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目的:总结直肠癌Mile’s手术中盆腔大出血的临床治疗经验。方法:回顾10余年间391例Mile’s手术,6例术中发生盆腔大出血,占1.53%;其中骶前大出血5例,前列腺出血1例,占0.26%。顿性分离直肠后间隙损伤骶前筋膜造成大出血2例;过度牵拉骶前,使骶前筋膜移位,电刀直接切割损伤骶前筋膜引起大出血2例;肿瘤过大并与骶前筋膜粘连,分离至盆底时损伤骶前筋膜导致大出血1例;会阴部切除直肠肿瘤时损伤前列腺导致大出血1例。结果:骶前大出血者,用明胶海绵、大纱布压迫止血成功止血2例;钛镍止血钉按压止血1例;直接缝合出血部位止血成功2例;前列腺出血直接缝合止血成功。6例均完成手术,术后恢复顺利,痊愈出院。结论:直肠全系膜切除、锐性分离是预防盆腔大出血的有效措施。盆腔大出血可通过纱布垫填塞压迫、不锈钢钉、骨蜡等方法止血。
Objective: To summarize the experience of clinical treatment of pelvic hemorrhage in Mile’s operation of rectal cancer. Methods: 391 Mile’s surgeries were reviewed over 10 years. Pelvic hemorrhage occurred in 6 cases, accounting for 1.53%. Among them, 5 cases had presacral hemorrhage and 1 case had prostate hemorrhage, accounting for 0.26%. 2 cases of hemorrhage caused by presacral fascia after the rectum gap was damaged; 2 cases of massive hemorrhage caused by presacral fascia caused by excessive displacement of the presacral space, Anterior fascia adhesion, separation to the pelvic floor when the injury caused by presacral fascia in 1 case of hemorrhage; perineal resection of the rectum tumor led to massive bleeding in 1 case. Results: Two cases of presacral hemorrhage were treated with gelatin sponge and large gauze to stop hemostasis. Two cases were treated with titanium-nickel hemostatic nail to stop hemostasis. Two cases were successful with direct suture and hemostasis. Prostate hemorrhage was directly sutured to stop bleeding. 6 cases were completed surgery, postoperative recovery smoothly, discharged. Conclusion: Total mesorectal excision and sharp separation are effective measures to prevent pelvic hemorrhage. Pelvic hemorrhage can be padded gauze pad compression, stainless steel nails, bone wax and other methods to stop bleeding.