Shen Yongshi, Xiao Min, Weng Jinsen, Yang Liuxin, Feng Ye, Ye Yong, Zheng Peng
Department of Intensive Care Unit, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
Department of Thoracic Surgical Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
J Gastrointest Oncol. 2023 Feb 28;14(1):110-118. doi: 10.21037/jgo-22-1203.
There are significant differences in terms of the pathophysiology and clinical manifestations between intra- and extra-luminal bleeding, and it is also difficult to determine the reasonable management of the bleeding. This study is to analyze the clinical characteristics of postoperative bleeding in gastric cancer, and to explore the management of postoperative intra-intestinal and extra-intestinal bleeding.
We collected the clinical data of 2,978 patients with gastric cancer from the Department of Surgery, Fujian Cancer Hospital, from May 2014 to September 2019. A total gastrectomy or a distal or proximal subtotal gastrectomy with regional lymph node dissection (D1+ or D2) was included. The clinic data and management of both early (postoperative days ≤6 d) and delayed (postoperative days ≥7 d) post-operative hemorrhage were explored. This retrospective study is to compare the clinical characteristics and treatment of intra-intestinal and extra-intestinal hemorrhage.
The incidence of postoperative bleeding in gastric cancer was 2.85% (n=85), and the bleeding-related mortality was 4.7% (4/85). There were 67 men and 18 women, and four patients died, with a bleeding-related mortality rate of 4.7%. There were 46 cases of intra-intestinal hemorrhage and 39 cases of extra-intestinal hemorrhage. The reoperation rate in the extraneous bleeding group was higher than that in the intra-intestinal bleeding group (66.67% 19.57%, P<0.001), and the incidence of delayed bleeding in the extra-intestinal bleeding group was higher than that in the intra-intestinal bleeding group (46.15% 8.70%, P<0.001). In the delayed phase, 11 patients underwent reoperation to stop the bleeding, and three patients died due to bleeding-related complications. Hemostasis was successfully achieved in four patients by transcatheter arterial embolization (TAE). In the reoperation group, 72.73% (8/11) suffered hemodynamic instability and 63.64% (7/11) had an abdominal infection, while in the TAE group, 25% (1/4) had hemodynamic instability and 50% (2/4) had an abdominal infection.
A greater number of gastric cancer patients with intra-intestinal hemorrhage are treated conservatively, while more patients with extra-intestinal hemorrhage are treated by reoperation. External bleeding is more likely to occur in the delayed period of bleeding. TAE is a safe and effective means of hemostasis if the hemodynamics is stable.
腔内出血和腔外出血在病理生理学和临床表现方面存在显著差异，确定出血的合理处理方法也很困难。本研究旨在分析胃癌术后出血的临床特征，并探讨术后肠内和肠外出血的处理方法。
我们收集了2014年5月至2019年9月福建医科大学附属肿瘤医院外科2978例胃癌患者的临床资料。纳入全胃切除术或远端或近端胃大部切除术加区域淋巴结清扫术（D1+或D2）。探讨了术后早期（术后≤6天）和延迟期（术后≥7天）出血的临床资料和处理方法。本回顾性研究旨在比较肠内和肠外出血的临床特征及治疗方法。
胃癌术后出血发生率为2.85%（n=85），出血相关死亡率为4.7%（4/85）。男性67例，女性18例，4例死亡，出血相关死亡率为4.7%。肠内出血46例，肠外出血39例。肠外出血组的再次手术率高于肠内出血组（66.67%对19.57%，P<0.001），肠外出血组延迟出血的发生率高于肠内出血组（46.15%对8.70%，P<0.001）。在延迟期，11例患者接受再次手术止血，3例患者因出血相关并发症死亡。4例患者通过经导管动脉栓塞术（TAE）成功止血。在再次手术组中，72.73%（8/11）出现血流动力学不稳定，63.64%（7/11）发生腹腔感染，而在TAE组中，25%（1/4）出现血流动力学不稳定，50%（2/4）发生腹腔感染。
更多的胃癌肠内出血患者采用保守治疗，而更多的肠外出血患者采用再次手术治疗。外出血更易发生在出血延迟期。如果血流动力学稳定，TAE是一种安全有效的止血方法。
