期刊文献+

胃十二指肠溃疡出血胃切除术后大出血的外科治疗 被引量:6

Surgical treatment of massive rebleeding after gastrectomy for bleeding gastroduodenal ulcer
原文传递
导出
摘要 目的总结胃十二指肠溃疡出血行胃大部切除术后大出血再手术治疗的经验。方法对我院1980年至2002年间收治的26例胃切除术后大出血再手术患者的临床资料进行回顾分析。结果本组有6例术前行急诊胃镜检查,11例行术中胃镜检查,2例采用超选择性动脉造影。11例球部旷置溃疡出血或球后溃疡出血者,采取旷置溃疡切除或十二指肠球部及降部纵行切开、直视下缝合出血点,同时阻断十二指肠周围血管手术;13例吻合口出血者,局部缝扎止血、切除原吻合口,再作毕Ⅱ式重建或行空肠胃Roux-en-Y吻合;还有2例行再次胃切除手术。治愈24例(92.3%);死亡2例(7.7%),均为术后再出血者。结论术前采用超选择性血管造影及术中胃镜检查,有利于明确出血部位及原因;选择恰当的手术方式对防止术后再出血非常重要。 Objective To summarize the reoperation experiences in treatment of massive rebleeding after subtotal gastrectomy for bleeding gastroduodenal ulcer. Methods From 1980 to 2002, clinical data of 26 cases with massive rebleeding after subtotal gastrectomy for bleeding gastrodenal ulcer were analyzed retrospectively. Results Preoperative gastroscopy was performed in 6 cases,intraoperative gastroscopy in 11,and preoperative superselective angiography in 2 cases. Eleven cases with left ulcer or post bulb ulcer bleeding underwent resection of the left ulcer or longitudinal incision of the duodenal descending part and direct hemostalsis. Thirteen cases with anastomotic stoma bleeding underwent local suture hemostalsis or resection of the stoma plus Billroth Ⅱor Roux en Y gastrojejunostomy. Two cases with gastric bleeding received reexcision of the stomach remnant. Twenty four cases(92.3%) were cured and 2 cases(7.7%) died of gastric bleeding. Conclusions Preoperative superselective angiography and intraoperative gastroscopy are beneficial to clarify the bleeding position and causes for massive rebleeding after gastrectomy. It is very important to select proper operative method to prevent postoperative rebleeding.
出处 《中华胃肠外科杂志》 CAS 2005年第1期32-34,共3页 Chinese Journal of Gastrointestinal Surgery
  • 相关文献

参考文献9

  • 1武正炎主编..普通外科手术并发症预防与处理[M].北京:人民军医出版社,2002:538.
  • 2吴在德 吴肇汉.外科学(第6版)[M].北京:人民卫生出版社,2003.456-457. 被引量:34
  • 3屈新才,郑启昌,余建明,卢晓明,张寿熙,陈道达.超选择性动脉血管造影及栓塞治疗胃切除术后大出血[J].中华外科杂志,2003,41(5):379-381. 被引量:15
  • 4王吉甫主编..胃肠外科学[M].北京:人民卫生出版社,2000:1462.
  • 5屈新才,郑启昌,卢晓明,张寿熙,陈道达.十二指肠球后溃疡并大出血的治疗[J].中华胃肠外科杂志,2003,6(1):11-11. 被引量:3
  • 6Fischer DR, Nussbaum MS, Pritts TA, et al. Use of omeprazole in the management of giant duodenal ulcer: results of a prospective study. Surgery, 1999, 126: 643-649. 被引量:1
  • 7Ohmann C, Imhof M, Roher HD. Trends in peptic ulcer bleeding and surgical treatment. World J Surg, 2000, 24: 284-293. 被引量:1
  • 8Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduodenectomy: the "sentinel bleed". Arch Surg, 1991,126: 1037-1040. 被引量:1
  • 9Savastano S, Feltrin GP, Miotto D, et al. Vascular parenchymal sources of upper gastrointestinal bleeding. Acta Radiol, 1989, 30:39-43. 被引量:1

二级参考文献9

  • 1杨建勇.消化道出血的介入诊断和治疗[A].见 :黄洁夫 主编.腹部外科学 :第 1版[C].北京 :人民卫生出版社,2001.452- 480. 被引量:4
  • 2李建平.胃切除术后并发症.见:武正炎,主编.普通外科手术并发症预防与处理.第1版.北京:人民军医出版社,2002.152-227.Li JP. Postoperative complications of gastrectomy. In: Wu ZY,ed.Prevention and management of operative complications for general surgery. 1st ed. Beijing: People′s Military Medical Publisher, 2002.152-227. 被引量:1
  • 3Brodsky JT, Turnbull AD. Arterial hemorrhage after pancreatoduodenectomy: the "sentinel bleed."Arch Surg, 1991,126:1037-1040. 被引量:1
  • 4胡国栋.选择性腹部血管造影和介入放射治疗在胃肠外科的运用.见:王吉甫, 主编.胃肠外科学.第1版.北京:人民卫生出版社,2000.1390-1410.Hu GD. Application of selective abdominal angiography and interventional radiology therapy in gastrointestinal surgery.In: Wang JF,ed. Gastrointestinal Surgery. 1st ed. Beijing: People′s Medical Publishing House, 2000.1390-1410. 被引量:1
  • 5Savastano S, Feltrin GP, Miotto D, et al. Vascular parenchymal sources of upper gastrointestinal bleeding. Acta Radiol,1989,30:39-43. 被引量:1
  • 6Sheedy PF 2nd, Fulton RE, Atwell DT. Angiographic evaluation of patients with chronic gastrointestinal bleeding. Am J Roentgenol Radium Ther Nucl Med, 1975,123:338-347. 被引量:1
  • 7Wagner HE, Stain SC, Gilg M, et al. Systematic assessment of massive bleeding of the lower part of the gastrointestinal tract. Surg Gynecol Obstet, 1992,175:445-449. 被引量:1
  • 8Lang EV, Picus D, Marx MV, et al. Massive arterial hemorrhage from the stomach and lower esophagus: impact of embolotherapy on survival. Radiology,1990,177:249-252. 被引量:1
  • 9Kramer SC,Gorich J, Rilinger N, et al. Embolization for gastrointestinal hemorrhages. Eur Radiol, 2000,10:802-805. 被引量:1

共引文献48

同被引文献23

引证文献6

二级引证文献29

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部