第Ⅷ肝段肿瘤切除术中主肝静脉损伤的处理

Management of main hepatic vein injury in hepatectomy for hepatic neoplasm of segment Ⅷ

目的总结第Ⅷ肝段肿瘤切除术中主肝静脉损伤的处理经验。方法对1996年8月至2008年8月12年间作者施术的64例第Ⅷ肝段肿瘤切除合并主肝静脉损伤处理病例资料进行回顾性分析。结果64例中同时涉及肝中与肝右静脉主干损伤者34例，仅肝中或肝右静脉主干损伤者分别为13例、17例。行主肝静脉缝合修补者39例，结扎者12例，直接肝断面对拢缝合者13例。全组手术切除及术中止血均获成功。术后3例活动性出血，其中2例再次手术缝合及纱布填塞止血成功，另1例术后5d放弃治疗并自动出院。结论第Ⅷ肝段肿瘤切除术中主肝静脉损伤是可以合理处理的。具体措施有肝静脉修补、肝静脉结扎、肝断面对拢缝合，术中可根据具体损伤情况灵活选择不同的处理方法。

Objective To summarize the experience in management of main hepatic vein injury due to hepatectomy for hepatic neoplasm of segment Ⅷ. Methods Clinical data of 64 patients suffering from main hepatic vein injury due to hepatectomy of hepatic neoplasm of segment Ⅷ in our hospital from October 1996 to October 2008 were retrospectively analyzed. Results Both the main trunks of the middle and right hepatic vein were injured in 34 patients, single right hepatic vein in 13 and middle hepatic vein in 17. In these patients with hepatic vein injury, the main trunk of the hepatic vein was repaired in 39, vessels ligated in 12 and direct liver wound surfaces sutured in 12. The hepatectomy and hemostasis were successfully performed during operation in all patients. After operation, 3 patients had active bleeding and 2 patients were reoperated on to sew up the bleeding points by wadding with the gelatin sponge and discharged after rehabilitation. One patient gave up treatment and was discharged automatically. Conclusion Main hepatic vein injury in hepatectomy of hepatic neoplasm of segment Ⅷ can be managed effectively by hepatic vein repair, hepatic vein ligation and suture of the liver section that can be chosen to control the bleeding of hepatic vein injury according to the actual conditions.