腹腔镜右半结肠手术中出血及对策

Intraoperative bleeding and its countermeasures during laparoscopic right hemicolon surgery

基于完整结肠系膜切除理念的腹腔镜右半结肠手术已成为治疗右半结肠肿瘤的主流术式。由于右半结肠血管变异较多,解剖复杂,容易造成手术出血。控制出血的关键在于预防,掌握正确的解剖结构、熟悉常见的血管变异、明确正确的手术层次、避免暴力操作是预防出血的关键。一旦发生出血,可采用吸引等手段保证术野清晰。对于小血管出血或渗血,可采用电凝、压迫等方法止血,若主干血管出血时应缝合、使用补片或及时中转开放手术。术前完善影像学检查可提供病人血管走行的直观数据,减少出血风险。

Based on the concept of complete mesocolic excision,laparoscopic right hemicolectomy has become the mainstream procedure for the treatment of right colon tumor.However,due to many vascular variations in the right colon and complexity in anatomy,it is easy to cause bleeding during operation.The key to control bleeding lies in prevention,and it is the key to prevent bleeding by mastering the correct anatomical structure,familiarizing with common vascular variation,defining the correct surgical level and avoiding violent operation.Once bleeding occurs,suction and other means can be used to ensure clear surgical field.For small blood vessels bleeding or oozing,electrocoagulation,compression and other methods can be used to stop bleeding.If the main blood vessel is bleeding,it should be sutured,patch should be used or converted to laparotomy in time.Perfect preoperative imaging examination can provide intuitive data related to vascular pathway of patients and reduce the risk of bleeding.