腹部手术后早期大出血的原因与防治

Causes and Treatment and Prevention of Early Postoperative Massive Hemorrhage after the Abdominal Procedure

摘要: 目的：探讨腹部手术后早期大出血的原因与防治。方法：对56例腹部手术后早期(72 h内)出现腹腔内及消化道大出血的临床资料进行回顾性分析。结果：术后大出血原因有血管结扎线滑脱出血19例，术后创面大量渗血17例，胃小弯断端出血6例及胃切开缝合处出血1例，吻合口出血13例。再次手术方式包括结扎线脱落血管再缝扎19例，出血部位缝扎止血15例，胃(肠)切开 + 缝合止血18例，残胃全切除1例，吻合口切除 + 再吻合1例，出血创面缝合结扎 + 电灼 + 生物胶物胶或止血纱覆盖止血2例。本组再手术治疗病例中治愈53例，死亡3例。结论：腹部手术后早期大出血主要与手术操作失误和吻合器械操作不当有关，早期再次手术是抢救的关键，认真仔细操作是预防的根本。

Abstract: Objective: To analyze the reason, treatment and prevention of early postoperative massive he-morrhage after the abdominal procedure. Methods: The clinical data of 56 cases with early (less than 72 hours) postoperative intra-abdominal and gastrointestinal massive hemorrhage after the abdominal procedure were analyzed retrospectively. Results: The reasons of postoperative he-morrhage included loosening of blood vessel ligation in 19 cases, blood oozing from the wound surface in 17 cases, hemorrhage from the gastric remnant margin (staple-line) of lesser curvature in 6 cases and hemorrhage from gastrotomy site in 1 case, hemorrhage from anastomosis (gastro [esophago]-jejunostomy, colorectal [anal] anastomosis) in 13 cases. The surgical procedures of reoperation were re-exploration and surgical ligation in 19 cases, re-exploration and suturing li-gation in 15 cases, gastrotomy and suturing ligation in 18 cases, total removal of remnant gastrec-tomy in 1cases, resection of gastrojejunostomy and re-anastomosis in 1 case, re-exploration and suturing ligation with oppression of absorbable hemostatic gauze in 2 cases. 53 cases were survived and 3 cases were died. Conclusions: Maltreatment of blood vessel during operation and in-appropriate application of staple were the main causes of early postoperative massive hemorrhage after the abdominal procedure. Diagnosis at early stage and secondary operation on time are essential for success of rescue, and careful manipulation is principle for prevention of this post-operative complication.