腹腔镜胆囊切除术中肝中静脉属支误伤预防和处理  

Prevention and treatment of injury to branches of the middle hepatic vein during laparoscopic cholecystectomy

作　　者：沈宏亮[1] 江道振[1] 郑向民[1] 仇明[1] 

机构地区：[1]第二军医大学长征医院微创外科中心,上海200003

出　　处：《中国实用外科杂志》2007年第9期713-715,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨腹腔镜胆囊切除术（LC）中胆囊床肝中静脉属支误伤出血的预防和处理方法。方法对2002年3月至2007年3月第二军医大学长征医院在行LC时发现胆囊床显现肝中静脉属支13例的临床资料进行分析。术中图像捕捉后估测其直径,其中4例误伤肝中静脉属支出血,均采用腹腔镜下钳夹出血点两侧血管支或直接缝扎法止血。结果13例术中所见肝中静脉属支直径平均2.4mm（1.6-3.5mm）,4例术中在腹腔镜下止血者和其余病例术后均恢复顺利,无并发症发生。结论LC中要尽量在正确的层次分离胆囊床,以减少肝中静脉属支的损伤。如出现肝中静脉属支损伤,可通过在腹腔镜下钳夹或缝扎有效止血。但中转开腹止血仍应作为腔镜下止血困难时的一种备选措施。Objective To investigate the prevention and treatment of injury to branches of the middle hepatic vein during laparoscopic cholecystectomy. Methods Branches of the middle hepatic vein were found in the gallbladder bed of 13 patients during laparoscopic cholecystectomy in Changzheng Hospital, Second Military Medical University during March 2002 to March 2007. And the pictures of the branches were captured during the operation for measurement of their diameter. In 4 of the patients, injuriy of the branches caused hemorrage, which was controlled by clipping the vessel at both sides of the rupture point or by suturing the ruptured vessel. Results In the 13 cases, mean diameter of the branches was 2.4mm （ 1.6 - 3.5mm）. All the patients, including the four undergoing hemostasis during laparoscopic operation, recovered without complication. Conclusion During laparoscopic cholecystectomy, gallbladder bed should be seperated in the correct plane to avoid injury to branches of the middle hepatic vein. Once injuried,the branches should be clipped or sutured under laparoscopy to effectively control the bleeding. While open surgery is still a choice when the hemostasis is difficult under laparoscopy.

关 键 词：腹腔镜胆囊切除术 肝静脉 

分 类 号：R6[医药卫生—外科学]