D'Ambra Luigi, Berti Stefano, Bonfante Pierfrancesco, Bianchi Claudio, Gianquinto Daniela, Falco Emilio
Division of Surgery, S. Andrea Hospital, 19100, La Spezia, Italy.
World J Surg. 2009 Apr;33(4):812-5. doi: 10.1007/s00268-008-9846-8.
A new procedure of hemostasis during laparoscopic total mesorectal excision is described.
In our surgical department, from January 2004 to December 2007, 128 patients underwent laparoscopic total mesorectal excision. Among them, 47 patients underwent laparoscopic anterior resection after preoperative radiotherapy, 68 patients underwent laparoscopic anterior resection without preoperative radiotherapy, and 13 patients underwent laparoscopic abdominal perineal amputation.
In seven laparoscopic rectal surgery cases, we encountered unstoppable presacral bleeding, not amenable by conventional hemostatic solutions. In these cases we applied a simple staging hemostatic procedure. We first performed local compression: tamponing with a small gauze or absorbable fabric hemostat. If bleeding did not stop, we localized an epiploic or omental scrap and excised it by using bipolar forceps and use it as a plug on the tip of a grasping forceps. This plug is then put on the bleeding source and monopolar coagulation is applied by electrified dissecting forceps through the interposed grasping forceps. If bleeding did not stop, we used a little scrap of bovine pericardium graft and tacked it to the bleeding site using endoscopic helicoidal protack.
Our experience suggests that this hemostatic step-by-step procedure is a valid option to control persistent presacral hemorrhages.
描述了一种腹腔镜全直肠系膜切除术中的新止血方法。
2004年1月至2007年12月，我院外科有128例患者接受了腹腔镜全直肠系膜切除术。其中，47例患者在术前放疗后接受了腹腔镜前切除术，68例患者未接受术前放疗直接进行了腹腔镜前切除术，13例患者接受了腹腔镜腹会阴联合切除术。
在7例腹腔镜直肠手术病例中，我们遇到了无法控制的骶前出血，常规止血方法无效。在这些病例中，我们采用了一种简单的分期止血方法。我们首先进行局部压迫：用小块纱布或可吸收织物止血钳填塞。如果出血不止，我们找到一块网膜或大网膜碎片，用双极电凝钳将其切除，然后将其作为塞子放在抓钳尖端。然后将这个塞子放在出血部位，通过插入的抓钳用电凝解剖钳进行单极电凝。如果出血仍不止，我们使用一小片牛心包补片，用内镜螺旋形钉合器将其固定在出血部位。
我们的经验表明，这种逐步止血方法是控制持续性骶前出血的有效选择。
