恶性肿瘤患者术后上消化道出血的原因分析及处理

目的总结探讨外科恶性肿瘤患者术后合并上消化道出血的高危因素以及相关处理措施.方法回顾性分析1994年1月—2008年12月间天津市天和医院普外科356例经手术诊断的恶性肿瘤患者的一般临床资料、实验室检查结果、术中情况及术后上消化道出血的发生情况。结果术后22例（6.2%）患者术后发生上消化道出血,单因素分析发现导致术后合并上消化道出血的高危因素有：性别（男）、既往溃疡病史、术前高胆红素水平、碱性磷酸酶（ALP）升高、血小板（PLT）减少、根治性手术方式、手术时间长和术中失血量多。多因素分析发现高危因素为既往溃疡病史、手术方式及术前胆红素水平。结论恶性肿瘤患者术后并发上消化道出血的主要原因是应激性消化道黏膜病变。良好的术前准备、术中维持生命体征稳定,术后针对高危因素患者加强抗感染和抑制胃酸等措施可以减少发生率和病死率。

Analysis and Treatment of the Postoperative Upper Gastrointestinal Bleeding in Patients with Malignant Tumors

Objectives]To sum up the high-risk factors of postoperative upper gastrointestinal bleeding in patients with malignant tumors and its treatment measures.Methods]356 patients with malignant tumors diagnosed by surgery in department of surgery in Tianhe Hospital of Tianjin from Jan 1994 to Dec 2008 were collected. The general clinical data, laboratory examinations results, intraoperative conditions and the incidence of postoperative upper gastrointestinal bleeding were retrospectively analyzed.Results]There were 22 （6.2%） cases of postoperative upper gastrointestinal bleeding. Univariate analysis showed that the high-risk factors induced postoperative upper gastrointestinal bleeding included gender （male）, history of ulcer diseases, high bilirubin before operation, increase of ALP, decrease of PLT, radical surgical method, longer operative time and a large amount of intraoperative blood loss. Multivariate analysis indicated that the high-risk factors were history of ulcer diseases, surgical method and bilirubin level before operation.Conclusion]The main cause of postoperative upper gastrointestinal bleeding in patients with malignant tumors was stress-induced gastric mucosal lesion. The measures, including sufficient preoperative preparations, maintaining stable vital signs during operation, strengthening anti-infection treatment and inhibiting gastric acid secretion after operation for the patients with risk factor, can reduce the incidence and mortality.