切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 224 -227. doi: 10.3877/cma.j.issn.1674-3946.2021.02.029

所属专题: 文献

综述

胃癌合并急性消化道大出血的处理和手术策略探讨
束翌俊1, 杨自逸1, 刘颖斌2, 董平1,()   
  1. 1. 200092 上海交通大学医学院附属新华医院普外科 上海市胆道疾病研究中心 上海交通大学医学院胆道疾病研究所
    2. 上海交通大学医学院附属仁济医院普外科
  • 收稿日期:2020-07-08 出版日期:2021-04-26
  • 通信作者: 董平

Discussion on Surgical treatment of gastric cancer with acute gastrointestinal hemorrhage

Yijun Shu1, Ziyi Yang1, Yinbin Liu2, Ping Dong1,()   

  1. 1. Department of General Surgery and Laboratory of General Surgery, Xinhua Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Received:2020-07-08 Published:2021-04-26
  • Corresponding author: Ping Dong
  • Supported by:
    National Natural Science Foundation of China(31701108); The Shanghai 'Rising Stars of Medical Talent’ Youth Development Program(Youth Medical Talents 2019 No.72)
引用本文:

束翌俊, 杨自逸, 刘颖斌, 董平. 胃癌合并急性消化道大出血的处理和手术策略探讨[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(02): 224-227.

Yijun Shu, Ziyi Yang, Yinbin Liu, Ping Dong. Discussion on Surgical treatment of gastric cancer with acute gastrointestinal hemorrhage[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(02): 224-227.

胃癌合并急性消化道大出血是进展期胃癌的危重急症之一。术前应在保证患者生命体征的情况下经消化内科、外科、药学、放射介入科和重症医学科等多学科会诊全面评估肿瘤分期和可切除性。内镜检查是胃癌合并急性大出血的主要确诊手段及重要治疗方式。外科手术是非手术疗法效果不佳或失败后的唯一补救方法,手术方式应根据肿瘤位置,分期适当选择,联合多脏器切除的扩大根治术对患者的收益值得进一步探索和积累经验。

Gastric cancer with acute hemorrhage is one of the criticalhallenging emergency of advanced gastric cancer. Preoperative Tumor staging and resectability should be fully evaluated by mMulti-disciplinary discussions including Gastroenterology, Surgery, Pharmacy, Radiological Intervention and Intensive care Medicine before surgery should be conducted to comprehensively evaluate tumor staging and resectability under the condition of ensuring the patient's vital signs.to ensure the patient's vital signs. Endoscopy is effective in diagnosing and treating of gastric cancer with acute massive hemorrhage. Surgical surgery is the only remedy for poor or failed non-surgical therapy, and Some patients required surgical treatment when it was impossible to achieve hemostasis by pharmacotherapy and endoscopy or if rebleeding occurred where the conservative treatment had failed, surgical treatment should be appropriate selected base on the location of tumor and staging. The benefits of extended radical mastectomy combined with multiple organ resection are worth further exploration and experience.

图1 胃癌合并急性消化道大出血的处理流程图
[1]
Francisca CF. Management of Acute Gastrointestinal Bleed[J]. Crit Care Nurs Clin North Am, 2018, 30(1): 55-66.
[2]
Meehan T, Stecker MS, Kalva SP, et al. Outcomes of transcatheter arterial embolization for acute hemorrhage originating from gastric adenocarcinom[J]. J Vasc Interv Radiol, 2014, 25(6): 847-851.
[3]
陈军,林言箴. 胃癌合并急性大出血的诊治经验[J]. 中国实用外科杂志,2005,25(7):394-396.
[4]
田丹,魏捷,晏晨,等. 以多学科协作为导向的重症上消化道大出血的急诊综合治疗[J]. 临床急诊杂志,2019,20(2):136-138.
[5]
Hao YP, Han L, Shen ZP, et al. Comparison of therapeutic effect on endoscopic metal clips and conservative drugs for the treatment of upper gastrointestinal bleeding[J]. J Mod Med Health, 2017, 33(20): 3106-3108.
[6]
《中华内科杂志》编辑部, 《中华医学杂志》编辑部, 《中华消化杂志》编辑部, 等. 急性非静脉曲张性上消化道出血诊治指南(2018年,杭州)[J]. 中华消化杂志, 2019, 39(2): 80-87.
[7]
徐美东,初元. 早期胃癌内镜治疗并发症特点及处理[J]. 中国实用外科杂志,2017,37(4):377-382.
[8]
Klingbeil KD, Balaban A, Fertig R, et al. Inflammatory fibroid polyp of the gastric antrum presenting as hypovolemic shock: Case report and literature review[J]. Intractable Rare Dis Res, 2017, 6(4): 304-309.
[9]
Obleaga CV, Vere CC, Patrascu AM, et al. Severe upper gastrointestinal bleeding determined by a gastric lymphoma associated with Helicobacter pylori-positive atrophic gastritis[J]. Rom J Morphol Embryol, 2017, 58(2): 611-617.
[10]
Kim YI, Choil J. Endoscopic management of tumor bleeding from inoperable gastric cancer[J]. Clin Endosc, 2015, 48(2): 121-127.
[11]
Barkun AN, Almadi M, Kuipers EJ, et al. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations from the International Consensus Group[J]. Ann Intern Med, 2019, 171(11): 805-822.
[12]
何裕隆. 胃癌联合脏器切除规范化实施若干问题[J]. 中国实用外科杂志,2014,34(7):624-627.
[13]
刘健,刘彤. 腹腔镜胃癌根治术联合脏器切除原则的疗效评价[J/CD]. 中华普外科手术学杂志(电子版),2018,12(2):103-106.
[14]
Steiner E, Breuer R, Kazianka L, et al. Gastric emptying and distal gastrectomy independently enhance postprandial glucagon-like peptide-1 release after a mixed meal and improve glycemic control in subjects having undergone pancreaticoduodenectomy[J]. Pancreas, 2019, 48(7): 953-957.
[15]
Li Z, Lian B, Chen J, et al. Systematic review and meta-analysis of splenectomy in gastrectomy for gastric carcinoma[J]. Int J Surg, 2019, 68: 104-113.
[16]
Watanabe M, Kinoshita T, Tokunaga M, et al. Complicaions and their correlation with prognosis in patients undergoing total gastrectomy with splenectomy for treatmeny of proximal advanced gstric cancer[J]. Eur J Surg Oncol, 2018, 44(8): 1181-1185.
[17]
Grassia R, Capone P, Iiritano E, et al. Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified Cyanoacrylate[J]. World J Gastroenterol, 2016, 22(48): 10609-10616.
[18]
Xiao C-J, Yu X-X, Wu K, et al. Transcatheter embolotherapy for acute gastrointestestinal hemorrhage: A clinical analysis of 52 cases[J]. J Intervent Radiol, 2013, 22(10): 860-862.
[19]
Cho SB, Hur S, Kim H-C, et al. Transcatheter Arterial Embolization for Advanced Gastric Cancer Bleeding: A Single-Center Experience with 58 patients[J]. Medicine(Baltimore), 2020, 99(15): e19630.
[20]
Tarasconi A, Baiocchi GL, Pattonieri V, et al. Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis[J]. World J Emerg Surg, 2019, 14: 3.
[21]
Wang L, Wang X-A, Hao J-Q, et al. Long-term outcomes after radical gastrectomy in gastric cancer patients with overt bleeding[J]. World J Gastroenterol, 2015, 21(47): 13316-13324.
[22]
季加孚,王宇宸,肖琪严. 中国胃癌腹腔镜手术临床研究现状[J/CD]. 中华普外科手术学杂志(电子版),2019,13(2):109-113.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[3] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[4] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[5] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[6] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[7] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[8] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[9] 孙莲, 马红萍, 吴文英. 局部进展期甲状腺癌患者外科处理[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 112-114.
[10] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[11] 刘海旺, 施海, 尚利峰. 不同吻合器在腹腔镜远端胃癌根治术Roux-en-Y式吻合中的应用对比[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 643-646.
[12] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[13] 刘卓, 张宗明, 张翀, 刘立民, 赵月, 齐晖. 腹腔镜手术治疗高龄急性梗阻性化脓性胆管炎患者的安全性与术式选择[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 795-800.
[14] 杭轶, 杨小勇, 李文美, 薛磊. 可控性低中心静脉压技术在肝切除术中应用的最适中心静脉压[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 813-817.
[15] 董晟, 郎胜坤, 葛新, 孙少君, 薛明宇. 反向休克指数乘以格拉斯哥昏迷评分对老年严重创伤患者发生急性创伤性凝血功能障碍的预测价值[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 541-547.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?