AIM: To investigate control of two different types of massive presacral bleeding according to the anatomy of the presacral venous system. METHODS: A retrospective review was performed in 1628 patients with middle or l...AIM: To investigate control of two different types of massive presacral bleeding according to the anatomy of the presacral venous system. METHODS: A retrospective review was performed in 1628 patients with middle or low rectal carcinoma who were treated surgically in the Department of Colorectal Surgery, Changhai Hospital, Shanghai, China from January 2008 to December 2012. In four of these patients, the presacral venous plexus (n = 2) or basivertebral veins (n = 2) were injured with massive presacral bleeding during mobilization of the rectum. The first two patients with low rectal carcinoma were operated upon by a junior associate professor and the source of bleeding was the presacral venous plexus. The other two patients with recurrent rectal carcinoma were both women and the source of bleeding was the basivertebral veins.RESULTS: Two different techniques were used to con-trol the bleeding. In the first two patients with massive bleeding from the presacral venous plexus, we used suture ligation around the venous plexus in the area with intact presacral fascia that communicated with the site of bleeding (surrounding suture ligation). In the second two patients with massive bleeding from the basivertebral veins, the pelvis was packed with gauze, which resulted in recurrent bleeding as soon as it was removed. Following this, we used electrocautery applied through one epiploic appendix pressed with a long Kelly clamp over the bleeding sacral neural foramen where was felt like a pit Electrocautery adjusted to the highest setting was then applied to the clamp to "weld" closed the bleeding point. Postoperatively, the blood loss was minimal and the drain tube was removed on days 4-7. CONCLUSION: Surrounding suture ligation and epiploic appendices welding are effective techniques for controlling massive presacral bleeding from presacral venous plexus and sacral neural foramen, respectively.展开更多
目的探讨改良方法在新生儿脐带水肿缝合结扎断脐中的可行性及其优势。方法 200例活产新生儿按分娩的先后顺序分为观察组和对照组各100例,对2组新生儿的临床资料进行回顾性分析,比较2组的操作难度、操作时间、脐部出血渗血、感染、正常...目的探讨改良方法在新生儿脐带水肿缝合结扎断脐中的可行性及其优势。方法 200例活产新生儿按分娩的先后顺序分为观察组和对照组各100例,对2组新生儿的临床资料进行回顾性分析,比较2组的操作难度、操作时间、脐部出血渗血、感染、正常脱落时间等指标。结果观察组操作时间为（15.0±0.3）s,对照组操作时间为（11.0±0.4）s,2组技术难度、操作时间差异无统计学意义;观察组残脐脱落时间3-6 d 25例,7-10 d 64例,〉10 d 11例,对照组残脐脱落时间3-6 d 15例,7-10 d 43例,〉10 d 42例,观察组残脐脱落所需时间明显少于对照组,差异有统计学意义（χ^2=24.754,P〈0.05）;脐部并发症方面,对照组发生脐部出血9例、线结脱落5例、脐炎8例,需二次剪脐5例,肉芽肿及创面不良19例,并发症发生率为46%,观察组无发生脐部出血、线结脱落,脐炎5例,需二次剪脐1例,肉芽肿及创面不良5例,并发症发生率为11%,观察组并发症明显少于对照组,2组比较差异有统计学意义（χ^2=34.149,P〈0.05）。结论改良缝扎断脐法处理水肿脐带可防止断脐后线结滑脱,防止脐部感染,杜绝脐部出血,加速脐部残端干燥。展开更多
基金Supported by Changhai Hospital 1255 Project Fund,No.CH125542500Shanghai Natural Science Foundation,No.134119a3800
文摘AIM: To investigate control of two different types of massive presacral bleeding according to the anatomy of the presacral venous system. METHODS: A retrospective review was performed in 1628 patients with middle or low rectal carcinoma who were treated surgically in the Department of Colorectal Surgery, Changhai Hospital, Shanghai, China from January 2008 to December 2012. In four of these patients, the presacral venous plexus (n = 2) or basivertebral veins (n = 2) were injured with massive presacral bleeding during mobilization of the rectum. The first two patients with low rectal carcinoma were operated upon by a junior associate professor and the source of bleeding was the presacral venous plexus. The other two patients with recurrent rectal carcinoma were both women and the source of bleeding was the basivertebral veins.RESULTS: Two different techniques were used to con-trol the bleeding. In the first two patients with massive bleeding from the presacral venous plexus, we used suture ligation around the venous plexus in the area with intact presacral fascia that communicated with the site of bleeding (surrounding suture ligation). In the second two patients with massive bleeding from the basivertebral veins, the pelvis was packed with gauze, which resulted in recurrent bleeding as soon as it was removed. Following this, we used electrocautery applied through one epiploic appendix pressed with a long Kelly clamp over the bleeding sacral neural foramen where was felt like a pit Electrocautery adjusted to the highest setting was then applied to the clamp to "weld" closed the bleeding point. Postoperatively, the blood loss was minimal and the drain tube was removed on days 4-7. CONCLUSION: Surrounding suture ligation and epiploic appendices welding are effective techniques for controlling massive presacral bleeding from presacral venous plexus and sacral neural foramen, respectively.
文摘目的探讨改良方法在新生儿脐带水肿缝合结扎断脐中的可行性及其优势。方法 200例活产新生儿按分娩的先后顺序分为观察组和对照组各100例,对2组新生儿的临床资料进行回顾性分析,比较2组的操作难度、操作时间、脐部出血渗血、感染、正常脱落时间等指标。结果观察组操作时间为（15.0±0.3）s,对照组操作时间为（11.0±0.4）s,2组技术难度、操作时间差异无统计学意义;观察组残脐脱落时间3-6 d 25例,7-10 d 64例,〉10 d 11例,对照组残脐脱落时间3-6 d 15例,7-10 d 43例,〉10 d 42例,观察组残脐脱落所需时间明显少于对照组,差异有统计学意义（χ^2=24.754,P〈0.05）;脐部并发症方面,对照组发生脐部出血9例、线结脱落5例、脐炎8例,需二次剪脐5例,肉芽肿及创面不良19例,并发症发生率为46%,观察组无发生脐部出血、线结脱落,脐炎5例,需二次剪脐1例,肉芽肿及创面不良5例,并发症发生率为11%,观察组并发症明显少于对照组,2组比较差异有统计学意义（χ^2=34.149,P〈0.05）。结论改良缝扎断脐法处理水肿脐带可防止断脐后线结滑脱,防止脐部感染,杜绝脐部出血,加速脐部残端干燥。
