肝切除术中静脉空气栓塞的防治

PREVENTION AND TREATMENT OF VENOUS AIR EMBOLISM OCCURRING DURING HEPATECTOMY

目的提高复杂肝叶切除术的安全性。方法对3例肝叶切除术并发肝静脉空气栓塞的原因、紧急处理和预防进行总结。结果3例肿瘤均位于第二肝门区,术中气栓均系肝静脉损伤引起,2例进气部位为左肝静脉,1例为右肝静脉。每个病人都经历了先是呼气末二氧化碳分压降低、紧接着血氧饱和度降低的共同过程。3例均于术中救治成功,2例术后恢复顺利,1例术后第7天死于呼衰及肝衰。结论持续呼气末二氧化碳分压监测对术中气栓有早期临床诊断意义。全肝血流阻断或肝静脉阻断是有效的预防手段。应重视手术适应证的选择、手术操作和方法的改进以及各种应急处理的果断实施。

Objective To improve the security of complicated hepatectomy. Methods The common causes, emergent steps and preventive measures of venous air embolism occurring during hepateetomy were summarized. Results Liver tumors of three pa- tients all involved the second porta hepatis, and intraoperative venous air embolism （VAE）was caused by injury to hepatic veins with laceration of the left hepatic vein in 2 cases and the right hepatic vein in 1 case. After VAE occurred, end-expiratory partial pressure of carbon dioxide decreased first, and then decrease of oxygen saturation of blood followed. Three patients were all rescued successfully; two patients recovered uneventfully after operation, and one patient died of respiratory failure and hepatic failiure on postoperative day 7. Conclusions Continuous end-expiratory CO2 monitoring can be used to diagnose venous air embolism at an early stage. Total hepatic vascular occlusion or selective hepatic venous occlusion attends to be an effective preventive measure against VAE. Adequate attention should be paid to the appropriate choice of surgical indications, improvement of surgical technique and resolute adoption of emergent measures.