咽后壁组织瓣转移术后渗血的原因分析和处理

目的:针对咽后壁组织瓣转移术后出血的部位及原因,分析探讨手术技巧及渗血处理对策。方法:对2003年1月—2017年12月间在上海交通大学医学院唇腭裂治疗研究中心接受咽后壁组织瓣转移术且围术期出现术区渗血的患者,根据其探查止血记录,总结渗血部位、原因及处理方法。结果:15年间,接受咽后壁组织瓣转移术的患者共1141例,术后出现伤口明显渗血9例（0.79%）,均返手术室在全麻下探查止血;出血部位分别为软腭部4例（44.5%）、咽瓣蒂部2例（22.2%）、鼻咽部3例（33.3%）,经缝扎和电凝后控制。结论:咽后壁组织瓣转移术中尤其要注意软腭部血管的保护,蒂部血管的处理,勿损伤鼻咽部黏膜。一旦术后发生渗血,较为凶险,一般需立即返手术室在全麻下探查止血。

Analysis of postoperative bleeding after pharyngoplasty with posterior pharyngeal flap

PURPOSE: The aim of this study was to analyse the location and cause of postoperative bleeding after posterior pharyngeal flap surgery and to investigate the surgical techniques for managing bleeding. METHODS: Patients who received pharyngoplasty with posterior pharyngeal flap in the Cleft Lip and Palate Treatment and Research Centre of Shanghai Jiao Tong University School of Medicine from January 2003 to December 2017 were reviewed, and postoperative bleeding in the surgical area was retrospectively analyzed. RESULTS: During 15 year's study, a total of 1141 patients received posterior pharyngeal flap pharyngoplasty. Among them, nine(0.79%) experienced significant postoperative bleeding with exploration of haemostasis. They were sent back to the operating room for exploration of bleeding under general anaesthesia. The sites of bleeding included 4 cases (44.5%) in the soft palate, 2 cases (22.2%) in the pharyngeal flap pedicle, and 3 cases (33.3%) in the nasopharynx. CONCLUSIONS: During posterior pharyngeal flap pharyngoplasty, particular attention should be paid to protection of blood vessels in the soft palate and handling of the vascular pedicle. Postoperative bleeding is very dangerous and generally requires immediate exploration in the operating room under general anaesthesia.