腹腔镜肝切除术下腔静脉解剖中的意外及处理  

Approaching the accident cause and remedy of anatomizing the inferior vena cava in laparoscopic hepatectomy

作　　者：袁玉峰[1] YUAN Yu-feng(Department of Hepatobiliary&Pancreatic Surgery,Zhongnan Hospital of Wuhan University,Clinical Medicine Research Center for Minimally Invasive Procedure of Hepatobiliary&Pancreatic Diseases of Hubei Province,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院肝胆胰外科,湖北省肝胆胰疾病微创诊治临床医学研究中心,湖北武汉430071

出　　处：《中国实用外科杂志》2022年第9期990-994,共5页Chinese Journal of Practical Surgery

基　　金：湖北省重点研发计划项目(No.2021BCA114);武汉大学中南医院肿瘤研究与转化平台工程项目(No.ZLYNXM202004)。

摘　　要：腹腔镜肝切除术正在迅速推广普及,这一过程中质量与风险控制尤为重要。术中出血是腹腔镜肝脏手术面临的首要问题,涉及下腔静脉及毗邻肝静脉的损伤或出血往往十分凶险,值得警惕。术前基于个体化病情对涉及下腔静脉解剖及出血风险的预判,选择合理的手术方式、入路及适当的预防措施,是安全实施下腔静脉区域解剖、防止出血的前提。手术当中充分利用腹腔镜足侧视野优势,以肝后下腔静脉前间隙无血管区作为入路核心,按照“由足侧向头侧,由浅入深,稳步推进”的原则以减少意外的发生。一旦发生大出血,手术野的良好显露,冷静、适宜的止血措施,精湛的术者技艺和熟练的团队配合非常重要;慌乱、盲目的止血可能会招致更为严重的出血或其他致命性并发症,应予避免。气体栓塞虽不常见,但可能后果严重,应时刻警惕其发生的可能性。Quality and risk control are paramount in rapidly promoting and popularizing laparoscopic hepatectomy.Intraoperative hemorrhage is the primary problem in laparoscopic liver surgery.Injuries or bleeding involving the inferior vena cava(IVC)and hepatic veins are often hazardous and deserve vigilance.Preoperative pre-judgment of IVC anatomy and bleeding risk based on individualized conditions,selection of a reasonable surgical procedure,approach,and appropriate preventive measures are the prerequisites for the safe implementation of IVC regional anatomy and prevention of bleeding.During the operatio,make full use of the foot-side view of laparoscopic surgery,using the avascular area in the anterior space of the IVC as the core approach.The principle of"from foot side to head side,from shallow to deep and steadily advancing"can reduce accidents.In the event of hemorrhage,good surgical field exposure,calm and appropriate hemostasis measures,superb surgical skills,and tacit teamwork are significant.Frantic and blind hemostasis may lead to more severe bleeding or other fatal complications and should be avoided.Although gas embolism is uncommon,it can have severe consequences,and should always be alert to the possibility of its occurrence.

关 键 词：腹腔镜肝切除 下腔静脉 术中意外 

分 类 号：R6[医药卫生—外科学]