Department of General Surgery, Shandong University Qilu Hospital, Jinan, Shandong, China.
J Gastrointest Surg. 2013 Feb;17(2):416-20. doi: 10.1007/s11605-012-2028-x. Epub 2012 Sep 21.
Presacral venous bleeding during rectal mobilization is uncommon but potentially life-threatening. Various methods have been proposed for controlling the bleeding, but each has some obvious limitations in clinical practice. We report a simple technique that was designated as circular suture ligation. This technique was efficient in controlling presacral venous bleeding encountered during rectal mobilization.
The key point of circular suture ligation was to control the bleeding by suture ligating the venous plexus in one or more circles in the area with intact presacral fascia that surrounds the bleeding site while the bleeding site was temporarily controlled with fingertip pressure. From September 2007 to December 2011, 258 patients underwent rectal surgery in our department because of rectal cancer. Uncontrolled presacral venous bleeding with traditional methods was encountered in eight patients (3 %) with estimated blood loss from 300 to 5,000 ml.
Bleeding was successfully controlled in all eight patients with the circular suture ligation. None of the patients required reoperation for bleeding or other issues. No patients developed chronic pelvic pain after the operation.
Our experience suggests that circular suture ligation of venous plexus in the area with intact presacral fascia that surrounds the bleeding site is an effective and simple technique to control presacral venous bleeding when traditional techniques fail.
直肠游离过程中发生骶前静脉出血并不常见，但可能有生命危险。各种方法已被提出用于控制出血，但在临床实践中，每种方法都有一些明显的局限性。我们报告了一种简单的技术，即环扎缝合。该技术在控制直肠游离过程中遇到的骶前静脉出血方面非常有效。
环扎缝合的关键在于通过缝合暂时控制出血部位的指压，在完整的骶前筋膜所环绕的出血部位区域内以一个或多个环结扎静脉丛，以控制出血。自 2007 年 9 月至 2011 年 12 月，我院 258 例直肠癌患者接受了直肠手术。在这 258 例患者中，有 8 例（3%）患者采用传统方法仍无法控制骶前静脉出血，估计出血量为 300-5000ml。
8 例患者均通过环扎缝合成功控制了出血。所有患者均无需因出血或其他问题再次手术。术后无患者出现慢性盆腔疼痛。
我们的经验表明，在传统技术失败时，在完整的骶前筋膜所环绕的出血部位区域内结扎静脉丛是控制骶前静脉出血的一种有效且简单的技术。
