CAJ | 학술논문

目的：探讨在耻骨后根治性前列腺癌切除术（retropubic radical prostatectomy，RRP）中，常规预防处理，加用集束血管钳处理阴茎背深静脉复合体（dorsal venous complex，DVC）预防术中大失血的疗效。方法：2006年6月～2010年9月50例采用Walsh方法处理 DVC，作为对照组（Ⅰ组）；2010年10月～2011年11月55例在Walsh方法的基础上，使用3项预防出血措施（Ⅱ组），即：（1）在离断DVC前在DVC近侧预置连续缝线，（2）有选择性地应用4-0可吸收线间断或连续缝合前列腺尖端血管蒂，（3）游离血管神经束（neurovascular bundle，NVB）后用4-0可吸收线连续缝合肛提肌筋膜残存侧和直肠浆膜上方的狄氏筋膜深层；2011年12月～2013年2月50例在Ⅱ组止血措施上加用集束血管钳处理DVC（Ⅲ组），通过三组术中出血量、术中输血量、手术时间、手术前后血红蛋白量的差值来比较预防出血措施的作用和集束血管钳的应用效果。结果：三组在手术前后血红蛋白量的差值无明显差异（P＞0．05）。Ⅰ组出血量和输血量分别为（918．00±490．60）ml 和（727．50±451．77）ml，明显高于Ⅱ组出血量（504．55±234．97）ml和输血量（442．11±213．62）ml 及Ⅲ组出血量（442．00±179．67）ml 和输血量（76.00±166.06）ml（P＜0．05）。结论：在离断DVC前在DVC近侧预置连续缝线；有选择性地应用4-0可吸收线间断或连续缝合前列腺尖端血管蒂；游离 NVB后用4-0可吸收线连续缝合肛提肌筋膜残存侧和直肠浆膜上方的狄氏筋膜深层；加用集束血管钳处理DVC，可以明显减少RRP术中失血。
목적：탐토재치골후근치성전렬선암절제술（retropubic radical prostatectomy，RRP）중，상규예방처리，가용집속혈관겸처리음경배심정맥복합체（dorsal venous complex，DVC）예방술중대실혈적료효。방법：2006년6월～2010년9월50례채용Walsh방법처리 DVC，작위대조조（Ⅰ조）；2010년10월～2011년11월55례재Walsh방법적기출상，사용3항예방출혈조시（Ⅱ조），즉：（1）재리단DVC전재DVC근측예치련속봉선，（2）유선택성지응용4-0가흡수선간단혹련속봉합전렬선첨단혈관체，（3）유리혈관신경속（neurovascular bundle，NVB）후용4-0가흡수선련속봉합항제기근막잔존측화직장장막상방적적씨근막심층；2011년12월～2013년2월50례재Ⅱ조지혈조시상가용집속혈관겸처리DVC（Ⅲ조），통과삼조술중출혈량、술중수혈량、수술시간、수술전후혈홍단백량적차치래비교예방출혈조시적작용화집속혈관겸적응용효과。결과：삼조재수술전후혈홍단백량적차치무명현차이（P＞0．05）。Ⅰ조출혈량화수혈량분별위（918．00±490．60）ml 화（727．50±451．77）ml，명현고우Ⅱ조출혈량（504．55±234．97）ml화수혈량（442．11±213．62）ml 급Ⅲ조출혈량（442．00±179．67）ml 화수혈량（76.00±166.06）ml（P＜0．05）。결론：재리단DVC전재DVC근측예치련속봉선；유선택성지응용4-0가흡수선간단혹련속봉합전렬선첨단혈관체；유리 NVB후용4-0가흡수선련속봉합항제기근막잔존측화직장장막상방적적씨근막심층；가용집속혈관겸처리DVC，가이명현감소RRP술중실혈。
Objective:To discuss the efficacy of the application of bunching forceps in dealing with dorsal venous complex(DVC)to prevent intraoperative massive haemorrhage in radical retropubic prostatectomy (RRP)on the basis of conventional haemostasis methods.Methods:Fifty cases of patients whose DVC were handled simply with the Walsh meth-od from June 2006 to September 2010 were chosen as the control group(GroupI).Fifty-five cases handled with the Walsh method and the following three additional procedures for hemostasis from October 2010 to November 201 1 were chosen as GroupII:(1)A continuous suture was set in the proximal position of DVC before dividing it.(2)The vascular bundle of the prostatic apex was selectively sutured with continuous or intermittent 4-0 Vicryl sutures.(3)A continuous suture was set in the remained levator ani myofascia and the deep layer of Denovilliers’fascia above the rectal serosa with 4-0 Vicryl absorbable sutures after freeing the neurovascular bundle (NVB).Fifty cases handled with all the procedures above plus bunching forceps from December 201 1 to February 2013 were chosen as GroupIII.The efficacy of the three hemostatic methods and bunching forceps application in RRP was evalua-ted by comparing the volume of intraoperative blood loss and transfusion,operation time and hemoglobin level before and after operations.Results:There was no significant difference among the 3 groups in perioperative hemoglobin levels (P>0.05).The volume of intraoporative blood loss and transfusion was remarkably higher in Group I [(918.00 ±490.60 )ml and (727.50 ±451.77 )ml]than in group II [(504.55 ± 234.97)ml and (442.11 ±213.62 )ml]and in GroupIII [(442.00 ±179.67 )ml and (76.00 ±166.06 )ml](P<0.05 ).Conclusion:Intraoperative blood loss in RRP could be significantly decreased by using the following methods :(1)To set a continuous suture in the proximal position of DVC before dividing it.(2)To selectively suture vascular bun-dle of the prostatic apex with continuous or intermittent 4 -0 Vicryl sutures.(3 )To set a continuous suture in the re-mained levator ani myofascia and the deep layer of Denovilliers'fascia above the rectal serosa with 4-0 Vicryl absorbable suture after freeing NVB.(4)To use bunching forceps to deal with the DVC.