门静脉高压症断流术后并发胃底坏死穿孔临床分析(附7例报告)

Clinical analysis of postoperative complication of gastric necrosis and gastrobrosis in patients with portal hypertension after devascularization:a report of 7 cases

目的 探讨门静脉高压症断流术后并发胃底坏死穿孔的发病原因及治疗。方法 回顾分析门静脉高压症断流术后并发胃底坏死穿孔 7例。非手术治疗 6例 ,手术治疗 1例。结果 在 7例胃底坏死穿孔中 ,并发大出血 3例 ,低钠低氯血症 6例 ,左胸腔感染 1例。死亡 4例。分别死于腹膜炎、中毒性休克 ;左胸腔严重感染、气液胸 ;多器官功能障碍 (MODS)。结论 并发胃底坏死穿孔的原因中有些与手术方法和技术有关 ,有些与胃的损伤、胰腺损伤有关。早期无腹膜炎的胃瘘 ,应避免再手术。

Objective To explore the reasons for postoperative complication of gastric necrosis and gastrobrosis in patients with portal hypertension after devascularization and its treatment. Methods The clinical data of 7 patients with postoperative complication of gastric necrosis and gastrobrosis after devascularization due to portal hypertension treated in our hospital were retrospectively. Of the 7 patients, 6 received conservative treatment and 1 surgical therapy. Results Massive bleeding occurred in 3 patients, hyponatremia in 6 and severe thoracic infection in 1. Four patients died of peritonitis, toxic shock, pneumohydrothorax and multiple organ dysfunction, respectively. Conclusions The reasons for the postoperative complication of gastric necrosis and gastrobrosis are operative methods and expertise in some patients and gastric and splenic injuries in others. For the gastric fistula without peritonitis in the early stage, re-operation should be avoided.