腹腔镜肝切除术中二氧化碳栓塞的原因与处理

The causes and management of carbon dioxide embolism in laparoscopic hepatectomy

目的探讨腹腔镜下肝切除术时患者二氧化碳（CO2）栓塞的术中处理对策。方法回顾性分析苏州大学附属第三医院2013年1月至2017年8月各类腹腔镜下肝切除术共321例患者资料。CO2气体栓塞主要依据术中呼气末二氧化碳分压（PetCO2）及血氧饱和度（SPO：）迅速降低并伴有快速性心律失常诊断。结果术中发现有临床症状的气体栓塞共12例，发生率为3．7％。其中10例腹腔镜下妥善处理，2例中转开放后完成手术。结论CO2气体栓塞在腹腔镜肝切除术患者中并不少见，目前尚无办法杜绝，特别是患者合并肝硬化时。术中精细操作及谨慎处理是预防CO2气体栓塞的最好办法。

Objective To investigate the strategies in dealing with intraoperative CO2 embolizm dur- ing Laparoscopic hepatectomy （LH）. Methods We collected and analyzed data from patients who under- went laparoscopic hepatectomy （LH） in our hospital from Jan. 2013 to Aug. 2017. There were 321 pa- tients. The criteria for the diagnosis of CO2 embolism were rapid intraoperative decrease in PetCO2 and SPO2 accompanied with tachyarrhythmia. Results 12 patients were diagnosed to have CO2 embolism. The rate was 3.7%. For these 12 patients, 10 patients were dealt with laparoscopically and 2 patients were converted to open surgery. Conclusion CO2 embolism did not rarely occur in LH patients. Sophisticated operations and careful manipulation in LH are the only ways to prevent CO2 embolism.