盆腔手术中骶前大出血三种止血方法  

Three methods for controlling presacral massive bleeding during pelvic operations

作　　者：王晓学 刘智敏 谢尚奎 任东林 吴印爱 

出　　处：《中华胃肠外科杂志》2017年第12期1414-1416,共3页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省科技计划项目（2014A020212123）

摘　　要：目的评价盆腔手术中骶前大出血的3种止血方法。方法回顾性分析2001年1月至2016年1月问在中山大学附属第六医院（9例）和解放军广州总医院一五七分院（2例）接受盆腔手术时出现骶前大出血（出血量超过300m1）的11例患者的临床资料。术中止血方法包括纱布填塞压迫止血法（整体压迫）、图钉按压止血法（局部点压迫）和吸收纱布粘贴法（局部点压迫后采用医用胶将可吸收纱布粘合至出血部位），分析评价上述3种止血方法的止血效果。结果11例患者中男性10例，女性1例，年龄40～79（平均65．2）岁。直肠癌患者8例，骶前恶性肿瘤2例，直肠良性病变l例。术中出血量300—2500（中位数800）ml。2001--2012年期间，4例术中出血后采用纱布填塞压迫止血法，其中3例手术方式由计划的直肠前切除术更改为Hamann手术：术后死亡3例，均死于慢性渗血以及感染导致的全身衰竭，另1例接受二次手术。2001--2012年期间，5例采用图钉按压止血法，成功止血3例，均按计划完成直肠前切除术，治愈出院；2例止血失败患者中1例改用纱布填塞压迫止血，后接受二次手术；另1例改用可吸收纱布粘贴法止血，治愈出院。2013--2016年期间．2例采用可吸收纱布粘贴法，止血成功后完成预定的直肠前切除术．治愈出院。结论纱布填塞压迫止血法是骶前大出血基本处理方法，图钉按压止血法和可吸收纱布粘贴法止血精准，无需更改手术方案，手术风险小；但图钉按压有止血失败的可能。Objective To evaluate three different methods for controlling presacral massive bleeding during pelvic operations. Methods Clinical data of ll patients with presacral massive bleeding during pelvic operation at The Sixth Affiliated Hospital of Sun Yat-sen University and 157 Branch Hospital of Guangzhou General Hospital of Guangzhou Military Command from January 2001 to January 2016 were analyzed retrospectively. Hemostasis methods for presacral massive bleeding during operation included gauze packing （whole pressure）, drawing pin （local pressure） and absorbable gauze （absorbable gauze was adhered to bleeding position with medical glue after local pressure）. Efficacy of these 3 methods for controlling bleeding was evaluated and compared. Results Ten patients were male and 1 was female with average age of 65.2 （40 to 79） years old. Eight cases were rectal cancer, 2 were presacral malignancies and 1 was rectal benign lesion. Bleeding volume during operation was 300 to 2 500 （median 800） ml. From 2001 to 2012, 4 cases received gauze packing, of whom, 3 cases were scheduled Dixon resection before operation and then had to be referred to Hartman resection; 3 cases died of systemic failure due to postoperative chronic errhysis and infection, and 1 underwentre-operation. At the same time from 2001 to 2012, 5 cases received drawing pin, of whom, bleeding of 3 cases was successfully controlled and Dixon resection was completed. In other 2 cases with hemostasis failure, 1 case underwent re-operation following the use of gauze packing, and another 1 case received absorbable gauze hemostasis. All the 5 patients were healing. From 2013 to 2016, 2 cases completed scheduled anterior resection of rectum after successful hemostasis with absorbable gauze and were healing and discharged. Conclusions Gauze packing hemostasis is a basic method for controlling presacral massive bleeding. Drawing pin and absorbable gauze hemostasis are more precise and may avoid the change of surgical procedure. But drawing pin has t

关 键 词：盆腔手术 骶前大出血 止血 治疗效果 

分 类 号：R657.1[医药卫生—外科学] R735.37[医药卫生—临床医学]