腹腔镜结直肠癌手术中意外大量出血的因素及应对措施

腹腔镜结直肠癌手术中意外大量出血的因素及应对措施
丁立腾;潘立强;张骏远
【期刊名称】《海南医学》
【年(卷),期】2014(25)16
【摘要】Objective To investigate the factors involved in intraoperative accidental bleeding in laparoscop-ic colorectal cancer operation and corresponding countermeasures. Methods Clinical data of 180 patients with rectal cancer which accepted laparoscopic operation from May 2009 to May 2013 in our hospital were analyzed retrospec-tively. The intraoperative accidental bleeding volume beyond 100 ml was recorded, and the affecting factors were ana-lyzed and the related treatments were summarized. Results The intraoperative accidental bleeding rate was 14.4%(26/180). Multivariate Logistic regression analysis showed improper intraoperative procedure (OR=1.648, P=0.017), inexperienced knowledge of laparoscopic anatomic structure (OR=1.812, P=0.010) and congenital anatomic variations (OR=1.176, P=0.021) were involved in intraoperative accidental bleeding, with statistical differences (P<0.05). The to-tal success rate of haemostasis was 88.5%(2326), among which hemostasis succeeded in 3 cases (11.5%)of LC con-vertion to laparotomy and 20 cases (76.9%) of endoscopic hemostasis. Conclusion Improper intraoperative proce-dure, inexperienced knowledge of laparoscopic anatomic structure and congenital anatomic variation may result in in-traoperative accidental
bleeding. And reasonable measures should be performed to stop bleeding.%目的：探讨腹腔镜结直肠癌手术中意外大量出血的因素和应对措施。

方法回顾性分析我院2009年5月至2013年5月收治的腹腔镜结直肠癌手术患者180例的临
床资料，记录术中一次性意外出血量≥100 ml的患者情况，分析原因和总结应对
措施。

结果所有患者术中意外大量出血率为14.4%(26/180)；多因素Logistic回
归分析发现，术中操作不当(OR=1.648，P=0.017)、腹腔镜下解剖结构认知水平不佳(OR=1.812，P=0.010)和先天解剖变异(OR=1.176，P=0.021)是术中意外大量出血的因素，差异具有统计学意义(P<0.05)；止血总成功率为88.5%(23/26)，其中术中3例(11.5%)患者中转开腹止血成功，20例(76.9%)镜下止血成功。

结论术中操作不当、腹腔镜下解剖结构认知水平不佳和先天解剖变异均可能导致腹腔镜结直肠癌手术中意外大量出血，应采取合理的措施予以止血。

【总页数】3页(P2366-2367,2368)
【作者】丁立腾;潘立强;张骏远
【作者单位】冀州市中医院外科河北冀州 053200;冀州市中医院外科河北冀州053200;冀州市中医院院办室河北冀州 053200
【正文语种】中文
【中图分类】R735.3+7
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