Wang Xiaoxue, Liu Zhimin, Xie Shangkui, Ren Donglin, Wu Yin'ai
Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.
Department of Surgery, 157 Branch Hospital, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510510, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Dec 25;20(12):1414-1416.
To evaluate three different methods for controlling presacral massive bleeding during pelvic operations.
Clinical data of 11 patients with presacral massive bleeding during pelvic operation at The Sixth Affiliated Hospital of Sun Yat-sen University and 157 Branch Hospital of Guangzhou General Hospital of Guangzhou Military Command from January 2001 to January 2016 were analyzed retrospectively. Hemostasis methods for presacral massive bleeding during operation included gauze packing (whole pressure), drawing pin (local pressure) and absorbable gauze (absorbable gauze was adhered to bleeding position with medical glue after local pressure). Efficacy of these 3 methods for controlling bleeding was evaluated and compared.
Ten patients were male and 1 was female with average age of 65.2 (40 to 79) years old. Eight cases were rectal cancer, 2 were presacral malignancies and 1 was rectal benign lesion. Bleeding volume during operation was 300 to 2 500 (median 800) ml. From 2001 to 2012, 4 cases received gauze packing, of whom, 3 cases were scheduled Dixon resection before operation and then had to be referred to Hartman resection; 3 cases died of systemic failure due to postoperative chronic errhysis and infection, and 1 underwent re-operation. At the same time from 2001 to 2012, 5 cases received drawing pin, of whom, bleeding of 3 cases was successfully controlled and Dixon resection was completed. In other 2 cases with hemostasis failure, 1 case underwent re-operation following the use of gauze packing, and another 1 case received absorbable gauze hemostasis. All the 5 patients were healing. From 2013 to 2016, 2 cases completed scheduled anterior resection of rectum after successful hemostasis with absorbable gauze and were healing and discharged.
Gauze packing hemostasis is a basic method for controlling presacral massive bleeding. Drawing pin and absorbable gauze hemostasis are more precise and may avoid the change of surgical procedure. But drawing pin has the possibility of hemostasis failure. Absorbable gauze hemostasis with medical adhesive is effective, simple and fast.
评估盆腔手术中控制骶前大出血的三种不同方法。
回顾性分析2001年1月至2016年1月在中山大学附属第六医院及广州军区广州总医院157分院行盆腔手术时发生骶前大出血的11例患者的临床资料。术中骶前大出血的止血方法包括纱布填塞（全压）、图钉（局部压迫）和可吸收纱布（局部压迫后用医用胶水将可吸收纱布粘贴于出血部位）。评估并比较这三种止血方法的疗效。
10例男性，1例女性，平均年龄65.2（40至79）岁。8例为直肠癌，2例为骶前恶性肿瘤，1例为直肠良性病变。术中出血量为300至2500（中位数800）ml。2001年至2012年，4例行纱布填塞，其中3例术前计划行 Dixon 切除术，后不得不改为 Hartman 切除术；3例因术后慢性渗血和感染死于全身衰竭，1例再次手术。同时，2001年至2012年，5例行图钉止血，其中3例出血成功控制并完成 Dixon 切除术。另外2例止血失败，1例在使用纱布填塞后再次手术，另1例采用可吸收纱布止血。所有5例患者均愈合。2013年至2016年，2例在使用可吸收纱布成功止血后完成计划的直肠前切除术，愈合出院。
纱布填塞止血是控制骶前大出血的基本方法。图钉和可吸收纱布止血更精确，可避免手术方式改变。但图钉有止血失败的可能。医用胶水粘贴可吸收纱布止血有效、简便、快捷。
