Objective:To investigate the clinical feature of acute massive hemorrhage from gastric cancer and evaluate the methods of diagnosis and management. Methods: Retrospective analysis was made from 82 patients who experienced acute massive upper gastrointestinal bleeding from advanced gastric cancer. Their history, pathologic types, manifestations and outcomes after management were reviewed. Results: Patients suffered from Borrmann Ⅱ and Ⅲ of stomach carcinoma accounted for the majority of this cohort. Most of the bleeding sites came from the upper part of lesser curvature of the stomach. The volume of blood loss could be up to 1000 ml. The frequent presentation was vomiting with blood, tar-like stool and even shock. Conclusions: For most of patients bleeding can be arrested and stabilized by hemostatics, therefore allow careful examination and preparation for radical gastrectomy.Generally, upper gastrointestinal barium X-ray examination and endoscopy are the reliable means to detect lesion.Surgery is the preferred treatment.%目的通过对82例胃癌并发大出血的病人进行临床分析,观察其临床特点,探讨改进诊治方法.方法分析82例胃癌并急性大出血病人的病史,临床表现,病理分型,治疗方法和治疗效果.结果胃癌并发急性大出血大部分病例发生在进展期胃癌BorrmannⅡ、Ⅲ型,少数病例发生于进展期胃癌BorrmannⅣ型及早期胃癌Ⅱc、Ⅲ型,而且大部分病灶位于胃体中上部小弯侧的前后壁.24 h出血量可达1000ml以上.临床特点主要表现呕血,排柏油样大便或暗红色便,半数病例出现呕血+排柏油样大便并伴有休克征象.结论胃癌并发急性大出血病人,大部分经保守治疗可使病情稳定或止血.少数出血严重病人经保守治疗无效需直接手术治疗.钡餐及纤维胃镜检查仍是基层医院可靠的诊断手段,手术是首选的治疗方法.
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