CAJ | 학술논문

目的探讨盆腔肿瘤手术中常见大出血的类型及临床特点、处理理念及手术技巧.方法回顾性分析2003年1月至2012年03月,19例盆腔肿瘤患者手术大出血的临床特点,总结治疗盆腔肿瘤手术中大出血的经验教训,分析大出血的手术技巧.结果本组19例患者中,术中骶前静脉丛大出血7例,术中髂内静脉出血5例,骶前静脉丛出血并髂内静脉出血6例,髂内外静脉出血1例.6例骶前静脉丛和4例髂内静脉大出血行缝扎止血；6例骶前合并髂内静脉大出血、1例骶前静脉、1例髂内静脉出血经腹会阴切口或经腹行棉垫压迫止血；1例髂内外静脉出血,髂外静脉直接给予结扎,髂内静脉给予压迫止血.19例患者中,18例术中有效止血,术中出血量为400～1500 ml,术后恢复尚可.1例术中大出血死亡,术中出血量约为4500 ml.结论盆腔肿瘤术中大出血多为骶前静脉丛及髂内静脉出血,术者应掌握手术止血技巧,视术中情况行缝扎或压迫止血以保证患者的生命安全.
목적 탐토분강종류수술중상견대출혈적류형급림상특점、처리이념급수술기교.방법 회고성분석2003년1월지2012년03월,19례분강종류환자수술대출혈적림상특점,총결치료분강종류수술중대출혈적경험교훈,분석대출혈적수술기교.결과 본조19례환자중,술중저전정맥총대출혈7례,술중가내정맥출혈5례,저전정맥총출혈병가내정맥출혈6례,가내외정맥출혈1례.6례저전정맥총화4례가내정맥대출혈행봉찰지혈；6례저전합병가내정맥대출혈、1례저전정맥、1례가내정맥출혈경복회음절구혹경복행면점압박지혈；1례가내외정맥출혈,가외정맥직접급여결찰,가내정맥급여압박지혈.19례환자중,18례술중유효지혈,술중출혈량위400～1500 ml,술후회복상가.1례술중대출혈사망,술중출혈량약위4500 ml.결론 분강종류술중대출혈다위저전정맥총급가내정맥출혈,술자응장악수술지혈기교,시술중정황행봉찰혹압박지혈이보증환자적생명안전.
Objective To explore the common types of massive intraoperative bleeding,clinical characteristics,treatment philosophy and operating skills in pelvic cancer surgery.Methods We treated massive intraoperative bleeding in 19 patients with pelvic cancer in our department from January 2003 to March 2012.Their clinical data were retrospectively analyzed.The clinical features of massive intraoperative bleeding were analyzed,the treatment experience and lessons were summed up,and the operating skills to manage this serious issue were analyzed.Results In this group of 19 patients,7 cases were of presacral venous plexus bleeding,5 cases of internal iliac vein bleeding,6 cases of anterior sacral venous plexus and internal iliac vein bleeding,and one cases of internal and external iliac vein bleeding.Six cases of anterior sacral plexus bleeding and 4 cases of internal iiiac vein bleeding were treated with suture ligation to stop the bleeding.Six cases of anterior sacral and internal iliac vein bleeding,one cases of anterior sacral vein bleeding,and one case of internal iliac vein bleeding were managed with transabdominal perineal incision or transabdominal cotton pad compression hemostasis.One case of internal and external iliac vein bleeding was treated with direct ligation of the external iliac vein and compression hemostasis of the internal iliac vein.Among the 19 patients,18 cases had effective hemostasis.Their blood loss was 400-1500 ml,and they had a fair postoperative recovery.One patient died due to massive intraoperative bleeding of ca.4500 ml.Conclusions Most of the massive intraoperative bleeding during pelvic cancer surgery is from the presacral venous plexus and internal iliac vein.The operator should go along with the treatment philosophy to save the life of the patient above all,and to properly perform suture ligation or compression hemostasis according to the actual situation,and with mastered crucial operating hemostatic skills.