腹腔镜肝切除术肝静脉系统出血处理策略

发布时间：2018-07-12 21:41

本文选题：腹腔镜 + 肝切除术　；参考：《中国实用外科杂志》2017年05期

【摘要】：肝静脉系统出血是腹腔镜肝切除术面临的难题之一,其处理重在预防,通过精确术前影像学评估和精细规范的术中镜下操作主动防范出血,尽可能避免出血后的被动处理。强化麻醉管理,采用控制性低中心静脉压技术,加强气腹条件下对CO_2气体栓塞的认知、预防和紧急处理。术中若遭遇肝静脉血管破裂出血,应及时准确判断严重程度及出血是否在可控范围内。在控制、减少出血条件下,显露确认出血的来源血管,及其管径、走行,破裂口位置、大小等,根据静脉血管损伤的类型及严重程度,采取相应措施进行迅速有效止血,必要时及时果断中转开腹处理。近年来,随着对肝脏影像及镜下解剖认识的深入、腹腔镜技术水平的提高、手术经验的积累及手术器械的不断更新,腹腔镜肝切除术肝中静脉系统出血的控制和处理水平及手术安全性已得到明显提升。
[Abstract]:Hemorrhage of the hepatic venous system is one of the difficult problems facing laparoscopic hepatectomy. Its treatment is to prevent bleeding by accurate preoperative imaging evaluation and fine standardized operation under the intraoperative mirror. It is possible to avoid passive treatment after bleeding. The management of anesthesia is strengthened, controlled low central venous pressure is used to strengthen the pneumoperitoneum condition. The cognition, prevention and emergency treatment of CO_2 gas embolism. If the hepatic vein ruptured bleeding is encountered during the operation, it should be timely and accurate to determine whether the severity and bleeding are in the controllable range. Under the control and reduction of bleeding conditions, the blood vessels that confirm the bleeding, its diameter, the position of the rupture, the size of the rupture, and so on, according to the vascular injury of the veins. In recent years, with the deep understanding of the imaging and microscopic anatomy of the liver, the improvement of the technical level of the laparoscopy, the accumulation of surgical experience and the non break up of the surgical instruments, and the hemorrhage of the middle hepatic vein in the laparoscopic hepatectomy. The level of control and treatment and surgical safety have been significantly improved.
【作者单位】：第三军医大学西南医院全军肝胆外科研究所;
【基金】：国家卫计委公益性行业科研专项(No.2015SQ00170) 第三军医大学西南医院重大领域技术创新项目(No.SWH2016ZDCX2015)
【分类号】：R657.3

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