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Subarachnoid venous hemorrhage in a patient with retrograde cerebral perfusion during surgery for a thoracic aortic aneurysm
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Presacral venous hemorrhage is a severe complication in low rectal surgery.
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Controlled Tamponade of Severe Presacral Venous Hemorrhage
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This technique may be applicable in similar cases when tamponade is required for uncontrolled venous hemorrhage.
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This newly designed hemorrhage occluder pin may represent an improved method of controlling presacral venous hemorrhage.
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| Objective:Hemorrhage from the gallbladder bed during laparoscopic cholecystectomy is caused by the injury to the branch of the middle hepatic vein.Detecting the relationship of the middle hepatic vein and the gallbladder bed before operation by Color Doppler ultrasonography can diminish the occur of extensive venous hemorrhage.Methods:Color Doppler ultrasound was used to examine the diameter of the vein at the C point and the distance between the gallbladder bed and the C point,which was defined as the... Objective:Hemorrhage from the gallbladder bed during laparoscopic cholecystectomy is caused by the injury to the branch of the middle hepatic vein.Detecting the relationship of the middle hepatic vein and the gallbladder bed before operation by Color Doppler ultrasonography can diminish the occur of extensive venous hemorrhage.Methods:Color Doppler ultrasound was used to examine the diameter of the vein at the C point and the distance between the gallbladder bed and the C point,which was defined as the point on the branch of the middle hepatic vein closest to the gallbladder bed in 136 cases.Results:Distance between the gallbladder bed and the C point was varied,16 cases were 0(11.8%),and diameter in 2-3mm were common(49/136,36%).Conclusions:Anatomically,the middle hepatic vein is known to extend close to the gallbladder bed,if the branch of the middle hepatic vein is rather large and adherent,especially the distance between the gallbladder bed and the C point were less than 1cm,detected by Color Doppler ultrasound before laparoscopic cholecystectomy,extreme care should be taken during operation in order to decease the likelihood of the injury to the branch of the middle hepatic vein. | 目的 :腹腔镜胆囊切除术因胆囊床受损引起的出血与术中损伤肝中静脉的分支有关 ,彩色多普勒检查术前了解肝中静脉与胆囊床的关系 ,以减免术中因损伤肝中静脉而大量出血以致中转的后果。方法 :136例拟行腹腔镜胆囊切除术患者术前用彩色多普勒寻找其与胆囊床的最密切的分支 ,测量至胆囊床的距离及该处内径。结果 :136例患者肝中静脉分支 C点至胆囊床的距离各异 ,有 16例为 0 (占 11.8%)。该处的内径个体差异也很大 ,以 2～ 3mm者最多 ,占 36 %(4 9/136 )。结论 :由于肝中静脉分支与胆囊床关系密切 ,彩色多普勒技术在腹腔镜胆囊切除术前可及时、准确地报告肝中静脉的分支与胆囊床的关系 ,其分支若很粗或与胆囊床紧贴 ,特别是 C点至胆囊床的距离≤1cm的患者 ,只要在术中仔细操作 ,即可避免术中因损伤肝中静脉的分支而出血的发生。 | Objective To investigate the cause of hemorrhage from the gallbladder bed during laparoscopic cholecystectomy.Methods Color Doppler ultrasound was used to examine the cause of venous hemorrhage from the gallbladder bed during laparoscopic cholecystectomy in a patient postoperatively and to examine the anatomic relationship between the gallbladder bed and branches of the middle hepatic vein in 91 patients preoperatively. Results There was a major branch of the middle hepatic vein close to the gallbladder... Objective To investigate the cause of hemorrhage from the gallbladder bed during laparoscopic cholecystectomy.Methods Color Doppler ultrasound was used to examine the cause of venous hemorrhage from the gallbladder bed during laparoscopic cholecystectomy in a patient postoperatively and to examine the anatomic relationship between the gallbladder bed and branches of the middle hepatic vein in 91 patients preoperatively. Results There was a major branch of the middle hepatic vein close to the gallbladder bed. The branch of the middle hepatic vein was completely adherent to the gallbladder bed in 14 of 91 patients(15 4%). The mean distance between the closest point of the middle hepatic vein and the gallbladder bed was 5 0±4 6?mm, and the mean diameter of this point was 3 2±1 1?mm. Conclusions Patients with large branches of the middle hepatic vein close to the gallbladder bed are at risk of hemorrhage during laparoscopic cholecystectomy and should be identified preoperatively with ultrasound. | 目的 探讨腹腔镜胆囊切除术中胆囊床出血的原因。方法 对 2 0 0 0年 9月～ 2 0 0 1年 3月接受腹腔镜胆囊切除手术的 617例患者中 ,发生胆囊床出血的病例进行回顾性分析 ,并随机选取其中 91例进行前瞻性研究。结果 多普勒超声检查均发现有 1根肝中静脉的重要分支从胆囊床后面通过 ,该血管离胆囊床的最近距离点 (C点 )到胆囊的平均距离为 ( 5 0± 4 6)mm ,其中 15 4 % ( 14例 )肝中静脉是直接和胆囊床相贴 ,11 0 % ( 10例 )和胆囊床的距离在 1mm以内 ,C点的内径为 ( 3 2± 1 1)mm ;约有 3 4 7% ( 3 1例 )C点位于胆囊纵轴左侧 ,位于右侧的有 3 9例 ( 4 2 9% ) ,正好落在胆囊纵轴上的有 2 1例 ( 2 3 1% )。C点肝静脉的流速为 ( 9 9± 3 3 )cm/s。结论 肝中静脉最靠近胆囊点 ,较多会出现在胆囊纵轴的右侧。建议在术前 ,尤其是在腹腔镜胆囊切除术前进行常规的多普勒超声检查 ,以明确肝中静脉和胆囊床的关系 ,高度重视肝中静脉和胆囊床直接相贴的病例。 | Objective To summarize the methods for preventing and treating the presacral venous hemorrhage in the surgery of rectum cancer. Methods The patients undergoing the radical surgery of rectum cancer from June 1983 to June 2002 were analyzed retrospectively. Of the 6 patients with presacral venous hemorrhage introperatively, 5 patients underwent Miles operation and one Dixon operation. The introperative blood loss was under 800 ml in 2 of 6 patients, 800～ 2 500 ml in 3 patients, >2 500 ml ... Objective To summarize the methods for preventing and treating the presacral venous hemorrhage in the surgery of rectum cancer. Methods The patients undergoing the radical surgery of rectum cancer from June 1983 to June 2002 were analyzed retrospectively. Of the 6 patients with presacral venous hemorrhage introperatively, 5 patients underwent Miles operation and one Dixon operation. The introperative blood loss was under 800 ml in 2 of 6 patients, 800～ 2 500 ml in 3 patients, >2 500 ml in 1 patient. On the basis of the bleeding site and tumor conditions, metallic thumbtack packing and packing with carbasus were adopted to control the bleeding. Results No further bleeding occurred. No patients died due to bleeding. Six patients fully recovered from the operation. Conclusion The main reason for presacral venous hemorrhage is tumor infiltration and incorrect procedure. Dissecting the presacral structure carefully is the key point of preventing presacral venous hemorrhage in the surgery of rectum cancer. Packing with carbasus is an effective method to treat the presacral venous hemorrhage. | 目的 总结直肠癌根治手术中骶前静脉出血的预防和处理方法。方法 对 1 983年 6月～ 2 0 0 2年 6月我院完成的直肠癌根治术进行回顾性分析 ,发生术中骶前静脉出血病例 6例 ,行Miles术 5例 ,Dixon术 1例 ,术中失血量 <80 0ml 2例 ,80 0～ 2 5 0 0ml 3例 ,>2 5 0 0ml 1例 ,根据出血的部位及肿瘤情况采用图钉按压止血法以及纱布填塞压迫止血法止血。结果 止血后未再发生出血 ,无因出血而死亡病例 ,6例病人均痊愈出院。结论 肿瘤的浸润及手术操作不当是导致骶前静脉丛出血的主要原因 ,直肠癌根治手术中按骶前解剖层次正确操作是预防术中骶前静脉丛出血的关键 ,纱布条填塞压迫止血是处理骶前静脉丛出血行之有效的方法 | | |
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