摘要
目的:总结肝癌切除术中防治大出血的经验,提高手术安全性和彻底性。方法:对本院近10年36例手术中和术后并发大出血病例进行总结,对其发生的原因、出血部位和应急处理及如何预防等进行分析和讨论。结果:大出血的常见原因:①术野显露差;②过度牵拉肝脏撕破大血管;③肝内解剖不熟判断失误;④术野粘连严重和操作粗疏;⑤创面处理不当等。损伤血管多发部位依次为:肝短静脉(19.0%)、肝右静脉(16.7%)、肝中静脉(14.3%)、瘤体破裂(11.9%)、下腔静脉和右肾上腺静脉(各9.5%)、肝创面(7.1%)、肝动脉或门静脉支(4.8%)、左肝静脉(2.4%)、其他(4.8%);术中出血26例,平均出血量1896.5ml; 13例术后继发出血(其中3例术中止血,术后再继发出血),9例再手术的平均出血量为1120ml,4例继发出血保守疗法治愈。本组无术中死亡,术后1个月内死亡4例。结论:应重视难治性肝癌手术切除的适应证选择、手术操作技术、应急处理措施和围手术期监护处理等,其是保证手术安全性的重要因素。
Objective: To learn lessons by summarizing the experience gained in the management of massive bleeding during liver resections. Methods: Thirty-six cases of massive intraoperative and postoperative bleeding occurred during the past 10 years; their common causes and sites, emergent management and preventive measures were studied. Results: The common causes of massive bleeding were: ①inadequate surgical exposure; ②tearing of major blood vessels due to excessive traction on the liver; ③familiarity with the liver anatomy; ④inadvertent surgical technique; ⑤improper management of resection surface. The common sites of bleeding were: short hepatic veins(19.0%), right hepatic vein(16.7%), middle hepatic vein(14.3%), rupture of tumor(11.9%), inferior vena cava(9.5%), right suprarenal vein (9.5%), raw surface of hepatic resection(71%), hepatic hilus(4.8%), left hepatic vein(2.4%) and other .sites(4.8%). The mean amount of intraoperative bleeding volume was 1896.5ml in 26 cases; the mean amount of bleeding volume in 9 cases of emergent re-exploratory surgery after hepatic resection was 1120ml; 4 cases of secondary hemorrhage were stopped by conservative means. There was no death during operation, while 4 cases died within one month after operation with a mortality rate of 0.062%. Conclusions: In order to ensure security during difficult hepatic resections, attention should be paid to the choice of appropriate surgical indications, adoption of meticulous surgical technique and perioperative care.
出处
《外科理论与实践》
2000年第4期241-244,共4页
Journal of Surgery Concepts & Practice
关键词
肝肿瘤
切除术
并发症
大出血
防治
Liver neoplasm Resection Complications Massive hemorrhage Preventive measures