肝癌切除术并发大出血的原因及处理

Causes and treatment of burst bleeding in liver cancer resection

目的 总结肝癌切除术中并发大出血的原因和处理中的经验与教训 ,提高手术的安全性和彻底性。方法 对 19992 0 0 2年 43例术中、术后并发大出血病例的病因、出血部位和应急处理以及预防进行分析讨论。结果 大出血的原因 :( 1)术野显露差 ;( 2 )过度牵拉肝脏撕裂大血管 ;( 3 )术野粘连 ,操作粗疏 ;( 4 )判断失误 ,误伤大血管 ;( 5 )创面处理不当。发生于肝短及肝后下腔静脉区域、肝右静脉为最多。发生率 :肝短静脉 2 2 4% ,肝右静脉18 4% ,肝创面 16 3 % ,肝中静脉 12 2 % ,肝后段腔静脉 10 2 % ,瘤体破裂 6 1% ,肝左静脉 6 1% ,门静脉支、肝动脉支 4 1% ,其他 4 1%。结论 对高难度肝癌的手术切除应重视适应证选择、手术操作技术 ,应急措施和围手术期处理等 。

Objective To make hepatic resection more safe and radical through summarizing the experience of how to prevent and treat burst bleeding in operation. Methods From 1999 to 2002,43 cases of intraoperative and postoperative burst bleeding occurred;their common causes and sites,emergent treating ways and prevention steps were studied.Results Common causes of burst bleeding were:1.Bad exposure of surgical field;2.Tearing major vessels due to pulling liver excessively;3.Severe adhesion and careless surgical technique;4.Being unfamiliar with the liver anatomy leading to an error judgment;5.Improper disposal of resection surface.Common sites of burst bleeding were:short hepatic vein (22 4%),right hepatic vein (18 4%),surface of hepatic resection (16 3%),middle hepatic vein (12 2%),posthepatic inferior vena cava (10 2%),rupture of a tumor (6 1%),left hepatic vein (6 1%) ,branches of hepatic artery and portal vein (4 1%),and others (4 1%).Conclusion To ensure a difficult hepatic resection safe,we should pay attention to the choice of surgical indication,meticulous surgical technique,emergent treating way and perioperative care and management.