目的 探讨脾切除术后再出血的原因及诊治方法并总结其预防措施。方法 对我院1998年8月至2009年3月收治的11例脾切除术后再出血患者的临床资料进行回顾性分析。结果 本组11例再出血患者均行急诊再手术治疗，10例治愈,无术后并发症，恢复顺利，切口愈合良好，均拆线出院，术后住院10～21 d（平均15 d）； 余1例外伤性脾破裂者术中探查为胃短动脉破裂出血，遂结扎胃短动脉，术后发生胃瘘，经禁食、静脉营养等治疗，效果差，于术后20 d死亡。结论 脾切除术后再出血原因较多，以胃短血管处理不当、脾蒂血管结扎线脱落、胰尾部血管损伤及患者凝血功能障碍为主。脾切除术后出血以预防为主，术前充分做好各项准备，术中止血彻底，术后特别是术后24 h内严密观察腹腔引流液的量、性质及速度。再出血后果严重，一旦发生，应及时准确诊断，行急诊再手术治疗。
目的:探讨住院期间自发性蛛网膜下腔出血患者再出血的相关因素和对策。方法:对42例自发性蛛网膜下腔出血患者住院期间引起再出血的各种相关因素进行分析。结果: 再出血危险因素:34例持续高血压,14例情绪激动,7例下床排便用力,6例剧烈活动,7例睡眠不佳烦燥后出血,4例再出血发生在术前8小时, 4例患者在腰穿时出血。结论: 自发性蛛网膜下腔出血患者住院时高血压和和各种引起血压升高的诱因是引起再出血最主要原因．同时出血时间间隔和住院期间不适当的腰穿也是引起再出血的重要原因。
Objective To explore the causes and treatment of rebleeding after operation on portal hypertension patients. Methods The clinical data of 41 rebleeding cases underwent the operational between January 2000 and December 2009 in Peking Union Medical College Hospital were retrospectively analyzed. Results All 13 cases who got rebleeding after shunt operation received lienectomy, but for those who got rebleeding after lienectomy, 23 patients received Phemister or modified Phemister or expanded lienectomy and 5 patients received shunt operation. Surgical related complications occurred in 7 cases (17.1%) at 2 weeks after operation, including abdominal bleeding (3 cases), gastrointestinal bleeding (2 cases), and intractable ascites (2 cases). After the follow-up of 3-60 months (mean 39 months), all patients were still alive. During the follow-up, 3 cases of recurrent esophageal varices were observed and one of them got rebleeding.Conclusion The majority of rebleeding after lienectomy tend to be ascribed to the wrong operations chose, while bad operation skill often contribute to the rebleeding after shunt operation, suggesting ideal therapeutic effect for rebleeding can benefit from appropriate operation choose.
目的 探讨门静脉高压症断流术后上消化道再出血的原因及防治措施。方法 对近8年解放军第302医院肝胆外科收治的因门静脉高压症行脾切除、贲门周围血管离断术后发生上消化道再出血的15例患者的临床资料进行回顾性分析。结果 15例术后消化道再次出血患者中，因急性胃黏膜病变出血9例，残留食管胃底曲张静脉再次破裂大出血5例，围手术期门静脉、脾静脉及肠系膜上静脉血栓形成并呕血1例。围手术期再出血并死亡2例，通过保守或手术治疗治愈13例。结论 断流术是治疗门静脉高压症引起上消化道大出血的良好术式，术后再出血是断流术后常见并发症之一，完善的手术操作、适时祛聚抗凝减少门静脉系统血栓形成可减少断流术后再出血的发生或减轻其症状
ObjectiveTo analyze risk factors of rebleeding after laparoscopic selective pericardial devascularization combined with splenectomy.MethodsThe clinical data of 147 cases of portal hypertension treated by the laparoscopic selective devascularization combined with splenectomy from February 2014 to September 2018 were retrospectively analyzed. The univariate analysis was used to find the difference between the rebleeding group (n=20) and the non-bleeding group (n=127), then the multivariate logistic regression analysis was selected for screening out the most closely related risk factors for the rebleeding.ResultsThe rebleeding occurred in 20 of 147 patients (13.6%). There were differences in the platelet count, prothrombin time, serum albumin, diameter of main portal vein, classification of liver function, ascites, hepatic encephalopathy, and portal hypertensive gastropathy between the rebleeding group and the non-bleeding group (P<0.050). The classification of liver function ［OR=3.444, 95% CI (1.211. 9.793）, P=0.020］, ascites ［OR=2.859, 95% CI (1.069, 7.645), P=0.036］, hepatic encephalopathy ［OR=4.265, 95% CI（1.121, 16.230）, P=0.033］, and portal hypertensive gastropathy ［OR=6.744, 95% CI (1.675, 27.156), P=0.007］, and platelet count ［OR=4.744, 95% CI (1.073, 20.969), P=0.040］ were the independent factors for the postoperative rebleeding by the logistic regression analysis.ConclusionFor patients with risk factors of rebleeding, preoperative treatment should be actively taken and postoperative prevention of rebleeding should be highly vigilant.