Gobrecht Ursula, Kuhn Annette, Fellman Bernhard
Bürgerspital Solothurn, 4500 Solothurn, Switzerland.
Int Urogynecol J. 2011 Apr;22(4):443-5. doi: 10.1007/s00192-010-1355-2. Epub 2011 Jan 18.
We report a serious bleeding complication due to injury of the corona mortis following insertion of a transvaginal tape, TVT-Secur™ (Ethicon Women's Health, Sommerville, NJ, USA).
The TVT-Secur™ was inserted using the U-Approach: the tape was pushed along the periost behind the arc of the pubic bone at an angle of 45°.
Surgery was unproblematic. Four hours after surgery, the patient showed shock signs; a CT scan revealed a 13.5 × 9.5-cm-sized retrosymphysic haematoma. Instant laparotomy with removal of the large haematoma, ligation of the bleeding corona mortis and administration of erythrocyte concentrates were necessary.
The corona mortis is an anastomosis between the arteria obturatoria and the external iliac vessels or its branches that passes over the superior pubic ramus. Its prevalence and anatomical relation to the pubic bone are important to bear in mind when applying new surgical techniques.
我们报告了一例因经阴道无张力尿道中段吊带术（TVT-Secur™，美国新泽西州萨默维尔市爱惜康女性健康公司生产）植入过程中损伤死亡冠而导致的严重出血并发症。
采用U型入路植入TVT-Secur™：将吊带以45°角沿耻骨弓后方的骨膜推送。
手术过程顺利。术后4小时，患者出现休克体征；CT扫描显示耻骨联合后有一个13.5×9.5厘米大小的血肿。需要立即进行剖腹手术，清除巨大血肿，结扎出血的死亡冠，并输注浓缩红细胞。
死亡冠是闭孔动脉与髂外血管或其分支之间的吻合支，跨过耻骨上支。在应用新的手术技术时，牢记其发生率以及与耻骨的解剖关系非常重要。
