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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。
Objective To summarize the risk factors of postoperative upper gastrointestinal bleeding in surgical malignancies and the related treatment measures.Methods Retrospective analysis of 356 cases of surgically diagnosed malignancies in Tianjin Tianhe Hospital from January 1994 to December 2008 The general clinical data of tumor patients, laboratory test results, intraoperative situation and postoperative upper gastrointestinal bleeding occurred. Results After operation, 22 patients (6.2%) had upper gastrointestinal bleeding after operation. Univariate analysis found that the risk factors of postoperative upper gastrointestinal bleeding were gender (male), previous history of ulcer, preoperative hyperbilirubin Level, increased alkaline phosphatase (ALP), reduced platelet (PLT), radical surgery, long operation time and intraoperative blood loss. Multivariate analysis found that the risk factors for the history of previous ulcers, surgical methods and preoperative bilirubin levels. Conclusion The main cause of postoperative gastrointestinal bleeding in patients with malignant tumors is stress-induced gastrointestinal mucosal lesions. Good preoperative preparation, intraoperative maintenance of vital signs stable postoperative high risk factors for patients with anti-infection and inhibition of gastric acid and other measures can reduce the incidence and mortality.