肝切除术中涉及肝静脉并发症的处理与预防

Management and prevention of complications associated with hepatic vein during hepatectomy

目的 对肝切除术中涉及肝静脉并发症的原因 ,处理方法及预防措施进行总结 ,减少并发症发生率。方法 对 17例涉及肝静脉并发症的病例进行分析 ,将其分成两类 ,一类为肝静脉破裂导致出血或空气栓塞 ,另一类为肝静脉狭窄导致肝脏血液回流受阻。对其发生的原因、处理经过及预防措施进行总结。结果 12例肝静脉破裂出血或空气栓塞的病人术中均抢救成功。 5例肝静脉狭窄的病人有 3例术中及时处理狭窄得到解除 ,另 2例术后经内科及介入治疗获得缓解。结论 仔细辨认 ,妥善处理肝静脉 ,是防止其破裂的关键。肝脏创面张力较大时应避免将其强行对拢缝合 ,以免压迫肝静脉。

Objective To investigate the causes of complications associated with hepatic vein during hepatectomy and summarize experience in their management and prevention. Methods According to type of damage, 17 cases were divided into 2 groups: hepatic venous rupture in 12 (group A) and hepatic venous obstruction in 5 (group B). The causes, diagnosis and management during or after operation were analyzed in both groups. Results Hepatic venous rupture caused mass bleeding in 11 and air embolism in 1. All the ruptures were immediately repaired and the patients were successfully saved. Hepatic venous obstruction was found and removed during the operation in 3 patients. The other 2 patients with hepatic venous obstruction postoperatively found by MRI or B-mode ultrasonography recovered after conservative therapy. Conclusions It is important to avoid blindly clamping the hepatic vein during resecting the tumor next to the second hepatic hilar and avoid squeezing the hepatic vein upon management of the resecting surface.