直肠癌根治术中骶前静脉大出血的处理  

Management of Presacral Vein Massive Hemorrhage During Rectal Cancer Surgery

作　　者：温文鸿 巴明臣[2] 黄祥成[2] 卿三华[2] 闻英[2] 李国新[2] 

机构地区：[1]广东省东莞市谢岗医院,广东东莞523590 [2]南方医科大学南方医院,广东广州510515

出　　处：《肿瘤学杂志》2005年第6期414-415,共2页Journal of Chinese Oncology

摘　　要：[目的]探讨直肠癌根治术中骶前静脉大出血的原因及纱布填塞压迫法的止血效果。[方法]5例直肠癌患者中3例(1例Miles术、2例Dixon术)因术中解剖层次错误、游离直肠后壁时撕裂骶前静脉引起的大出血,2例因Dixon术中骶前静脉渗血处理不当撕裂骶前静脉引起的大出血,使用纱布填塞压迫法止血。[结果]5例患者均成功止血,顺利完成手术,术后72h去除纱布,无再次继发性出血发生,患者恢复好,随访无不良反应发生。[结论]直肠癌根治术中未掌握正确的解剖层次或骶前渗血处理不当是骶前静脉大出血主要原因;纱布填塞压迫法仍然是目前直肠癌根治术中骶前静脉大出血的最有效方法。[Purpose]To investigate the reasons and management of presacral vein massive hemorrhage during rectal cancer surgery and the effect of gauze compression packing hemostasis. [Methods] Five rectal cancer patients with presacral vein massive hemorrhage underwent packing hemostasis by gauze compression method. Among them, 3 cases （1 cases with Miles operation and 2 cases with Dixon operation） were due to lacerating presacral fascia during dissecting the presacral tissues for improper anatomic layer; 2 cases were due to lacerating presacral veins plexus leading to severe presacral hemorrhage for improper management of presacral vein oozing of blood during Dixon operation. [Results] Five patients were successfully packing hemostasis by gauze compression and completed operations. No recurrent presacral hemorrhage occurred after drawing off compression gauze 72 hours later. All patients had a rather better restoration postoperation. No side effects occurred during the follow-up. [Conclusion] Manipulation with improper anatomic layer or improper management of presacral vein oozing of blood are the main reasons of severe presacral vein hemorrhage during rectal cancer surgery. The packing hemostasis by gauze compression method is still the most effective method for patients with severe presacral vein hemorrhage during rectal cancer surgery.

关 键 词：直肠肿瘤 骶尾部 静脉 失血 手术 止血 手术 

分 类 号：R735.37[医药卫生—肿瘤]