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Clinical Analysis of 61 Patients with Postoperative Hemorrhage after Abdominal Surgery: A Single-center Retrospective Study
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摘要:
目的 探讨腹腔手术后继发出血的原因和干预时机，以优化治疗方案。 方法 回顾性分析北京协和医院2013年1月至2018年12月腹腔手术后继发出血患者的临床资料，分析出血原因、治疗方案及预后情况。 结果 61例符合纳入和排除标准的腹腔手术后继发出血患者入选本研究，其中男性49例，女性12例，以胰十二指肠切除术患者最多(50.8%，31/61)，其次为肝脏手术(16.4%，10/61)和胃部手术(14.8%，9/61)。56例患者明确了出血原因，其中创面渗血和/或创面小动脉活动性出血24例(42.9%，24/56)，吻合口出血11例(19.6%，11/56)。出血后多数患者采取手术止血(65.6%，40/61)，成功率为87.5%；其次采取介入栓塞止血(24.6%，15/61)，成功率为26.7%，差异具有统计学意义(P＜0.01)。成功止血55例、死亡5例，1例患者放弃治疗。 结论 腹腔大手术后出血机率更高，手术止血效果可能优于介入栓塞止血。 Abstract:Objective The aim of this study was to explore the causes of postoperative rebleeding after abdominal surgery and the timing of intervention, so as to optimize the treatment plan. Methods The clinical data of patients with abdominal bleeding after abdominal surgery from January 2013 to December 2018 were retrospectively collected in Peking Union Medical College Hospital. The causes of bleeding, treatment plan, and prognosis were analyzed. Results A total of 61 patients with postoperative hemorrhage after abdominal surgery who met the inclusion and exclusion criteria were enrolled in this study, including 49 males and 12 females. Among them, most patients had pancreaticoduodenectomy (50.8%, 31/61), followed by liver surgery (16.39%, 10/61) and gastric surgery (14.8%, 9/61). The causes of bleeding were identified in 56 patients, including 24 cases of wound bleeding and/or arteriolar active bleeding (42.9%, 24/56) and 11 cases of anastomotic bleeding (19.6%, 11/56). After hemorrhage, most patients (65.6%, 40/61) underwent surgical hemostasis, with a success rate of 87.50%; hemostasis by interventional embolization was adopted in the other patients(24.6%, 15/61), with a success rate of 26.7%(P > 0.01). Successful hemostasis was achieved in 55 cases. Five cases died, and one gave up treatment. Conclusions Major abdominal surgery increases hemorrhage risk. Hemostasis of surgery may be superior to that of interventional embolization. -
Key words:
- abdominal operation /
- bleeding /
- reoperation of bleeding /
- interventional embolism
利益冲突 无 -
表 1 61例腹腔手术后继发出血患者的一般临床资料
观察项目 例数(%) 性别 男 49(80.3) 女 12(19.7) 术前抗凝药物使用 有 3( 4.9) 无 58(95.1) 手术方式 胰十二指肠切除术 31(50.8) 肝脏 10(16.4) 胃 9(14.8) 结直肠 7(11.5) 小肠 3( 4.9) 脾 1( 1.6) 出血表现 引流管出血 42(68.8) 呕血 4( 6.6) 便血 8(13.1) 胃管出血 4( 6.6) 休克症状 3( 4.9) 转归 好转 55(90.2) 死亡 5( 8.2) 自行出院 1( 1.6) 
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表 2 61例腹腔手术后继发出血患者出血部位及止血方案效果分析
观察项目 保守治疗(n=4) 手术探查(n=40) 介入栓塞(n=15) 胃镜(n=1) 抢救无效(n=1) 总计 出血部位 - 40 15 1 - 56 创面 - 21 3 0 - 24 吻合口 - 9 2 1 - 12 脾血管 - 2 1 0 - 3 胃十二指肠 - 2 2 0 - 4 胰腺坏死 - 1 0 0 - 1 胃壁坏死 - 1 0 0 - 1 乙状结肠坏死 - 1 0 0 - 1 门脉破裂 - 1 0 0 - 1 结肠中静脉 - 1 0 0 - 1 肝动脉 - 0 2 0 - 2 胃左动脉分支 - 0 1 0 - 1 肠系膜上动脉 - 0 1 0 - 1 肠系膜上静脉 - 0 1 0 - 1 无明确出血 - 1 2 0 - 3 止血效果 单次成功 4 35 4 1 - 44 单次失败 0 5 11 - - 16 追加手术成功 - 2 8 - - 10 追加胃镜成功 - 0 1 - - 1 放弃治疗 - 1 0 - - 1 死亡 0 2 2 0 1 5
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表 3 介入栓塞止血组与手术止血组亚组分析结果
项目 单次介入栓塞止血 单次手术止血 成功(n=4) 失败(n=11) P值 成功(n=35) 失败(n=5) P值 年龄(x±s, 岁) 57.3±7.5 54.9±13.1 0.770 54.8±14.4 63.4±14.7 0.220 有基础疾病(%) 50.0 36.4 0.530 45.7 60.0 0.450 术中出血量(x±s, ml) 500.0±264.6 452.0±317.5 0.820 865.2±700.4 660.0±517.7 0.540 APTT(x±s, s) 入院时 26.2±3.7 26.1±2.9 0.950 29.6±6.6 28.1±4.1 0.630 治疗前 29.0±2.7 42.8±16.8 0.023 31.7±8.9 38.0±6.2 0.135 治疗后 26.8±3.5 43.9±9.4 0.004 37.6±12.1 35.2±5.5 0.660
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