腹腔镜结直肠癌手术中意外大出血的原因及对策

目的探讨腹腔镜结直肠癌手术中意外大量出血的原因及应对措施。方法我院普外科腹腔镜专业组2007年7月～2010年11月完成386例腹腔镜结直肠癌手术。一次出血量>100 ml的术中意外出血17例,发生率为4.4%。出血原因包括:①大血管处理失败导致出血:右结肠动脉出血1例,结肠中动脉右支出血2例,肠系膜下动脉主干出血2例,左结肠血管出血3例,乙状结肠血管或肠系膜下动脉其他分支出血4例;②手术中误伤,右结肠动脉出血1例,左侧阴部内静脉损伤出血3例,骶前静脉出血1例。联合应用纱布填塞、钛夹夹闭、能量刀头等止血。结果中转开腹止血2例,其余15例术中出血均在腹腔镜下止血。结论腹腔镜手术中的意外出血应根据具体出血原因进行相应处理。

Causes and Management of Unexpected Massive Hemorrhage during Laparoscopic Surgery for Colorectal Cancer

Objective To investigate the causes and countermeasure of unexpected massive hemorrhage during laparoscopic surgery for patients with colorectal cancer. Methods Data were collected retrospectively from 386 patients who underwent laparoscopic surgery for colorectal cancer in our hospital between July 2007 and November 2010. The rate of unexpected massive intraoperative hemorrhage (>100 ml) in the patients was 4.4% (17 cases). The causes of the hemorrhage included failure in managing large vessels (right colic artery in 1 case, middle colic artery in 2, trunk of the inferior mesenteric artery in 2, left colic vessels in 3, and right sigmoid vessels or branches of the inferior mesenteric artery in 4);and accidental injury to the vessels (right colic artery in 1, internal pudendal vein in 3, and presacral vein in 1). Compression with gauze, titanium clips, and energy tool bit were used to control the bleeding. Results The hemorrhage was controlled in 15 of the patients under laparoscope, the other two were converted to open surgery. Conclusion Unexpected massive hemorrhage during laparoscopic surgery shall be managed based on the causes of the bleeding.