腹腔镜肝切除术肝静脉系统出血处理策略  

Management strategy of hepatic venous system bleeding in laparoscopic hepatectomy

作　　者：郑树国[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所,重庆400038

出　　处：《中国实用外科杂志》2017年第5期485-489,共5页Chinese Journal of Practical Surgery

基　　金：国家卫计委公益性行业科研专项(No.2015SQ00170);第三军医大学西南医院重大领域技术创新项目(No.SWH2016ZDCX2015)

摘　　要：肝静脉系统出血是腹腔镜肝切除术面临的难题之一,其处理重在预防,通过精确术前影像学评估和精细规范的术中镜下操作主动防范出血,尽可能避免出血后的被动处理。强化麻醉管理,采用控制性低中心静脉压技术,加强气腹条件下对CO_2气体栓塞的认知、预防和紧急处理。术中若遭遇肝静脉血管破裂出血,应及时准确判断严重程度及出血是否在可控范围内。在控制、减少出血条件下,显露确认出血的来源血管,及其管径、走行,破裂口位置、大小等,根据静脉血管损伤的类型及严重程度,采取相应措施进行迅速有效止血,必要时及时果断中转开腹处理。近年来,随着对肝脏影像及镜下解剖认识的深入、腹腔镜技术水平的提高、手术经验的积累及手术器械的不断更新,腹腔镜肝切除术肝中静脉系统出血的控制和处理水平及手术安全性已得到明显提升。Hepatic vein bleeding is one of the problems faced in laparoscopic liver resection. It＇ s important that activeprevention of bleeding through accurate preoperative imaging evaluation and meticulous laparoscopic operation, as far as possible to avoid the passive treatment after hemorrhage. Intensive anesthesia management as well as controlled low central venous pressure is necessary for successful operation. Emphasis should be put on the diagnosis, prevention and emergency treatment of C02 gas embolism in the pneumoperitoneum conditions. During the operation, if the hepatic veins injury and bleeding occurred, the severity of bleeding and if it can be controlled laparoscopically should be timely and accurately determined. Once the bleeding has been controlled or reduced, the injured vessel should be isolated, and its diameter, direction and the size and location of the split must be confirmed. Corresponding measures should be applied to make hemostasis rapidly and effectively according to the type and severity of the venous vascular injury, when necessary, conversion to open surgery should be taken rapidly. In recent years, with the accumulation of surgical experiences, the understanding of laparoscopic anatomy of the liver and the constantly updated surgical instruments, the technical level of hepatic vein system bleeding control and treatment during laparoscopic liver resection as well as the safety of the operation has been improved significantly.

关 键 词：腹腔镜 肝切除术 出血 肝静脉 

分 类 号：R65[医药卫生—外科学]