介入治疗在出血性胃十二指肠溃疡病术后大出血的应用评价

Evaluation of transarterial embolization for massive rebleeding after gastrectomy for bleeding gastroduodenal ulcer

目的 评价出血性胃十二指肠溃疡患者在胃大部切除术后大出血时予以介入栓塞治疗的效果。方法 对我院1980～2002年间收治的49例出血性胃十二指肠溃疡患者,在胃大部切除术后大出血时的手术与介入治疗效果进行回顾性比较分析。结果 本组49例患者中,予以再手术治疗26例(再手术组),介入治疗23例(介入治疗组),均取得了较好的疗效。两组在治愈率、病死率、并发症及再出血发生率方面比较,差异无显著性意义(P>>0.05)。但平均住院日及输血量再手术组明显增多,两组比较,差异有极显著性意义(P<0.01)。结论 对于出血性胃十二指肠溃疡患者,术后大出血行介入栓塞治疗是安全有效的,应及早进行;对介人治疗效果不佳者应及时手术。

Objective To evaluate the interventional embolization therapy in the treatment of massive rebleeding after subtotal gastrectomy for bleeding gastroduodenal ulcer. Methods Forty-nine cases with massive rebleeding after gastrectomy for bleeding gastroduodenal ulcer were admitted from 1980 to 2002. Reoperation was performed in 26 and interventional therapy in 23 cases. The clinical data were analyzed retrospectively and the results of the two methods were compared. Results There were no significant differences in the morbidity, mortality and rebleeding rate between the reoperation and interventional therapy groups ( P > 0. 05). The mean hospital stay was longer and volume of blood transfusion was more significantly in reoperation group than those in interventional therapy group. Conclusions Transarterial embolization for massive rebleeding after gastrectomy is safe and effective. Early interventional therapy of recurrent bleeding should be promptly carried out. Early reoperation is beneficial to the patients with failure of interventional embolization.