腹部手术后腹腔内出血的诊治(附26 例报告)

第39卷　第3期

2003年9月

青岛大学医学院学报

ACT A ACADE MIAE ME DICINAE QING DAO UNIVERSIT ATIS

V ol.39,N o.3September 2003

[收稿日期]2003202218;　[修订日期]2003204208[作者简介]邱法波(19622),男,博士,副主任医师。

腹部手术后腹腔内出血的诊治(附26例报告)

邱法波,吴力群,王豪夫,张　顺,张炳远,张　斌,杨金镛

(青岛大学医学院附属医院肝胆外科,山东青岛　266003)

[摘要]　①目的　总结腹部手术后腹腔内出血的诊治经验。②方法　对1981年1月～2001年9月腹部手术

后24h 内腹腔内出血>300m L 的26例病人进行回顾性分析。肝癌切除术9例,脾切除加断流术7例,腹膜后肿瘤切除术和直肠癌Mile 手术各3例,胰头十二指肠切除术2例,其他手术2例。③结果　14例再手术治疗,12例非手术治疗,死亡7例,腹腔内出血量>3000m L 的6例病人均死亡,出血量1000～3000m L 的11例病人死亡1例。④结论　腹部手术后出血但生命体征稳定者,可在严密监测下非手术治疗。术后24h 内出血量<600m L 或累计出血量<1000m L 可作为非手术治疗的参考指标。对于创面广泛渗血或不能清楚显示出血部位者,应用长纱布条压迫止血是有效的方法。

[关键词]　外科手术,消化系统;出血;并发症;腹部肿瘤

[中图分类号]　R656 [文献标识码]　A [文章编号]　167224488(2003)0320253202

THE DIAGN OSIS AN D TREATMENT OF INTRA 2AB DOMINA L B LEE DING OF POST 2AB DOMINA L OPERATION :A REPORT OF 26CASES QIU Fa 2bo ,WU Li 2qun ,WANG Hao 2fu ,et al (Department of Surgery ,The A ffiliated H ospital of Qingdao University M edical C ol 2lege ,Qingdao 266003,China )

[ABSTRACT]　Objective T o summarize the experience in the diagnosis and treatment of intra 2abdominal bleeding after abdominal opera 2tion.　Methods From Jan.1981to Sept.2001,26cases of intra 2abdominal bleeding ,over 300m L ,within the first 24hours after operation ,were analyzed retrospectively.The initial operations were :hepatectomy for liver cancer in 9patients ,splenectomy and devascularization for portal hypertention in 7,resection of retroperitoneal tum or in 3,M ile operation for rectal cancer in 3,pancreatoduodenectomy in 2and other operations in 2.　Results Re 2operations were done in 14cases and 12cases treated conservatively.Seven died.S ix cases with blood loss of m ore than 3000m L all died ,for 11cases whose blood loss was 1000to 3000m L ,one died.　Conclusion Patients with stable vital signs could be treated non 2surgically under intensive m onitoring.The blood loss less than 600m L within 24hours after operation or the accumulative blood loss of less than 1000m L could be taken as reference parameter for conservative therapy.F or diffuse oozing or the bleeding site that can not be exposed clearly ,long ribbon gauze plugging is an effective way to control bleeding.

[KE Y WOR DS]　surgery ,digestive system ;hem orrhage ;com plications ;abdominal neoplasms

腹部手术后腹腔内出血是严重并发症,病死率高,是腹部手术后死亡主要原因之一。我们对1981年1月～2001年9月腹部手术后24h 内腹腔内出血>300m L 的26例病人进行了回顾性分析,旨在积累诊断和治疗经验。现报告如下。1　临床资料

26例病人,男24例,女2例;年龄34～71岁,平

均50.2岁。肝癌切除术9例,脾切除加断流术7

例,腹膜后肿瘤切除术(包括1例盆腔腹膜后复发性肿瘤切除术)和直肠癌Mile 手术各3例,胰头十二指肠切除术2例,单纯脾脏切除术和胆总管切开取石术各1例。累计出血量≥1000m L 者17例(术后24h 内出血量均>600m L ),其中16例有失血性休克;出血量>3000m L 者6例;出血量1000～3000m L 者11例;出血量<1000m L 者9例。19例通过

观察引流物的性质明确诊断,4例通过腹腔穿刺而

确诊,3例延误诊断。1992年以前的7例中死亡4例,此后的19例中死亡3例。血管出血13例,创面渗血10例,凝血功能不良、DIC 和原因不明出血各1例。出血量>3000m L 的6例均死亡;出血量1000～3000m L 的11例中死亡1例,是肝癌复发部分切除术病人,术后肿瘤创面广泛渗血,再次手术长纱布条压迫止血,最终死于肝脏衰竭;出血量<1000m L 的9例无死亡。再手术治疗的14例中死亡4例,非手术治疗的12例中死亡3例。2　讨 论

2.1　腹部手术后腹腔内出血的概念和诊断

腹部手术后引流管流出少量血性液体是正常现象,引流量的多少与许多因素有关,包括止血是否彻