带蒂大网膜集束式缝扎控制盆腔手术中骶前静脉出血  

Cluster ligature and tamponade of pedicled greater omentum in the control of presaeral venous hemorrhage during pelvic surgery

作　　者：王刚成[1] 韩广森[1] 任莹坤[1] 刘英俊[1] 程勇[1] 张健[1] 赵玉洲[1] 徐勇超[1] 鲁朝敏[1] 

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)普通外科,河南450008

出　　处：《中华普通外科杂志》2013年第5期386-388,共3页Chinese Journal of General Surgery

摘　　要：目的探讨联合带蒂大网膜集束式缝合技术对骶前静脉丛出血的止血效果。方法回顾性分析12例骶前术操作过程中骶前出血患者的临床资料，其中男8例，女4例，年龄45-82岁，中位年龄（68±11）岁。12例患者中，6例为直肠癌；2例为骶前畸胎瘤；3例为子宫肉瘤术后复发；1例盆腔恶性神经鞘瘤。12例患者均采用联合带蒂大网膜集束式缝合控制骶前出血的方法进行缝合止血，观察12例患者利用该方法处理过程中骶前静脉的出血量及所需要的处理时间。结果12例患者中，11例利用联合带蒂大网膜集束式缝合技术止血效果满意，缝合完成至术后1周未再出血，1例止血效果差，行经尾骨骶前辅助切口棉垫压迫方法进行止血。11例患者中位止血时间15min，中位出血量150ml。结论联合带蒂大网膜集束式缝合技术是处理骶前静脉丛出血有效方法之一，适合于单纯缝合止血效果差、不接受骶前棉垫填塞止血的患者。Objective To evaluate the effect of cluster ligature combined with pedicled omentum coverage in controlling presaeral venous plexus hemorrhage during pelvic surgery. Methods A total of 12 patients [8 males and 4 females, median age of （68 ±11 ） years] with presacral venous plexus hemorrhage were treated using cluster ligation combined with pedicled omentum coverage. Pelvic surgery included rectal cancer in 6 cases, recurrent uterine sarcoma in 3, pelvic teratoma in 2, malignant neurinoma in 1, respectively. Results Of the 12 patients complicated with massive intraoperative bleeding, 11 were successfully treated. The patient in whom the procedure failed received subsequent pad packing with an arc- shaped transperineal incision in front of the apex of coccyx. There was no patient suffered from postoperative hemorrhage. Conclusions For massive presacral venous plexus hemorrhage, cluster ligation combined with pedicled greater omentum coverage is effective.

关 键 词：止血 手术 缝合技术 骶前静脉丛出血 带蒂大网膜 

分 类 号：R73[医药卫生—肿瘤]