肝叶切除手术出血的处理

Treatment of massive hemorrhage during hepatectomy

目的总结肝叶切除术中并发出血的原因和处理中经验与教训,提高手术安全性.方法回顾性分析48例肝叶切除术中出血原因,对术中出血紧急状态处理、预防出血紧急状态处理和预防出血措施分析讨论.结果出血原因:肝脏解剖不熟悉;手术显露不理想;肝脏肿瘤巨大和位置特殊;肝周严重粘连;过度牵拉;肝疾病种类及合并症.术中出血量:＜300 mL占58.3%、300～500 mL占19.8%、500～800mL占16.7%:＞800mL占5.2%.其中500mL以上11例,直径10 cm以上10例占90%;出血部位:肝短静脉5例,左肝静脉1例,右肝静脉3例,肝断面2例.肝癌病人因合并肝硬化出血率较其他病种高.结论对肝脏占位病灶大,位于第二肝门及肝短静脉附近,尤其是肝癌合并肝硬化,侧支循环建立与开放,手术要重视操作技术,出血紧急方法和预防措施,这些是保证手术安全的重要因素.

[Objective] To exlopre the cause of massive hemorrhage during hepatectomy and increase the operative safety. [Methods] 48 patients were retro-analyzed how to prevent and control massive haemorrhage during hepatectomy. [Results] The patients with bleeding less than 300 mL were 20.5%, 500~800 mL were 16.7%; more than 800 mL were 5.2%. there are 11 patients with bleeding more than 500 mL. The bleeding come from the liver vein in 5 patients, the left liver vein in 1 patients, the right liver vein in 3 patients and the scar of liver in 2 patients. There are more massive haemorrhage in liver cancer patients with cirrhosis than others. [Conclusions] The import successful factors that ensure the hepatectomy safety are the skillful operative technique, effective measures to prevent and control massive hemorrhage during hepatectomy.