作者：朱晓峰1，黄海鹏2，熊文俊2，罗立杰2，郑燕生2，李金2，薛玉玲1，罗思静1，徐钰婷1，王伟2

单位：1. 广州中医药大学，广东 广州 510405；2. 广州中医药大学第二附属医院/广东省中医院 胃肠外科，广东 广州 510120

Authors:  Zhu Xiaofeng1, Huang Haipeng2, Xiong Wenjun1, Luo Lijie1, Zheng Yansheng1, XueYuling1, Luo Sijing1, Xu Yuting 1, Wang Wei2

Unit:  1.Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China；2.Department of Gastrointestinal Surgery, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine/Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong, China

摘要：

目的 总结分析胃癌D2根治术后发生大出血的原因及治疗方法并探讨其对生存预后的影响。方法 回顾性分析广东省中医院2012年1月至2016年3月258例行胃癌D2根治术患者的临床资料,根据术后是否发生大出血分为出血组和非出血组。结果 14例患者(5.4%)术后发生大出血;吻合口出血、十二指肠残端瘘或破裂是出血的主要原因;二次手术和胃镜止血是主要治疗措施。两组的短期总生存期有统计学意义(1年:P=0.017,3年:P=0.011)。结论 吻合口出血、十二指肠残端瘘或破裂是胃癌D2根治术后出血的主要原因,及时诊断和治疗能有效降低病死率。胃癌D2根治术后大出血会降低患者的短期总生存期。

关键词：  胃癌; 大出血; 原因; 治疗; 预后

Abstract：

Objective To summarize the causes and treatment of massive hemorrhage after radical gastrectomy with D2 lymph node dissection and to explore its effect on survival. Methods The clinical data of 258 cases of radical gastrectomy with D2 lymph node dissection from January 2012 to March 2016 in Guangdong Provincial Hospital of Chinese Medicine were analyzed retrospectively. According to whether there is major bleeding after operation, it is divided into bleeding group and non-bleeding group. Results 14 patients (5.4%) had massive hemorrhage after surgery. Anastomotic bleeding, duodenal stump fistula or rupture of bleeding is the main cause of bleeding; Secondary surgery and endoscopy for hemostasis are the main treatments. There were statistically significant in the short-term overall survival (1 year: P=0.017; 3 year: P=0.011). Conclusion Anastomotic bleeding, duodenal stump fistula or rupture hemorrhage is the main cause of bleeding after radical gastrectomy with D2 lymph node dissection. Timely diagnosis and treatment can effectively reduce mortality. Massive hemorrhage after radical gastrectomy with D2 lymph node dissection will reduce short-term overall survival of patients.

Key Words:  Gastric cancer; Massive hemorrhage; Cause; Treatment; Prognosis