腹腔镜穿刺孔大出血的预防和处理（附五例报告）

Prevention and management of massive trocar puncture hole hemorrhage after laparoscopic operation： a report of 5 cases

目的探讨腹腔镜手术后穿刺孔大出血的预防和处理。方法回顾性分析我院2000年5月至2013年8月间5例腹腔镜手术后穿刺孔大出血的病例资料。结果5例病人术后出血量500-1200ml，均经再次腹腔镜探查手术，最后确诊为腹壁穿刺孔出血，除1例肝硬化门脉高压病人为脐部交通静脉损伤出血外，其余4例均为腹壁肌层或腹膜外动脉损伤出血；并在腹腔镜直视下穿刺孔部位重新缝合止血，均治愈。结论腹腔镜手术中重视穿刺孔出血是防止术后腹腔大出血的重要原因。

Objective To explore the prevention and treatment of massive trocar puncture hole hemorrhage after laparoscopic operations. Methods Five cases of massive trocar puncture hole hemor- rhage after laparoscopic operation from May 2000 to August 2013 were analyzed retrospectively. Re- suits The bleeding volume ranged from 500-1,200 ml. The bleeding sources were umbilical communi- cating vein of cirrotic portal hypertension （n = 1） and abdominal wall muscular or extra-pritoneal artery （n = 4）. Under direct laparroscopic vision, bleeding was arrested with suturing. Conclusions Proper control of trocar puncture hole hemorrhage is essential for preventing massive intraabdominal hemor- rhage after laparoscopic operations.