肝切除术并发流出道梗阻的防治  

Prevention and treatment of hepatic venous outflow obstruction after hepatectomy

作　　者：潘泽亚[1] 刘辉[1] 周伟平[1] 李爱军[1] 傅思源[1] 唐庆贺[1] 吴伯文[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外三科,上海200438

出　　处：《中国医学工程》2008年第1期5-8,共4页China Medical Engineering

摘　　要：目的加深对流出道梗阻这一并发症的认识,提高复杂肝切除术的安全性。方法对5例肝切除术并发流出道梗阻的原因、临床表现和防治进行总结。结果5例肿瘤均位于第二肝门区,3例术中发生,表现为肝创面出血难止、肝肿大,经切除失去肝静脉引流的肝段后血止,术后恢复顺利;2例术后发生,表现为胸腹水、肝脾肿大、下肢水肿等典型布-加氏综合征症状,1例经内科保守治疗治愈,1例经球囊导管行血管狭窄段扩张治愈。结论术中预防流出道梗阻的关键是使主肝静脉(或下腔静脉)免受损伤性或压迫性狭窄;术后治疗的有效手段是用球囊对狭窄段行反复扩张或行内支架管置入术。[Objective] To give an insight to hepatic venous outflow obstruction after hepatectomy and to improve the security of complicated hepatectomy. [Methods] The common causes, clinical manifestation, and preventive and therapeutic measures of hepatic venous outflow obstruction following hepatectomy were summarized. [Results] Liver tumors of five patients were all involved the second porta hepatis. Hepatic venous outflow obstruction was diagnosed in 3 patients with the common manifestation of hepatomegaly and unmanageable oozing of blood from resection surface. Hemostasis was obtained in these 3 patients by resecting the hepatic segment losing blood backflow, and these 3 patients recovered uneventfully after operation. Hepatic venous outflow obstruction was diagnosed after operation in 2 patients with typical clinical manifestation of Budd-chiari syndrome including ascites, thorax, hepatomegaly, splenomegaly, and edema of lower extremities. One patient was cured by conservative medical treatment; another patient was cured by pereutaneous balloon catheter angioplasty. [Conclusions] In operation the key point in pre- venting hepatic venous outflow obstruction is to avoid stenosis of the main hepatic veins or inferior vena cava due to injury or compression. After operation valid treatment is percutaneous balloon catheter angioplasty or hepatic vein （or infereior vena cava） stenting.

关 键 词：肝切除术 肝静脉流出道梗阻 

分 类 号：R657.3[医药卫生—外科学]