肝切除术后凝血功能障碍大出血的防治体会

Prevention and treatment of severe hemorrhage from coagulation disorders after hepatectomy.

目的 探讨肝切除术后凝血功能障碍导致大出血的原因和防治方法。方法 以术后出血量超过2500ml为大出血标准，对6例巨大肝脏肿瘤切除术后早期出现凝血功能障碍性大出血患者采用纠正凝血功能紊乱为主的综合治疗方法，配合手术巩固止血。结果 以纠正凝血功能紊乱为主的综合治疗3例，均治愈；配合手术治疗3例，治愈2例，死亡1例。结论 肝脏手术后，凝血功能障碍导致的大出血重在预防，再次手术探查要慎重，手术时机要准确，以手术巩固止血和纠正凝血功能紊乱为主的综合治疗可取得较好疗效，如果只注重手术止血，常事与愿违。

Objective To explore the causes of severe hemorrhage from coagulation disorders after hepatectomy and ways for prevention and treatment. Methods The severe hemorrhage was defined as the amount of bleeding over 2500 ml. A retrospective analysis was made on 6 cases with serious hemorrhage from coagulation disorders following hepatectomy of the huge liver tumors. A combined therapy was adopted to mainly correct the coagulation disorder and surgery used to assist hemostasis. Results Three cases were treated with the combined therapy and all cured. The other cases were treated and assisted with surgery and 2 cured and 1 died. Conclusion Prevent severe hemorrhage from coagulation disorders should be made after hepatectomy. The combined therapy of correction of the coagulation disorder, assistant hemostasis and secondary surgery if necessary should be applied.