黏附于胆囊床的肝中静脉损伤是腹腔镜胆囊切除术胆囊床大出血的危险因素  

Middle hepatic vein adjacent to gallbladder bed is the risk factor of extensive hemorrhage from gallbladder bed during laparoscopic cholecystectomy

作　　者：武小宪[1] 李一民[1] 王岩任 武军 王永兴[1] 

机构地区：[1]解放军第二五三医院普通外科,呼和浩特市010051 [2]解放军第二五三医院特诊科,呼和浩特市010051

出　　处：《中华肝胆外科杂志》2003年第3期147-149,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的　探讨黏附于胆囊床的肝中静脉与腹腔镜胆囊切除术术中胆囊床大出血的关系。方法　彩色多普勒超声波用于术后对 2例腹腔镜胆囊切除术术中胆囊床静脉出血原因的检查 ,并检查了 2 0 0例健康自愿者胆囊床与肝中静脉属枝的解剖关系。结果　在出血的 2例病人中 ,发现损伤的肝中静脉较大的属枝紧邻近于胆囊床。 2例均需中转开腹手术来控制出血。在 2 0 0例门诊体检人员中有 18例其肝中静脉属枝完全附着于胆囊床上 ,有 10例其直径 3 0～ 3 8mm ,自胆囊床 1 0mm处穿过。结论　具有肝中静脉较大属枝邻近胆囊床的病人在行腹腔镜胆囊切除时具有出血的危险。在术前可用超声检查确定之。Objective To investigate the relationship between middle hepatic vein adjacent to gallbladder bed and extensive hemorrhage from the gallbladder bed during laparoscopic cholecystectomy. Methods Color Doppler ultrasonography was used to determine the cause of postoperative extensive hemorrhage from gallbladder bed during laparoscopic cholecystectomy in 2 patients as well as the relationship between the gallbladder bed and branches of the middle hepatic vein in 200 healthy volunteers. Results The injury to a large branch of middle hepatic vein adjacent to gallbladder bed was found in the 2 patients. Meanwhile, conversion to open cholecystectomy was performed in the 2 patients to control bleeding. The branch of the middle hepatic vein completely adhered to the gallbladder in 18 of the 200 volunteers. Of these 20 healthy volunteers, the diameter of the branch of the middle hepatic vein was 3 0～3 8 mm and the branch transversed as close as 1 0 mm from the gallbladder bed in 10. Conclusions Patients with large branches of the middle hepatic vein close to the gallbladder bed are at risk of hemorrhage during laparoscopic cholecystectomy and should be identified preoperatively with ultrasonography.

关 键 词：术中并发症 炎症 肝中静脉 腹腔镜胆囊切除术 胆囊床出血 

分 类 号：R657.4[医药卫生—外科学] R63[医药卫生—临床医学]