72 Cases Of Non-variceal Upper Gastrointestinal Bleeding In Clinical Analysis

In the past 20 years, non-variceal upper gastrointestinal bleeding in surgical treatment of steady decline. Widespread use of acid suppression drugs and improved treatment of Helicobacter pylori infection is the key to reducing surgical treatment. The introduction of endoscopic hemostasis and wide application, greatly reducing the need for emergency surgery to stop bleeding and improve the mortality and morbidity in patients. Full stomach or gastrectomy, supplemented by gastric vagotomy has been successfully applied in the past treatment of non-variceal upper gastrointestinal bleeding, but a stomach ulcer anastomotic complications after resection, and these ulcers bleeding is a dangerous complication. Although the rising level of medical care, non-variceal upper gastrointestinal bleeding in surgical treatment decreased significantly, but still showed high morbidity and mortality, only about 2% of patients need surgical treatment, how to master surgical indications requires further Discussion. In general, surgical treatment for patients whose disease is often more severe than non-surgical patients, indication for surgery is usually based on the diameter of ulcer, suspected cancer, recurrent bleeding, shock symptoms and by the failure of medical treatment and other factors. According to our country, patients with chronic bleeding for a long time, visiting time later, the long-term consumption of poor nutritional status due to the clinical features, timely and safe treatment modality is crucial. This paper aims to study non-variceal upper gastrointestinal bleeding surgical indications and results.Gastrointestinal surgery in our hospital from January 2007 to December 2010 treatment of non-variceal upper gastrointestinal bleeding in patients studied 72 cases, of which 31 patients underwent surgery, and non-surgical treatment of 41 patients in the etiology, bleeding sites, surgical factors, the timing and manner of selection and treatment were analyzed.Causes of bleeding in the surgical group were 16 cases of peptic ulcer (51.6%), gastric cancer in 10 cases (32.3%), anastomotic ulcer in 4 cases (12.9%), stromal tumor in 1 case (3.3%); non-surgical group peptic ulcer 28 cases (68.3%), Dieulafoy disease in 4 cases (9.8%), anastomotic ulcer in 3 cases (7.3%), Mallory-Weiss 3 cases (7.3%). Bleeding site, the 22 cases of stomach surgery group (71.0%), including 2 cases of gastric body and cardia (6.5%), gastric body in 5 cases (16.1%), gastric in 15 cases (48.4%),6 cases of duodenal (19.4%), anastomotic 3 cases (9.7%), while the lesser curvature gastric ulcer in 15 cases (48.4%), duodenal posterior wall in 3 cases (9.7%),25 cases of gastric non-surgical group (61.0%), of which 11 cases of gastric body and cardia (26.8%), gastric body in 3 cases (7.3%), gastric in 11 cases (26.8%), duodenum in 12 cases (29.4%), anastomotic 4 cases (9.8%), while the lesser curvature of gastric ulcers in 12 patients (29.4%), posterior wall of duodenal bulb in 4 cases (9.8%). Line after endoscopy, peptic ulcer surgery group diameter> 1cm 21 cases (67.7%), ulcers or highly suspected cancer in 12 patients (38.7%), non-surgical group of peptic ulcer diameter> 1cm 2 cases (4.9%), ulcers, cancer, or highly suspected in 2 cases (4.9%), compared the two groups was statistically significant (P<0.05).The amount of bleeding, the surgery group 12 patients with mild bleeding (38.7%), moderate bleeding in 18 cases (58.1%), severe bleeding in 1 case (3.2%), non-surgical group with mild bleeding in 19 patients (46.7%), moderate bleeding in 19 patients (46.7%), severe bleeding in 3 cases (7.3%), the two groups had no significant amount of bleeding (P> 0.05). Other factors including age, rebleeding, endoscopic shows jet-like bleeding, shock symptoms and medical treatment fails, surgical group and non-surgical group, no statistical significance (P> 0.05). Surgery patients according to clinical manifestations and supporting test results, surgical methods in the surgery decision.And based on the nature of ulcers, surgical decisions:a benign ulcer disease 14 cases, the line gastrectomy (BillrothⅡ) 13 cases,1 case of ulcer lesion excision; Ulcers in patients with cancer or highly suspected 12 cases of benign ulcer disease in 2 cases, distal gastric cancer surgery in 9 cases, palliative resection of gastric cancer in 3 cases. Line partial excision of the remnant stomach, gastrointestinal anastomosis in 3 cases (9.5%), remnant stomach incision suture hemostasis was performed in 1 case.1 case diagnosed as duodenal stromal tumor patients with pancreatic head duodenectomy. Operation group after treatment during hospitalization in patients with no rebleeding, complications in 6 cases (pneumonia in 2 cases, ascites in 4 cases), multiple organ failure in 1 case (3.2%),1 patient died (3.2%).Non-surgical group was bleeding in 2 cases, complications in 3 cases (pneumonia in 3 cases), no death. Complications of surgical group and non-operated group was not significant (P> 0.05). Hospital stay surgery group (19.1±10.1) was significantly higher than non-surgical group (6.4±2.8), two groups were statistically significant (P<0.001). Conclusion:1, surgical treatment of non-variceal upper gastrointestinal bleeding in patients with peptic ulcer disease causes are mainly bleeding site more in the antrum.2, Peptic ulcer diameter> 1cm, and ulcers or highly suspected cancer who are absolute indications for surgery, blood loss was not as an absolute indication for surgery. 3, Non-variceal upper gastrointestinal bleeding preferred surgical gastrectomy.4, Control non-variceal upper gastrointestinal bleeding indications for surgery can effectively prevent the occurrence of rebleeding and mortality.