盆底重建手术出血及血肿并发症的评估与处理

Evaluation and management of bleeding and hematoma complications in pelvic floor reconstruction surgery

盆底重建手术是盆腔器官脱垂(pelvic organ prolapse,POP)患者手术治疗的主要方法。盆底重建手术通过悬吊和修补松弛的组织,采用符合盆底形状的网片修补、加强、重建盆底组织,以达到恢复解剖、重建盆底功能的目的。由于盆底血管解剖复杂且术中需要进行盲穿操作,故在分离组织间隙或穿刺器引导植入网片过程中极易引起出血或隐匿性出血,后者常形成血肿。文章就盆底重建手术的特点以及出血相关的解剖知识进行总结,并阐述了手术出血和血肿形成的相关因素及防治措施。

Pelvic floor reconstruction is the main surgical approach for the treatment of female pelvic organ prolapse(POP).The procedure involves suspending and repairing lax tissues,as well as using mesh that conforms to the shape of the pelvic floor to repair,strengthen,and rebuild the pelvic floor tissues,in order to restore anatomy and reconstruct pelvic floor function.Owing to the complex pelvic floor vascular anatomy and the need for blind puncture operations,bleeding or occult bleeding is very likely ot occur during tissue gap separation or puncture device-guided mesh placement,and the latter often leads to hematoma formation.This article summarizes the characteristics of pelvic floor reconstruction surgery and anatomical knowledge related to bleeding,and describes factors associated with surgical hemorrhage and hematoma formation,as well as preventive and curative measures.