腹腔镜D2胃癌根治术术中出血原因与防治  

Prevention of intraoperative bleeding in laparoscopic D2 radical gastrectomy for gastric cancer

作　　者：邹瞭南[1] 杨双[1] 莫德龙 何耀彬[1] 李洪明[1] 万进[1] 陈志强[1] 

机构地区：[1]广东省中医院胃肠外科,广州510120

出　　处：《中华普外科手术学杂志（电子版）》2016年第1期41-43,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜下胃癌根治术术中出血并发症的原因分析及防治。方法回顾性分析2013年4月至2014年12月施行腹腔镜下胃癌根治性切除手术146例,对术中出血情况进行统计分类,处理方法归类并分析出血原因,总结防治措施。结果本组146例中,平均出血量(88±72.1)ml,7例(4.79%)发生术中大出血(出血量大于300 ml),其中3例因为超声刀误伤导致胃右动静脉或胃十二指肠动脉出血,2例患者因为肥胖、暴力牵拉导致胃网膜左动静脉或胃周实质性脏器损伤出血,1例患者因为肥胖、肿瘤侵犯导致脾动静脉出血达500 ml,为本研究最大出血量,所有出血均在腹腔镜下采用夹闭、电凝、缝扎等止血方法成功止血,无1例中转开腹。结论出血是腹腔镜下胃癌根治术术中的常见的并发症之一,患者和术者两方面因素共同决定手术中的出血量,术中一旦发生出血,在助手充分暴露术野的前提下,执行"5P"原则止血。Objective To investigate the causes of intraoperative bleeding and its prevention in laparoscopic D2 radical gastrectomy for gastric cancer. Methods The clinical data of 146 patients with gastric cancer who had undergone laparoscopie D2 radical gastrectomy were analyzed retrospectively from April 2013 to December 2014. Risk factors of intraoperative bleeding were analyzed, and the causes and preventive measures were summarized. Results Average blood loss was （ 88 ± 72. 1 ） mL in the 146 patients, including 7 （4.79%） patients with massive hemorrhage （ 〉300 ml）,of whom 3 had accidental injury of fight gastric vessels or gastroduodenal arteries by ultrasonic scalpel, 2 had accidental injury of left gastroepiploic vessels or adjacent organ damage due to obesity or violence dragging, 1 had injury of splenic vessels （with maximum bleeding of 500 ml） caused by obesity and tumor invasion. Surgical management of hemorrhage included clipping, electro-coagulation and ligation under laparoseopy without conversion. Conclusion Hemorrhage is one of the common complications of laparoscopic D2 radical operation for gastric cancer. Intraoperative blood loss is determined by both patients and surgeons. Once the intraoperative hemorrhage occurs, ＂5 p＂ principles should be implemented to stop the bleeding under adequate exposure of operative field.

关 键 词：胃肿瘤 腹腔镜检查 胃切除术 失血 手术 

分 类 号：R735.2[医药卫生—肿瘤]