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目的总结分析胃癌根治术后30 d内非计划再手术原因和预防措施。方法回顾性分析2012年1月至2015年6月复旦大学附属中山医院普外科收治的行胃癌根治术的4587例病人的临床资料,其中术后30 d内非计划再手术病人26例,总结其临床治疗经验。结果胃癌根治术后30 d内非计划再手术26例病人中,腹腔出血11例(42.3%);吻合口相关并发症10例(38.5%),其中吻合口漏6例,吻合口梗阻1例,十二指肠残端漏3例;切口裂开5例(19.2%)。25例(96.2%)病人经再手术治疗后顺利出院,1例(3.8%)吻合口漏病人再手术后因多器官功能衰竭死亡。结论胃癌根治术后非计划再手术的原因主要包括腹腔出血、吻合口漏、吻合口梗阻、十二指肠残端漏以及切口裂开;规范精细的手术操作和合理有效的围手术期支持是减少胃癌根治术后非计划再手术的关键。
Objective To summarize the causes and preventive measures of unplanned reoperation within 30 days after radical operation of gastric cancer. Methods The clinical data of 4587 patients undergoing radical gastrectomy from January 2012 to June 2015 at Zhongshan Hospital Affiliated to Fudan University were retrospectively analyzed. Among them, 26 patients underwent unplanned reoperation within 30 days after operation, Clinical experience. Results Among the 26 patients who underwent unplanned reoperation within 30 days after radical operation of gastric cancer, 11 cases (42.3%) had intraperitoneal hemorrhage and 10 cases (38.5%) had anastomotic complications, including 6 cases of anastomotic leakage and 1 case of anastomotic obstruction , 3 cases of duodenal leakage; incision open in 5 cases (19.2%). Twenty-five patients (96.2%) were discharged after reoperation. One patient (3.8%) with anastomotic leakage died of multiple organ failure after reoperation. Conclusions The causes of unplanned reoperation after radical gastrectomy include intraperitoneal hemorrhage, anastomotic leakage, anastomotic obstruction, duodenal stump leakage and incision rupture. The standard fine operation and rational and effective perioperative support are Reduce the key to unplanned reoperation after radical operation of gastric cancer.