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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。
OBJECTIVE: To investigate the preventive and therapeutic effects of routine preventive treatment in patients with retropubic radical prostatectomy (RRP) and the use of bundle forceps to treat dorsal venous complex (DVC) Efficacy. Methods: From June 2006 to September 2010, 50 patients underwent Walsh’s method to treat DVC as control group (group Ⅰ); from October 2010 to November 2011, 55 patients on the basis of Walsh’s method were treated with 3 preventive hemorrhages (Group II), namely: (1) presetting a continuous suture proximal to the DVC before disconnecting DVC; (2) selectively applying a 4-0 absorbable line intermittent or continuous suture of the prostatic aortic vessel; ( 3) After the free neurovascular bundle (NVB), the 4-0 absorbable line was used to suture deep layers of the fascia of the levator ani fascia on the remnant side of the levator ani muscle and the rectal serosa; December 2011 ~ February 2013 Fifty cases were treated with bundle vascular clamp in group Ⅱ, and the effects of bleeding prevention measures were compared by three groups of intraoperative blood loss, intraoperative blood transfusion, operation time and the difference of hemoglobin before and after operation And bundle forceps application effect. Results: There was no significant difference in hemoglobin before and after operation between the three groups (P> 0.05). The blood loss and blood transfusion in group Ⅰ were (918.00 ± 490.60) ml and (727.50 ± 451.77) ml, respectively, which were significantly higher than those in group Ⅱ (504.55 ± 234.97) ml and blood transfusion (442.11 ± 213.62) ml and group Ⅲ (442.00 ± 179.67) ml and blood transfusion volume (76.00 ± 166.06) ml (P <0.05). CONCLUSIONS: Serial sutures are pre-diced at the DVC proximal to DVC before disconnection, with intermittent sutures of 4-0 absorbable sutures or continuous suturing of prostatic aortic vessels, continuous suturing of anus with 4-0 absorbable lines after free NVB Remnant fascia and the rectal serosal remnant above the fascia deep fascia; plus bundle vascular clamp treatment of DVC, can significantly reduce blood loss in RRP surgery.