肝切除术后出血的临床分析及治疗策略  

Clinical analysis and treatment strategies for post-hepatectomy haemorrhage

作　　者：徐达[1] 王崑[1] 包全[1] 孙谊[1] 王宏伟[1] 金克敏 邢宝才[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所肝胆胰外科恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华肝胆外科杂志》2016年第4期231-235,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：基金项目：国家自然科学基金（81371868）

摘　　要：目的探讨肝切除术后出血（PHH）的临床特点及治疗策略。方法回顾分析北京大学肿瘤医院肝胆胰外一科肝切除手术后发生出血患者的临床资料。结果自2005年1月至2014年12月10年，共有1548例患者接受了肝切除手术，术后出血的发生率为1．6％（25／1548）。在发生出血的25例患者中，76％（19／25）有肝脏基础疾病。主要的肝切除手术方式为：右半肝切除44％（11／25），肝Ⅶ、Ⅷ段切除32％（8／25）。发生出血的中位时间为术后27h，发生出血至二次手术或介入止血的中位时间为3．5h。依据国际肝脏手术协作组肝切除术后出血标准，A级1例，B级16例，C级8例。保守治疗17例，二次手术或介入治疗8例。术后出血患者死亡2例，病死率8％（2／25）。最常见出血部位为肝动脉。结论PHH是肝切除术后的严重并发症，病死率高。大部分PHH为早期出血，患者可通过保守治疗治愈，生命体征不稳者需二次手术止血。术前仔细评估、术中严格止血、术后严密监控、出血后积极治疗可以最大程度降低肝切除术后出血的发生率及病死率。Objective To analyze the clinical data of patients with post-hepatectomy haemorrhage （PHH） and to discuss the treatment strategies. Method The elinicopathologic data of patients with PHH between 2005 -2014 in the HPB Surgery Ward I, Peking University Cancer Hospital, were studied retro- spectively. Results In the study period of 10 years, 25 of 1 548 patients who underwent hepatectomy suf- fered from PHH, and 76% （19/25） of these patients had underlying liver diseases. The common surgical operations followed by PHH were right hemihepatectomy （11/25 ）, and segment Ⅶ/Ⅷ resection （8/25）. The median time for PHH to be diagnosed was 27 h, and the median time from diagnosis of postoperative bleeding to reoperation or intervention was 3.5 h. Using the classification of PHH by the International Study Group of Liver Surgery （ISGLS） , there were 1 patient in grade A, 16 patients in grade B, and 8 patients in grade C. The perioperative mortality of PHH was 8% （2/25）. The most common bleeding site was from the hepatic artery. Conclusions PHH is a serious complication after liver resection, with low occurrence but high mortality. Most patients with PHH can be managed by conservative treatment. Emergency reoperation is required when instability in vital signs appears. Careful evaluation before operation, strict hemostasis during operation, and close monitoring after operation can effectively reduce the incidence and mortality of PHH.

关 键 词：肝切除 术后出血 保守治疗 二次手术 

分 类 号：R657.3[医药卫生—外科学]