目的:探討住院期間自發性蛛網膜下腔出血患者再出血的相關因素和對策。方法:對42例自發性蛛網膜下腔出血患者住院期間引起再出血的各種相關因素進行分析。結果: 再出血危險因素:34例持續高血壓,14例情緒激動,7例下床排便用力,6例劇烈活動,7例睡眠不佳煩燥后出血,4例再出血發生在術前8小時, 4例患者在腰穿時出血。結論: 自發性蛛網膜下腔出血患者住院時高血壓和和各種引起血壓升高的誘因是引起再出血最主要原因．同時出血時間間隔和住院期間不適當的腰穿也是引起再出血的重要原因。
Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed. Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.
ObjectiveTo analyze risk factors of rebleeding after laparoscopic selective pericardial devascularization combined with splenectomy.MethodsThe clinical data of 147 cases of portal hypertension treated by the laparoscopic selective devascularization combined with splenectomy from February 2014 to September 2018 were retrospectively analyzed. The univariate analysis was used to find the difference between the rebleeding group (n=20) and the non-bleeding group (n=127), then the multivariate logistic regression analysis was selected for screening out the most closely related risk factors for the rebleeding.ResultsThe rebleeding occurred in 20 of 147 patients (13.6%). There were differences in the platelet count, prothrombin time, serum albumin, diameter of main portal vein, classification of liver function, ascites, hepatic encephalopathy, and portal hypertensive gastropathy between the rebleeding group and the non-bleeding group (P<0.050). The classification of liver function ［OR=3.444, 95% CI (1.211. 9.793）, P=0.020］, ascites ［OR=2.859, 95% CI (1.069, 7.645), P=0.036］, hepatic encephalopathy ［OR=4.265, 95% CI（1.121, 16.230）, P=0.033］, and portal hypertensive gastropathy ［OR=6.744, 95% CI (1.675, 27.156), P=0.007］, and platelet count ［OR=4.744, 95% CI (1.073, 20.969), P=0.040］ were the independent factors for the postoperative rebleeding by the logistic regression analysis.ConclusionFor patients with risk factors of rebleeding, preoperative treatment should be actively taken and postoperative prevention of rebleeding should be highly vigilant.
目的 探討脾切除術后再出血的原因及診治方法并總結其預防措施。方法 對我院1998年8月至2009年3月收治的11例脾切除術后再出血患者的臨床資料進行回顧性分析。結果 本組11例再出血患者均行急診再手術治療，10例治愈,無術后并發癥，恢復順利，切口愈合良好，均拆線出院，術后住院10～21 d（平均15 d）； 余1例外傷性脾破裂者術中探查為胃短動脈破裂出血，遂結扎胃短動脈，術后發生胃瘺，經禁食、靜脈營養等治療，效果差，于術后20 d死亡。結論 脾切除術后再出血原因較多，以胃短血管處理不當、脾蒂血管結扎線脫落、胰尾部血管損傷及患者凝血功能障礙為主。脾切除術后出血以預防為主，術前充分做好各項準備，術中止血徹底，術后特別是術后24 h內嚴密觀察腹腔引流液的量、性質及速度。再出血后果嚴重，一旦發生，應及時準確診斷，行急診再手術治療。
目的 探討門靜脈高壓癥斷流術后上消化道再出血的原因及防治措施。方法 對近8年解放軍第302醫院肝膽外科收治的因門靜脈高壓癥行脾切除、賁門周圍血管離斷術后發生上消化道再出血的15例患者的臨床資料進行回顧性分析。結果 15例術后消化道再次出血患者中，因急性胃黏膜病變出血9例，殘留食管胃底曲張靜脈再次破裂大出血5例，圍手術期門靜脈、脾靜脈及腸系膜上靜脈血栓形成并嘔血1例。圍手術期再出血并死亡2例，通過保守或手術治療治愈13例。結論 斷流術是治療門靜脈高壓癥引起上消化道大出血的良好術式，術后再出血是斷流術后常見并發癥之一，完善的手術操作、適時祛聚抗凝減少門靜脈系統血栓形成可減少斷流術后再出血的發生或減輕其癥狀