Analysis And Prevention Of Postoperative Delayed Massive Hemorrhage Associated With Laparoscopic D2 Radical Gastrectomy

Research background;Radical laprascopic gastrectomy for gastric cancer involves more organs,complex steps,with a certain degree of difficulty for standard carrying out,there will inevitably be some complications after surgery.Bleeding is one of the most common complications of gastric cancer surgery,some patients with large bleeding and even lead to serious consequences.A part of the patients showed delayed hemorrhage,such patients progress rapidly,are difficult to deal with,so is often not timely diagnosis or improper handling,have high mortality.In recent years,laparoscopic gastric cancer surgery have attract more and more attention of the general surgeon for its good vision,small trauma,quick recovery and other advantages.Although its clinical anatomy,surgical approach,surgical techniques,processes and electrical energy equipment have made great progress,its operation has its unique characteristics,delayed hemorrhage is also the problems this operation should face.Therefore,it is necessary to summarize the common causes of delayed bleeding after gastric cancer and analyze the risk factors.Methods:The clinical data of 421 patients who underwent laparoscopic D2 radicalgastrectomy in the Provincial Hospital Affiliated Shandong University from June 2013 to June 2016 were retrospectively analyzed.according to the established criteria for hemorrhagic patients,12 cases of hemorrhage cases were retrospectively analyzed.The data of patients with massive hemorrhage after radical resection of laparoscopic radical gastrectomy were analyzed retrospectively.According to their auxiliary examination,treatment plan and treatment outcome,the possible causes and prevention methods were discussed.Results:12 cases of laparoscopic assisted gastric cancer in patients with delayed bleeding after radical resection,laparoscopic perforation in 1 case,intra-abdominal hemorrhage in 8 cases,anastomotic bleeding in 3 cases.Intra-abdominal hemorrhage can be divided into two types of early-onset bleeding and delayed bleeding,the former is mostly due to improper vascular processing,technology,the latter mostly postoperative anastomosis or residual leakage caused by vascular pseudoaneurysm rupture.Treatment include conservative treatment,surgical treatment,endoscopic or vascular interventional therapy.Of the 12 patients,3 underwent a second operation,5 were subjected to digital subtraction angiography(DSA)and transcathete arterial embolization(TAE)to stop hemorrhage.Endoscopic hemostasis was performed to stop hemorrhage in 1 case.Conservative treatment was administered to stop hemorrhage in 3 case.Intraperitoneal delayed bleeding can easily lead to hemorrhagic shock and even death under improper treatment as large amount of bleeding,rapid deterioration of the disease,digital subtraction angiography(DSA)+ transcatheter arterial embolization(TAE)is the best treatment.Conclusion:1?Postoperative delayed massive hemorrhage is an important complication of D2 radical laprascopic gastrectomy for gastric cancer,mainly including puncture hole bleeding,intra-abdominal bleeding,anastomotic bleeding,different types of predisposing factors are different,we should pay attention to analysis and prevention.2?Puncture hole bleeding is mostly caused by epigastric arteries injury,light-guided puncture and the exact closure of the whole layer are the key to prevention.3?Intra-abdominal hemorrhage is divided into early-onset bleeding and delayed bleeding,early onset of bleeding is caused by improper vascular surgery;delayed bleeding is mostly caused by rupture of vascular pseudoaneurysm,the disease progress rapidly,mortality highly.Digital subtraction angiograff(DSA)+transcatheter arterial embolization(TAE)are the best treatment.4?With the development of anastomosis and anastomosis of the device,the incidence of anastomotic bleeding has been significantly reduced.We should be familiar with the characteristics of laparoscopic anastomosis.Postoperative routine application of proton pump inhibitors can reduce the risk of anastomotic stress ulcer bleeding,as the operative injury and body stress of laparoscopic surgery for gastric cancer is small.