腹腔镜结直肠癌手术中出血原因及对策

Cause and management of hemorrhage during laparoscopic colorectal cancer surgery

腹腔镜根治手术在结直肠癌的治疗中的地位举足轻重。术中出血是一直是结直肠外科医生面临的难题之一。腹腔镜手术出血原因主要包括:解剖层次的识别错误、血管解剖的变异、腹腔镜下操作不当、消化道重建时引起吻合口出血、trocar穿刺出血以及病人自身原因等。腹腔镜结直肠癌手术术中出血重在预防。术前设计手术方案时应评估血管解剖走行以及预期解剖层次显露难度。术中应精细解剖,每一步均行预止血处理。若术中不幸发生出血,应尽可能暴露出血位置,应用能量器械、结扎血管夹、缝扎以及纱布压迫止血,腹腔镜下止血效果不佳或止血困难时,应及时中转开放手术。

Laparoscopic radical resection plays an important role in the treatment of colorectal cancer,while intraoperative bleeding is one of the difficult problems for colorectal surgeons.The causes of hemorrhage in laparoscopic surgery mainly include misidentification of anatomical planes,variation of vascular anatomy,improper operation under laparoscopy,anastomotic bleeding caused by digestive tract reconstruction,trocar puncture,and patient’s personal factors.The prevention of intraoperative bleeding in laparoscopic colorectal cancer surgery is important.The vascular anatomy and the difficulty of exposure of anatomical planes should be evaluated when surgical plan is designed before operation.In addition,meticulous dissection should be performed during the operation,and the treatment to prevent bleeding should be done at every step.If bleeding occurs during the operation,the bleeding location should be exposed as soon as possible,and energy instruments,vascular clip ligation,suture and gauze compression should be applied for hemostasis.It should be converted to laparotomy in time when the hemostasis is poor or difficult under laparoscopy.