腹腔镜肝切除术中严重CO2栓塞的处理  

Treatment of C02 embolism in laparoscopic hepatectomy

作　　者：吴宝强[1] 屈振[1] 胡俊 刘文松[1] 江勇[1] 孙冬林[1] Wu Baoqiang;Qu Zhen;Hu Jun;Liu Wen-song;Jiang Yong;Sun Donglin(Department of Hepatobiliary and Pancreatic Surgery,the First People＇s Hospital of Changzhou,the Third Affiliated Hospital of Soochow University,Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院常州市第一人民医院肝胆胰外科,常州213003

出　　处：《中华肝胆外科杂志》2018年第8期518-521,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨腹腔镜肝切除术（LH）中严重CO2栓塞的诊断和处理。方法回顾性分析2016年6月-2017年11月80例LH患者，特别是其中4例并发严重CO：栓塞患者的临床资料。结果80例患者手术时间65～345min，平均170min。术中出血量50～2500ml，平均450ml；输血者有28例，占35．0％（28／80）。因无法控制术中出血而中转手术者2例。4例发生严重CO2栓塞导致循环、呼吸明显改变者经积极有效处理，均未中转开腹，术后恢复良好。结论LH术中必须有CO2栓塞意识，并做好准备。一旦突发循环、呼吸改变应想到并发严重CO2栓塞可能，及时有效的处理能化险为夷。Objective To study the diagnosis and treatment of CO2 embolism in laparoscopic hepa- tectomy （LH）. Methods A retrospective study was conducted on 80 patients who underwent various types of LH from June 2016 to November 2017. The clinical data of 4 patients who suffered from severe CO2 embolism were analyzed. Results The operation time of 80 patients varied from 65 min to 345 min （ average 170 min）. The amount of blood loss ranged from 50 ml to 2 500 ml （average 450 ml）. 28 patients （35%） required blood transfusion. Two patients were converted to open operation because of uncontrollable bleeding. Four patients suffered from severe CO2 embolism with significant changes in circulation and respiration. After active and effective treatment, none required open conversion and all recovered well. Conclusions Any sudden respiratory and circulatory changes during LH should lead us to think of severe CO2 embolism. Timely and effective treatment could convert a dangerous situation to become safe.

关 键 词：腹腔镜肝切除 CO2栓塞 经食管超声心动图 

分 类 号：R657.3[医药卫生—外科学]