直肠癌根治术骶前静脉大出血的原因及处理对策

The causes and managed strategy of massive presacral hemorrhage during radical operation of rectal cancer

目的探讨直肠癌根治术中骶前大出血的原因及纱布填塞压迫法治疗骶前大出血的临床应用价值。方法对我院2001年1月-2006年9月的直肠癌患者术中发生的5例骶前静脉大出血的原因及纱布填塞法压迫止血治疗的经验进行回顾性分析。结果本组患者1例因用手指分离至骶尾部时撕破骶前筋膜致骶前静脉破裂出血,2例为未进入正常解剖层次盲目钝性分离骶前筋膜而引起出血,2例因术中骶前静脉出血处理不当致大出血,均使用纱布填塞压迫法后很快止血成功,顺利完成手术。术后72小时去除纱布,无再次继发性出血发生,患者恢复好,随访无不良反应。结论直肠癌根治术中未能掌握正确的解剖层次或操作方法失当是骶前静脉丛大出血主要原因,纱布填塞压迫止血是处理骶前静脉破裂大出血可靠的方法。

Objective To study the causes and the experience of packing hemostasis by gauze compression measurement for severe presacral hemorrhage during radical operation of rectal cancer. Methods From Jan.2001 to Sep.2006,5 cases of causes of massive presacral hemorrhage during radical operation of rectal cancer and experiences of packing hemostasis with gauze compression management were analyzed retrospectively. Results All patients were successful to packing hemostasis with gauze compression measurement for massive presacral hemorrhage during operation. No recurrent presacral hemorrhage was occurred after removing gauze. No side effects were found during follow-up period. Conclusion The main cause of massive bleeding of presacral venous plexus is not correct control of anatomical layer or improper surgical manipulation during radical operation of rectal cancer. Hemostasis of gauze tamponade is a reliable hemostatic method for the treatment of massive bleeding of presacral venous rupture.