Department of Colorectal Surgery, Royal Prince Alfred Hospital, University of Sydney, Suite 415, 100 Carillon Ave, Newtown, NSW, 2042, Australia.
Tech Coloproctol. 2017 Jun;21(6):445-450. doi: 10.1007/s10151-017-1638-4. Epub 2017 May 26.
The risk of significant haemorrhage in pelvic exenterative surgery requiring sacrectomy has been well described. Patients requiring a sacrectomy above S3 are placed in the prone position, posing an increased challenge to gaining control of haemorrhage when it occurs. We describe a technique of pre-emptive control of the internal iliac vein and its three named tributaries to tame the pelvis prior to sacrectomy.
A retrospective, descriptive analysis was performed on a cohort of 25 consecutive patients operated on by one of the authors (AA E) between January 2005 and December 2010; all of whom underwent pre-emptive internal iliac vein triple tributary venous ligation, either unilaterally or bilaterally prior to sacrectomy above the level of S3.
The cohort of patients was a heterogenous group ranging in age from 20 to 80 (mean 46.2) years, with primary tumours in 19 (76%), and secondary tumours in 6 (24%). Median operating time was 8.5 h (range 2.32-19.67 h). Median blood loss was 5500 mL (range 1600-18000 mL), with associated median transfusion of packed red blood cells of 9 units (range 0-34 units). Average stay in the intensive care unit was 1 day (range 0-10 days), with a median length of hospital stay of 18 days (range 5-148 days). There was no intraoperative mortality, with one death at 30 days secondary to gram-negative septicaemia. Postoperative morbidity occurred in 17 (68%) patients.
Our results show that pre-emptive triple tributary internal iliac vein ligation is feasible for taming the pelvis prior to sacrectomy in the prone position where control of significant haemorrhage can prove challenging. The technique has broader relevance for visceral resections in the pelvis involving the pelvic side walls.
需要进行骨盆切除术的患者存在发生大出血的风险，这一点已经得到了充分的描述。需要进行 S3 以上的骶骨切除术的患者被置于俯卧位，这增加了术中控制出血的难度。我们描述了一种在进行骶骨切除术之前预先控制髂内静脉及其三个分支的技术。
对作者之一（AA E）在 2005 年 1 月至 2010 年 12 月期间连续治疗的 25 例患者进行了回顾性描述性分析；所有患者均在 S3 以上进行骶骨切除术之前，行单侧或双侧预先的髂内静脉三分支静脉结扎。
患者的年龄范围从 20 岁到 80 岁（平均 46.2 岁），包括 19 例原发性肿瘤（76%）和 6 例继发性肿瘤（24%）。中位手术时间为 8.5 小时（范围 2.32-19.67 小时）。中位出血量为 5500 毫升（范围 1600-18000 毫升），平均输血量为 9 单位浓缩红细胞（范围 0-34 单位）。平均入住重症监护病房 1 天（范围 0-10 天），中位住院时间为 18 天（范围 5-148 天）。无术中死亡，1 例患者术后 30 天因革兰氏阴性菌败血症死亡。术后并发症发生率为 17 例（68%）。
我们的结果表明，在俯卧位进行骶骨切除术之前，预先进行髂内静脉三分支结扎是可行的，可以控制骨盆的大出血。该技术对于涉及骨盆侧壁的盆腔内脏切除术具有更广泛的意义。
