Department of Colorectal Surgery, Changhai Hospital, Shanghai 200433, China.
World J Gastroenterol. 2013 Jul 7;19(25):4039-44. doi: 10.3748/wjg.v19.i25.4039.
To investigate control of two different types of massive presacral bleeding according to the anatomy of the presacral venous system.
A retrospective review was performed in 1628 patients with middle or low rectal carcinoma who were treated surgically in the Department of Colorectal Surgery, Changhai Hospital, Shanghai, China from January 2008 to December 2012. In four of these patients, the presacral venous plexus (n = 2) or basivertebral veins (n = 2) were injured with massive presacral bleeding during mobilization of the rectum. The first two patients with low rectal carcinoma were operated upon by a junior associate professor and the source of bleeding was the presacral venous plexus. The other two patients with recurrent rectal carcinoma were both women and the source of bleeding was the basivertebral veins.
Two different techniques were used to control the bleeding. In the first two patients with massive bleeding from the presacral venous plexus, we used suture ligation around the venous plexus in the area with intact presacral fascia that communicated with the site of bleeding (surrounding suture ligation). In the second two patients with massive bleeding from the basivertebral veins, the pelvis was packed with gauze, which resulted in recurrent bleeding as soon as it was removed. Following this, we used electrocautery applied through one epiploic appendix pressed with a long Kelly clamp over the bleeding sacral neural foramen where was felt like a pit Electrocautery adjusted to the highest setting was then applied to the clamp to "weld" closed the bleeding point. Postoperatively, the blood loss was minimal and the drain tube was removed on days 4-7.
Surrounding suture ligation and epiploic appendices welding are effective techniques for controlling massive presacral bleeding from presacral venous plexus and sacral neural foramen, respectively.
根据骶前静脉系统的解剖结构，探讨两种不同类型的大量骶前出血的控制方法。
回顾性分析 2008 年 1 月至 2012 年 12 月在上海长海医院肛肠外科接受手术治疗的 1628 例中低位直肠癌患者的临床资料。其中 4 例患者在直肠游离过程中损伤骶前静脉丛（n=2）或骶正中动脉（n=2），导致大量骶前出血。前 2 例低位直肠癌患者由低年资副主任医师手术，出血源为骶前静脉丛；后 2 例复发直肠癌患者均为女性，出血源为骶正中动脉。
采用 2 种不同的技术控制出血。对于前 2 例骶前静脉丛大出血的患者，我们使用缝线围绕与出血部位（周围缝合结扎）相通的骶前筋膜完整区域的静脉丛进行结扎。对于后 2 例骶正中动脉大出血的患者，骨盆用纱布填塞，取出纱布后再次出血。随后，我们使用电灼通过长 Kelly 钳压在出血骶骨神经孔上的一个阑尾网膜进行电灼，电灼调节到最高设置，以“焊接”闭合出血点。术后出血量少，引流管于术后第 4-7 天拔除。
周围缝合结扎和阑尾网膜电灼分别是控制骶前静脉丛和骶骨神经孔大出血的有效方法。
