【摘要】 传统认为,直肠切除术中发生骶前大出血的原因是由于损伤骶前静脉丛引起。但据临床及解剖学研究发现。尚有骶椎椎体静脉损伤出血的特殊类型。后者可表现远侧骶椎骨盆面上大量出血,或具有一个至多个涌血的静脉骨孔。该类出血的危险性远较骶前静脉丛出血为重,且需及时采用特殊止血措施。本文详述了脊椎静脉系统及其尾端结构的解剖特点及其与骶前出血的关系,并介绍了防治该并发症的初步经验。更多还原

【Abstract】 Presacral haemorrhage has long been considered as a serious complication resulted from the injury of presacral venous plexus during rectectomy. However, the experience in clinical practice and the anatomical study of distal structure of vertebral venous system has led us to consider a new concept about the cause and several other aspects of this complication.Among 323 cases undergone abdomino-perineal rectectomy, serious presacral haemorrhage occured in 16 cases, of which presacral venous plexus was injured in 10 cases and sacral basivertebral veins in the other 6 cases. In these latter patients haemorrhage presented itself as massive cozing form the distal pelvic surface of the sacrum, or bleeding from one to several venous foramens in that area, and often associated with the injury of presacral venous plexus simultaneousty. This special type of bleeding was more dangerous and even life-threatenning, than that from simple injury of presacral venous plexus, and special manipulation was needed for prompt hemostasis.In clinic, the source of massive bleeding during operation, the machanism and the causes of why it is often unable to be controled are three puzzling problems for the surgeons. In this paper the authors studied the features of spinal venous system especially its distal structure and the relationship between these features and the above-mentioned three problems. In addition, the methods of prevention and treatment of presacral haemorrhge have also been discussed.更多还原