管时脱落引起出血,经手术治疗止血成功;1例病人腹腔内出血原因不明,经保守治疗后痊愈。结论胃癌根治术后腹腔出血病因复杂,需根据不同病因灵活选择止血方法,DSA及胃镜检查可帮助诊断及治疗,有时可避免再次开腹手术。

Objective To investigate the causes,treatments,and prognosis of hemorrhage in patients who underwent radical gastrectomy.Methods The clinical data of 20 patients who underwent radical gastrectomy in the Zhejiang Cancer Hospital from August 2015 to August 2017 were retrospectively analyzed.Results Fourteen patients suffered from early hemorrhage,including 4 cases of gastrointestinal bleeding and 10 cases of abdominal bleeding.Hemorrhage was terminated by conservative treatment in 10 cases,3 cases underwent a second operation after conservative treatment failed to stop hemorrhage,and 1 case received digital subtraction angiography（DSA）and transcathete arterial embolization（TAE）to stop hemorrhage.All patients recovered well.There were 6 cases of delayed hemorrhage,including 1 case of bleeding due to gastroduodenal artery pseudoaneurysm rupture,treated by DSA and TAE to stop hemorrhage;3 cases of anastomosis leakage-induced hemorrhage,given a second operation（2 patients recovered well and 1 patient was dead after second operation）;one case of hemorrhage due to removing off the abdominal drainage tube,given the surgical operation to stop the hemorrhage;once of unexplained abdominal bleeding,who recovered by conservative treatment.Conclusions The causes of hemorrhage after radical gastrectomy were complicated and the method of hemostasis should be flexibly chosen according to different causes.DSA and endoscope can be used for diagnosis and treatment,and sometimes can avoid re-operation.