直肠癌Mile's手术盆腔大出血的防治

目的:总结直肠癌Mile's手术中盆腔大出血的临床治疗经验。方法:回顾10余年间391例Mile's手术,6例术中发生盆腔大出血,占1.53%;其中骶前大出血5例,前列腺出血1例,占0.26%。顿性分离直肠后间隙损伤骶前筋膜造成大出血2例;过度牵拉骶前,使骶前筋膜移位,电刀直接切割损伤骶前筋膜引起大出血2例;肿瘤过大并与骶前筋膜粘连,分离至盆底时损伤骶前筋膜导致大出血1例;会阴部切除直肠肿瘤时损伤前列腺导致大出血1例。结果:骶前大出血者,用明胶海绵、大纱布压迫止血成功止血2例;钛镍止血钉按压止血1例;直接缝合出血部位止血成功2例;前列腺出血直接缝合止血成功。6例均完成手术,术后恢复顺利,痊愈出院。结论:直肠全系膜切除、锐性分离是预防盆腔大出血的有效措施。盆腔大出血可通过纱布垫填塞压迫、不锈钢钉、骨蜡等方法止血。

Prevention and management of massive pelvic hemorrhage in Miles operation for rectal cancer

Objective:To summarize the experience of clinical management of massive pelvic hemorrhage in the mile's operation for the rectal carcinoma. Methods: A review study was completed for 391 cases from January 1992 to December 2005, among them the massive pelvic hemorrhage were occurred in 6 cases (1.53%). There were 5 cases of sacro-anterior massive hemorrhage (1.28%) and 1 case of prostate massive hemorrhage (0.26%). The massive hemorrhage was caused by a blunt separation of the posterior position of rectum in 2 cases and a director cutting of the sacro-anterior fascia by electrocautery knife in 2 cases because of the sacro-anterior translocation by excessive traction, the avulsed wound of the sacro-anterior in 1 case during seperation of the pelvic cavity due to the overlarge tumor and adhesion with the sacro-anterior and direct cutting wound of the prostate in 1 case during the perineal operation. Results: All cases of massive pelvic hemorrhage were successfully managed by the press with gelatin and gauze roll in 2 cases, by the press with nail of nichrome titanate in 1 case, and by direct suture of the site of bleeding in 2 cases, by direct suture the prostate in 1 case. All 6 cases were completed operation, recovery was fluentely after operation. And all cases were discharged from the hospital by fully recovery. Conclusion: Radical resection with total mesentery excision and sharp separation are effective for prevention of massive pelvic hemorrhage. Massive pelvic hemorrhage can be managed by using of gauze packing, thumbtacks and bone wax.