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61例腹腔手术后继发出血的临床分析:单中心回顾性研究

阴海鑫 陈伟杰 何小东

阴海鑫, 陈伟杰, 何小东. 61例腹腔手术后继发出血的临床分析:单中心回顾性研究[J]. 协和医学杂志, 2019, 10(4): 336-341. doi: 10.3969/j.issn.1674-9081.2019.04.005
引用本文: 阴海鑫, 陈伟杰, 何小东. 61例腹腔手术后继发出血的临床分析:单中心回顾性研究[J]. 协和医学杂志, 2019, 10(4): 336-341. doi: 10.3969/j.issn.1674-9081.2019.04.005
Hai-xin YIN, Wei-jie CHEN, Xiao-dong HE. Clinical Analysis of 61 Patients with Postoperative Hemorrhage after Abdominal Surgery: A Single-center Retrospective Study[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(4): 336-341. doi: 10.3969/j.issn.1674-9081.2019.04.005
Citation: Hai-xin YIN, Wei-jie CHEN, Xiao-dong HE. Clinical Analysis of 61 Patients with Postoperative Hemorrhage after Abdominal Surgery: A Single-center Retrospective Study[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(4): 336-341. doi: 10.3969/j.issn.1674-9081.2019.04.005

61例腹腔手术后继发出血的临床分析:单中心回顾性研究

doi: 10.3969/j.issn.1674-9081.2019.04.005
基金项目: 

国家自然科学基金面上项目 81372578

中国医学科学院医学与健康科技创新工程 2017-12M-4-003

详细信息
    通讯作者:

    何小东电话:010-69152611,E-mail: hexdpumch@sina.com

  • 中图分类号: R619;R656;R816

Clinical Analysis of 61 Patients with Postoperative Hemorrhage after Abdominal Surgery: A Single-center Retrospective Study

More Information
  • 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。
    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)
    下载: 导出CSV

    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
    下载: 导出CSV

    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 成功(n=35) 失败(n=5) P
    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
    下载: 导出CSV
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  • 收稿日期:  2019-03-07
  • 刊出日期:  2019-07-30

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