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郁宝铭教授直肠癌切除手术中最大的风险就是骶前静脉丛的破裂出血。导致骶前静脉丛破裂出血的常见原因有:①在盆腔内分离直肠时,解剖层次不清,进行钝性分离,误伤静脉丛;②癌肿浸润骶前筋膜,在强行分离时损伤静脉丛;③在会阴部分离进入盆腔时因解剖层次不对,误将骶前筋膜掀起,损伤骶前静脉丛;④术中由于操作不当使用器械误伤血管。例如将吸引器头置于盆腔内吸除积血时不慎将吸引头抵于血管上而引起血管破裂。因此,预防比发生出血后的紧急处理更为重要。首先在分离直肠时应在骶前间隙中进行,自骶岬处切开乙状结肠系膜与后腹膜交界缘,进入骶前间隙,然后在直视下进行锐性分离。由于此间隙内为疏松结缔组织,并无重要血管,故只要层次正确,不会引起出血。分离直肠切忌钝性使用暴力。盆腔内操作和使用各种器械,特别在应用吸引器吸除积血时,应十分小心,切勿损伤血管。自会阴部向上分离时,在切断肛尾韧带后,腹部组医师应从盆腔内予以导引,以免会阴
Professor Yu Baoming’s greatest risk in resection of rectal cancer is the rupture of anterior venous plexus. Common causes of hemorrhage before the anterior sacral venous plexus are: 1 When the rectum is separated from the pelvic cavity, the anatomical gradation is unclear, and blunt dissection is performed. The venous plexus is accidentally injured; 2 The presurgical fascia is infiltrated into the cancer, and the venous plexus is damaged when forcibly separated. 3 When the perineum is separated into the pelvic cavity, the anatomic level is incorrect, and the presacral fascia is accidentally lifted to injure the anterior sacral venous plexus. 4 Inadequate use of the device due to improper operation may cause injury to blood vessels. For example, when the aspirator head is placed in the pelvic cavity to absorb blood, the suction head is accidentally pressed against the blood vessel to cause the blood vessel to break. Therefore, prevention is more important than emergency treatment after bleeding occurs. First, the rectum should be separated from the anterior tibial space, and the sigmoid mesocoelia and the posterior peritoneum should be cut at the junction of the fistula and enter the anterior tibial space. Then the sharp separation should be performed under direct vision. Since the gap is loose connective tissue, there is no important blood vessels, so as long as the correct level, will not cause bleeding. Separation of rectum should not use blunt use of violence. Intra-pelvic operation and use of various instruments, especially in the use of aspirator suction hematocrit, should be very careful not to damage blood vessels. When the perineum is separated upwards, after cutting off the anal ligament, the doctor in the abdominal group should be guided from the pelvic cavity to avoid perineal