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이중 봉합기 술식 후 문합부 출혈에 대한 단계별 보존적 치료 성적

Step-by-step Management and Treatment Outcome of Bleeding Control for Anastomosis Site after Low Anterior Resection with Double Stapling Technique

대한대장항문학회지 2005년 21권 6호 p.390 ~ 395
김혁문 ( KIm Hyuk-Moon ) - 순천향대학교 의과대학 외과학교실 대장항문클리닉

신응진 ( Shin Eung-Jin ) - 순천향대학교 의과대학 외과학교실 대장항문클리닉
송옥평 ( Song Ok-Pyung ) - 순천향대학교 의과대학 외과학교실 대장항문클리닉
김재준 ( Kim Jae-Joon ) - 순천향대학교 의과대학 외과학교실 대장항문클리닉
장용석 ( Jang Young-Suk ) - 순천향대학교 의과대학 외과학교실 대장항문클리닉
박내경 ( Park Nae-Kyung ) - 순천향대학교 의과대학 외과학교실 대장항문클리닉
백무준 ( Baek Moo-Joon ) - 순천향대학교 의과대학 외과학교실 대장항문클리닉

Abstract


Purpose: This study reviews our experience with a step- by-step management approach of increasing aggressiveness and evaluates the treatment outcome for intraluminal hemorrhage.

Methods: The study group was comprised of patients who had experienced intraluminal hemorrhage after a low anterior resection with the double stapling technique from 1999 to 2003. The choice of management was selected according to our step-by-step management protocol, and the outcomes were evaluated for each step, lincluding mortality and complications.

Nine patients (6 males and 3 females, mean age 55 years) were identified, the mean volume of packed RBC transfusion was 2 pints, and the mean distance of the anastomotic site from the anal verge was 6 cm. The median stapler size was 31 mm. The first step was cold saline irrigation and drainage; four of 9 patients were controlled. The second step was retention enema with topical hemostatics; one of remaining 5 patients stopped bleeding. The third step was colonoscopic hypertonic saline injection around the bleeding site with direct colonoscopic electrocauterization, two of remaining 4 patients were controlled. The last step was suturing the bleeding site through the anus, the remaining 2 patients stopped bleeding. One of the 9 patients developed leakage from the anastomotic site after the last step management, three of the 9 patients had long standing ileus, and one of the 9 patients developed acute renal failure after a massive transfusion. There were no postoperative deaths.

Conclusions: It is safer and easier to control bleeding with step-by-step management system of increasing aggressiveness. J Korean Soc Coloproctol 2005;21:390-395

키워드

직장암;저위 전방 절제술;출혈;봉합기
Rectal cancer;Low anterior resection;Hemorrhage;Stapling
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