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Diagnosis and Treatment of Small Intestinal Haemorrhage with Laparoscopy: Experience of 15 Patients

目的　探討腹腔鏡對小腸大出血的診斷和治療。方法　對15例懷疑小腸大出血的患者進行腹腔鏡探查。結果　探查陽性率100%，其中小腸腫瘤7例，小腸憩室5例，小腸憩室并套疊1例，小腸血管畸形2例，均在腹腔鏡輔助下行小腸部分切除或憩室切除術。結論　腹腔鏡對小腸出血的診斷尤其是治療方面有較高的價值。

Study of Upper Gastrointestinal Bleeding Surgical Approach

目的:研究上消化道大出血的外科處理辦法。方法:選因上消化道大出血而進行手術者共34例,尋找術前病因及出血部位,對不同病因和部位出血病例進行了相應的手術治療。結果:所有病例無1例死亡。術后出現吻合口滲血2 例,經止血,對癥治療出血停止。無1例再出血就診。結論: 對上消化道大出血患者,針對不同的情況,可分別采用全胃切除術、接近全胃切除術、迷走神經切斷加胃大部分切除術、迷走神經切斷加幽門成形等外科手術方式處理。

持續封閉式負壓引流治療嚴重軟組織損傷致出血的臨床觀察

目的 總結持續封閉式負壓引流（vacuum sealing drainage，VSD）治療嚴重軟組織損傷過程中發生創面大量快速出血的原因。 方法 2008 年8 月－ 2011 年8 月，收治9 例四肢嚴重軟組織損傷患者。男7 例，女2 例；年齡25 ～ 51 歲，平均39.2 歲。損傷原因：電燒傷2 例，交通事故傷6 例，其他傷1 例。創面污染及軟組織損傷嚴重；伴動脈損傷6 例，神經損傷6 例，骨筋膜室綜合征3 例，骨折7 例。傷后至入院時間1 ～ 12 h，平均3.5 h。入院后急診清創，對應處理合并傷后行VSD 治療。 結果 患者于VSD 治療后7 ～ 14 d 出現數分鐘內吸出大量血性液體，拆開VSD 敷料見創面新鮮肉芽組織少，動脈血管壁及移植血管糜爛、破潰出血。再次徹底清創止血后，7 例采用皮瓣或皮片修復后創面愈合；2 例截肢。 結論 VSD 治療嚴重軟組織損傷出現創面大量快速出血，與損傷嚴重程度及部位有關。對于伴主要血管、神經嚴重損傷的四肢，尤其關節周圍軟組織損傷慎用VSD 治療。

Excessive bleeding and reexploration after cardiac surgery is a simple and worth thinking about issue

The incidence of postoperative excessive bleeding and reexploration is relatively high, and it will bring a series of serious complications, such as an additional surgery, a longer intensive care unit stay, longer time on mechanical ventilation, an increase need of allogeneic blood product transfusions and increased mortality. However, the understanding of postoperative excessive bleeding and reexploration in China is significantly different from the international level, and the understanding of postoperative excessive bleeding and reexploration after cardiac surgery in clinical work is still not enough. This review will focus on some problems, such as related factors analysis of postoperative excessive bleeding, hemostatic process optimization and the serious complications of reexploration after cardiac surgery.

THE IMPORTANCE OF SURGICAL TREATMENT OF MASSIVE UPPER GASTROINTESTINAL HEMORRHAGE CAUSED BY ACUTE GASTRIC MUCOSAL LESIONS

From 1984 to 1994, 196 patients with massive upper gastrointestinal hemorrhage (hemorrhagic gastritis 137 cases, gastric ulcer 59 cases) caused by acute gastric mucosal lesions were treated in our hospital. As soon as the diagnosis was established, the stress factors in relation to acute gastric mucosal lesions and the factors damaging gastric mucosal barrier should he dispeled and hypovolemia should he corrected. In this group, the operative mortality were as follow: stress ulcer 6.3%, hemorrhagic gastritis 33.3%. According to this result, we consider that in cases of hemorrhagic gastritis the surgical operation must be considered with great care, but for stress ulcer with massive bleeding energetic surgical operation should be taken.

Uterine Artery Embolization in Treating Emergency Cesarean Scar Pregnancy Massive Bleeding

目的　探討急診行子宮動脈灌注藥物栓塞術治療剖宮產后切口妊娠的可行性和臨床價值。 方法　2009年10月－2011年12月，對17例臨床證實切口瘢痕妊娠并陰道出血患者，急診行雙側子宮動脈灌注甲氨蝶呤并超選擇栓塞術，術后通過觀察人絨毛膜促性腺激素（HCG）水平、陰道出血及術后清宮術來評價療效。 結果　17例患者急診行子宮動脈灌注栓塞術成功，術后陰道出血均停止或減少，HCG水平均明顯下降，3例因孕囊自行排除而未行清宮，14例術后2～4 d行胚胎鉗刮術，術中出血量較少。所有患者1周后均治愈出院。 結論　子宮動脈灌注栓塞術是治療剖宮產術后切口瘢痕妊娠的一種有效方法，可及時治療陰道大出血，促進殺胚，并為術后清宮提供安全保障。

右側胸腔巨大占位伴右全肺不張行右全肺切除術中大出血的圍手術期管理一例

EFFECT OF TRANSCATHETER ANGIOGRAPHIC EMBOLIZATION ON MASSIVE HAEMORRHAGE FROM LARGE WOUND DUE TO CRUSH SYNDROME AFTER WENCHUAN EARTHQUAKE

Objective To evaluate the safety and efficacy of transcatheter angiographic embol ization (AE) in the control of massive haemorrhage from large wound due to crush syndrome after Wenchuan earthquake. Methods From May 12 to May 26, 2008, 11 injured persons in Wenchuan earthquake with massive haemorrhage from large wound due to crush syndrome were treated, including 6 males and 5 females aged 16-36 years old (average 21 years old). All 19 wounds were infected.The hemorrhage was from the hip in 7 cases, the thigh stump in 3 cases, and the shoulder in 1 case. Six patients had hemorrhagic shock. All patients underwent arteriography to locate the bleeding artery, and transcatheter AE was performed according to the result of arteriography. Contrast-enhanced spiral CT scan and three-dimensional angiography were performed 48 hours after AE to evaluate leakage of contrast media and collapse of distal artery of embol ism site. Results Angiography for 11 injured persons after AE showed no occurrence of contrast media leakage, faint shadow to the distal branch artery of embol ic level, and significant increase of blood pressure of the bleeding artery, indicating the embol ization was successful. No active hemorrhage was evident in the wounds 48 hours after AE. For the 6 patients with hemorrhagic shock, obvious decrease of hemorrhage was observed after AE, gradual recovery of blood pressure and vital signs, and stabil ity of their condition were evident after supportive therapy. During the first 24 hours after AE, total volume of infusion was 6 750-19 600 mL (average 8 740 mL), and total volume of blood and plasma transfusion was 1 800-6 400 mL (average 3 500 mL). In 6 cases, contrast-enhanced spiral CT scan demonstrated faint shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography showed collapse of the distal artery; in the rest 5 cases, contrast-enhanced spiral CT scan demonstrated shadow of the distal artery without contrast media leakage, and three-dimensional CT angiography displayed the full-fill ing of distal artery with obviously decreased vascular cavity. No severe compl ications such as muscle necrosis in the buttock and hip, bladder necrosis,dysuria, fecal incontinence, and impotence occurred. Conclusion The transcatheter AE is a safe, fast, effective and miniinvasive method of controll ing massive haemorrhage from large wound caused by crush syndrome after Wenchuan earthquake.

The Clinical Analysis of 35 Patients with Late Postpartum Hemorrhage

摘要：目的：探討晚期產后大出血的發生原因，提出防治措施。方法：對我院1992年1月至2000年1月收治的晚期產后大出血36例病例進行回顧性分析。結果：晚期產后出血的原因依次為胎盤殘留、子宮復舊不全、切口裂開。結論：重視第三產程的處理，特別是對產時出血米索前列醇的應用，可有效預防大出血的發生。采用宮縮素及抗感染、清宮術等對癥治療可獲得滿意的治療效果，對嚴重急性出血者可行子宮切除術。

Clinical Analysis of Reoperative Treatment of Recurrent Massive Hemorrhage of the Upper Gastrointestinal after Gastrectomy （Report of 14 Cases）

目的 探討胃切除術后近期上消化道大出血的原因及再手術治療。 方法 對我院1986~2002年間收治的14例胃切除術后近期（24～72 h內）上消化道大出血行再手術治療的病例資料進行回顧性分析。 結果 本組14例，術后吻合口出血4例，殘胃粘膜損傷出血2例，殘胃腸套疊出血2例，十二指腸殘端出血1例，遺漏十二指腸球后潰瘍及賁門粘膜撕裂出血各1例，原因不明出血3例，均經再次手術治療后痊愈。 結論 胃切除術后近期上消化道大出血原因多為操作不當及病灶遺漏所致，出血灶直視下縫扎為有效止血方法。