Tseng Yau-Lin, Wu Ming-Ho, Lin Mu-Yen, Lai Wu-Wei
Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China.
World J Surg. 2004 Jan;28(1):50-4. doi: 10.1007/s00268-003-6831-0. Epub 2003 Dec 5.
Our purpose was to delineate the characteristics and outcome of massive upper gastrointestinal bleeding (UGI) caused by acid-corrosive injury and to determine its management protocol. From June 1988 to June 2000, all patients with the history of acid-corrosive injury at our institution were reviewed. Patients with massive UGI bleeding (hematocrit level <25% or transfusion of three or more units of whole blood required to restore normal vital sign) were enrolled into this study. Altogether, 12 (3.2%) of 378 patients with acid-corrosive injury developed massive bleeding: 8 gastric bleeding, 2 duodenal bleeding, and 2 first gastric and then duodenal bleeding. Gastric bleedings started an average of 12.1 days after the initial injury (range 9-21 days). Duodenal bleeding usually occurred later, at 10.1 days (range 6-18 days) after a gastric or esophagogastric operation. Nine of the ten patients with gastric bleeding underwent surgery during the subacute stage: three esophagogastrectomy, three gastric mucosectomy with gastrostomy and jejunostomy, and three total or subtotal gastrectomy. Operative findings were hemorrhagic gastritis with diffuse mucosal bleeding. Two of four patients with duodenal bleeding underwent duodenotomy with suture-ligation of bleeding vessels, and the other two had conservative treatment. Nine patients (75%) had postoperative complications. One patient (8%) died from complications of surgery performed to stop duodenal bleeding. Massive UGI bleeding rarely occurs after acid-corrosive injury; but when it does, it occurs during the subacute stage. Aggressive surgical treatment is mandatory for gastric bleeding. How duodenal bleeding can be better managed requires further study.
我们的目的是描述酸腐蚀伤所致大量上消化道出血（UGI）的特征及转归，并确定其治疗方案。回顾了1988年6月至2000年6月在我院有酸腐蚀伤病史的所有患者。纳入有大量UGI出血（血细胞比容水平<25%或需要输注三个或更多单位全血以恢复正常生命体征）的患者进行本研究。378例酸腐蚀伤患者中，共有12例（3.2%）发生大量出血：8例胃出血，2例十二指肠出血，2例先胃出血后十二指肠出血。胃出血平均在初始损伤后12.1天开始（范围9 - 21天）。十二指肠出血通常发生较晚，在胃或食管胃手术后10.1天（范围6 - 18天）。10例胃出血患者中有9例在亚急性期接受了手术：3例行食管胃切除术，3例行胃黏膜切除术加胃造口术和空肠造口术，3例行全胃或次全胃切除术。手术所见为出血性胃炎伴弥漫性黏膜出血。4例十二指肠出血患者中有2例行十二指肠切开术并缝合结扎出血血管，另外2例接受保守治疗。9例（75%）患者有术后并发症。1例（8%）患者死于为止血十二指肠出血而进行的手术并发症。酸腐蚀伤后很少发生大量UGI出血；但一旦发生，多在亚急性期。胃出血时必须积极进行手术治疗。十二指肠出血如何更好地治疗有待进一步研究。
