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经会阴尾骨前辅佐切口行骶前压迫止血在放疗后直肠癌切除术中的应用

The clinical application of compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx in controlling presacral venous plexus hemorrhage during rectectomy

摘要:

目的 探讨经会阴尾骨前辅佐性切口行骶前压迫止血在放疗后T4NxM0期直肠癌切除术中的应用效果.方法 回顾性研究2002年10月至2012年10月行直肠癌(T4NxM0)切除术中出现骶前静脉丛出血的52例患者的临床资料,其中男性36例,女性26例,年龄35 ~ 65岁.全部患者术前均行放疗,术中出现骶前静脉丛出血,分析患者骶前静脉丛出血的止血时间、止血期间的出血量、止血效果及患者住院时间之间的关系;分析经会阴尾骨前辅佐性切口行骶前压迫止血的临床效果.结果 52例患者手术均为R0切除,其中,35例患者15 min内术中平均出血量(196±44) ml,平均住院时间为(15.2±1.7)d.11例患者20 min内术中平均出血量(1016±86) ml,平均住院时间为(21.7 ±6.3)d.6例患者30 min内术中平均出血量(2508 ± 73) ml,平均住院时间为(28.8±3.3)d.3组患者间平均出血量(F=4289.562)、平均住院时间(F=50.121)比较差异有统计学意义(P=0.000).结论 对于放疗后的直肠癌(T4NxM0)术中骶前出血患者,如果短时内不能缝扎止血,应迅速改用其他止血方式;行会阴尾骨前辅佐性切口行骶前压迫止血是简单、安全、快速有效的止血方式.

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abstracts:

Objective To evaluate the effect of compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx in controlling presacral venous plexus hemorrhage during rectectomy.Methods From October 2002 to October 2012,52 patients with rectal cancer received neoadjuvant radiotherapy and developed presacral venous plexus hemorrhage during rectectomy,included 36 male and 26 female cases.Their age were 36-65 years.The hemostasis time and blood loss were analyzed.Results All 52 patients achieved R0 resection.Of which 13 patients achieved suture hemostasis within 15 minutes,whereas 22 patients unsuccessfully treated within 15 minutes received compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx.The median blood loss was (196 ± 44)ml and hospitalization time was (15.2 ± 1.7)days in this group.Additionally,7 patients achieved suture hemostasis within 20 minutes except 4 patients who received compression hemostasis,with a median blood loss of (1016 ± 86) ml and hospitalization time of (21.7.± 6.3) days.Other 6 patients achieved suture hemostasis within 30 minutes except 3 patients who received compression hemostasis,with a median blood loss of (2508 ± 73) ml and the hospitalization time was (28.8 ± 3.3) days.There was statistically significant difference of bleeding (F =4289.562) and hospitalization time (F =50.121) in 3 groups of patients (P =0.000).Conclusions Once intraoperative presacral venous plexus hemorrhage can't be stopped timely,compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx is an effective alternative for the patients with tectalcancer who received neoadjuvant radiotherapy.

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