腹手术后重大术后出血的临床管理
Lars Kollmann1, Maximilian Gruber1, Johan F Lock1
1Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital Wuerzburg, Würzburg, Germany.
Obesity surgery
|January 20, 2024
概括
大型术后出血 (mPOB) 是一种常见的减肥手术并发症. 治疗策略因手术类型而异,在袖子胃切除术 (SG) 后出现严重出血,首先建议手术,而胃绕道 (GB) 出血可能首先受益于内镜检查.
科学领域:
- 腹部外科手术的结果
- 胃肠道并发症 胃肠道并发症
- 外科手术患者管理
背景情况:
- 大型术后出血 (mPOB) 是减肥手术后最常见的并发症.
- 流血的严重程度从轻微到危及生命的,需要建立管理协议.
研究的目的:
- 分析减肥手术后重大术后出血 (mPOB) 的发生率和特征.
- 为了比较胃绕道 (GB) 和袖子胃切除术 (SG) 程序之间的mPOB.
- 评估与mPOB相关的因素,并提出量身定制的治疗方法.
主要方法:
- 对前性收集的减肥患者数据库 (2012-2022) 的回顾性分析.
- mPOB的定义:血红蛋白下降>2g/dL或需要干预的临床显著出血.
- 对二次终点的评估,包括克拉维恩-丁多分类和综合复杂性指数 (CCI).
主要成果:
- 在1017名患者中 (667 GB, 350 SG),3.8%的患者经历了mPOB.
- mPOB与2型糖尿病,慢性功能衰竭和抗血小板使用有关.
- 出血的特征有所不同:GB后的光线 (61.3%),SG后的腹腔 (100%);SG后的重复手术更高 (75%).
结论:
- mPOB的临床表现依赖于手术,SG与更严重的出血有关.
- 在SG之后的mPOB建议采用"手术第一"的方法.
- 建议在GB之后对mPOB进行"内镜检查"的方法.
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