【摘要】 目的探讨残胃并发上消化道出血的临床特征和有效治疗方法。方法收集青岛市市立医院在2005年1月-2015年1月收治的71例经胃镜诊断明确的残胃并发上消化道出血患者的临床资料,应用Kruskal Wallis检验对独立的多组有序分类资料进行比较。结果残胃并发上消化道出血患者男性多于女性[男性59例(83.1%),女性12例(16.9%)],老年患者占74.6%(53/71),以黑便为主要症状者占66.4%(47/71),发生在术后5年以上者占63.4%(45/71),毕Ⅱ式吻合术者占71.8%(51/71)。青年、中年、老年组的出血病因差异有统计学意义(H=24.354,P<0.001),吻合口溃疡是最常见的病因。病情轻、中、重度患者组的出血病因、Forrest分级以及治疗方法差异均有统计学意义(H=16.319,P=0.005;H=18.681,P=0.003;H=14.226,P=0.009)。内科保守治疗的有效率为93.0%(66/71),内镜止血成功率为83.3%(15/18)。结论残胃患者中男性、老年人、术后5年以上及毕Ⅱ式吻合术均为出血的高危因素。药物、内镜止血及内外科协作治疗是成功救治危重患者的关键。更多还原

【Abstract】 Objective To explore the clinical feature and effective method of treatment for upper gastrointestinal bleeding from remnant stomach. Methods Seventy-one patients with remnant stomach suffering from upper gastrointestinal bleeding as confirmed by gastroscopy were admitted to Qingdao Municipal Hospital from January 2005 to January 2015. Kruskal Wallis test was used to compare the separate multiple sets of ordered categorical data. Results Remnant stomach complicated by upper gastrointestinal bleeding was more common in males than females(83.01% vs 16.9%), and in elder patients(53/71, 74.6%), accompanied by tarry stool(47/71, 66.4%), undergoing subtotal gastrectomy over 5 years(63.4%, 45/71), and the procedure was Billroth Ⅱ subtotal gastrectomy(71.8%, 51/71). The differences in cause of bleeding were statistically different among younger, middle-aged and older groups(H=24.354, P<0.001), and the most common cause of bleeding was marginal ulcer. There were statistical differences in degree of bleeding, Forrest classification, and treatment methods(H=16.319, P=0.005; H=18.681, P=0.003; H=14.226, P=0.009) between patients with mild, moderate and severe condition. The efficacy rate for conservative medical treatment was 93.0%(66/71). The success rate of endoscopic hemostasis was 83.3%(15/18). Conclusions Male, old age, longer than 5 years postoperation, and Billroth Ⅱ gastrectomy are high-risk factors for bleeding in the patients undergone subtotal gastrectomy. The comprehensive treatment with drugs, endoscopic hemostasis and surgical treatment are essential in rescuing critical patients.更多还原