Prevention and Management of Massive Pelvic Hemorrhage in Radical Operations for Rectal Carcinoma
10.3969/j.issn.1007-9610.2001.01.018
- VernacularTitle:直肠癌术中盆腔大出血的预防和处理
- Author:
Fanghai HAN
1
;
Zhaoda ZHANG
;
Gaohong DONG
Author Information
1. First University Hospital West China University of Medical Sciences
- From:
Journal of Surgery Concepts & Practice
2001;6(1):43-45
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To summarize the experience in the management of massive pelvic hemorrhage during radical operations for rectal carcinoma. Methods: From August 1993 to April 2000, 627 patients underwent radical operations for rectal carcinoma. Massive pelvic hemorrhage occurred in 12 cases, including injury of the presacral venous plexus in 6 cases, of the sacral intervertebral vein in 1 case, of the branches of internal iliac artery or vein in 2 cases, of the common iliac vein in 1 case. Prophylaxis and treatment: The operator should master the anatomy of pelvic cavity, dissect alongside anatomical spaces, protect well the presacral venous plexus, and manage the lateral ligament close to the falciform fascia, medial to the internal iliac artery. If the vagina or the prostate is infiltrated, resection is carried out by cutting and suturing alternatively. If the pelvic wall is slightly involved, branches of the internal iliac artery and/or vein should be ligated while excising the lymph nodes. Hemostatic nail pressing, sponge pressing, blood vessel transfixion-suture, or angiorrhaphy could be used according to the site and the severity of the hemorrhage. Results: The rate of massive hemorrhage was 1.91% in this series. The amount of bleeding volume was less than 150ml in 5 cases, 150～500ml in 6 cases and >500ml in 1 case. The Miles procedure was performed in 3 cases and sphincter-preserving operations in 6, no mortality occurred during surgery. Conclusions: Dissection according to anatomy is recommended in order to prevent massive pelvic hemorrhage during radical surgery for rectal carcinoma. Nail pressing, sponge pressing and angiorrhaphy could be selectively used while massive hemorrhage occur.
