巨大右半肝肿瘤切除术时的出血控制

Bleeding Control when Resecting the Huge Tumor Situated in the Right Liver

巨大右半肝肿瘤切除过程中的出血量是决定手术能否成功的关键因素,控制手术过程中出血的技术也是右半肝切除术中的最重要的技术,有效控制术中出血的方法贯穿于整个手术过程中:良好的术前评估,术中于第一肝门处选择性阻断支配右半肝的入肝血流,于第二肝门处切断肝右静脉,于第三肝门处切断肝短静脉,在无血条件下用超声吸引刀切除预定的右半肝以及肝断面的处理等。此方法能有效控制手术过程中出血,保证左半肝血液供应,减轻肝脏缺血/再灌注损伤,减少术后肝功能不全的发生,保证了胃肠道血流的通畅,避免了黏膜屏障受损,全身血流动力学平稳,对其他脏器功能影响小,缩短了手术时间,极大地提高了手术的安全性。

The amount of bleeding is a key factor to determine the success of huge right liver tumor surgery.The technology of bleeding control during surgery is the most important technology in right liver resection.Effective blood loss control method plays an important role throughout the entire surgical process： good preoperative evaluation,Intraoperative procedures like selective block of blood flow to the right liver at the first porta hepatis,cutting off the right hepatic vein at the second porta hepatis,and cutting off the short hepatic veins at the third porta hepatis,as well as resecting resected the predetermined right liverunder no blood condition with ultrasound attract knife and dealing with liver sectional.This method can effectively control blood loss,ensure blood supply to the left half of the liver,reduce the liver ischemia reperfusion injury,reduce the occurrence of postoperative hepatic insufficiency,ensure the patency of the gastrointestinal blood flow,void damage to the mucosal barrier,stable systemic hemodynamic,small impact on the function of other organs,and shorten the operation time,thus greatly improve the security of surgery.