肝切除术并发胸腔积液的影响因素分析及诊治体会

目的：探讨肝切除术后并发胸腔积液的影响因素及防治方法。方法：回顾分析123例肝切除术后并发胸腔积液35例患者的临床资料。35例胸腔积液患者均予以保肝、营养支持及利尿治疗；对其中10例中等量以上积液者同时采用B超定位下胸腔穿刺引流治疗，3例合并膈下积液者行膈下积液穿刺引流并加强抗感染治疗，3例合并肺部感染者依据药敏加强抗感染及排痰治疗。结果：本组肝切除术后胸腔积液发生率为28．5％（35／123）；其发生与患者术前肝功能、肝切除量、术中肝门阻断时间及术后腹水量有关（P〈0．05），与患者的性别、年龄无关（P〉0．05）。35例中，治愈34例；另1例治疗过程中出现肝衰，并发多脏器功能衰竭死亡。结论：胸腔积液是肝切除术后的常见并发症。严格掌握肝切除术适应证、控制肝切除范围，加强术前术后保肝治疗，根据积液量和合并症情况选择合适的治疗方案，对于胸腔积液的预防和治疗具有十分重要的意义。

Factor Analysis and Treatment Experience of Pleural Effusion after Hepatectomy

Objective：To investigate the influencing factors of pleural effusion after hepatectomy, and discuss the methods for preventing and treating this complication. Methods：The clinical data from 35 patients suffering from pleural effusion after hepatectomy was analyzed retrospectively, all these patients accepted nutritional support, liver - protecting and diuretic therapy. Moreover, lO patients with hydrothorax over medium volume received thoracentesis and draining under B -mode uhrasonography; 3 cases with subphrenic effusion accepted drainage and anti - infective therapy ; 3 cases with pulmonary infection were treated by expectoration and Anti-infective therapy on the evidence of antimicrobial susceptibility. Results：The incidence of pleural effusion after hepatectomy was 28.5% （35/123）in this study, which related to preoperative liver function, liver residuum, blockage time of hepatic hilum, and postoperative ascetic volume （ P 〈 0. 05 ）, did not relate to the pateints＇ sex and age（P 〉0.05）. Thirty-four patients were healed well, and another patient showed liver func- tion failure during the operation, and then died of muhiorgan dysfunction syndrome. Condusions：Pleural effusion is a common complication after hepatectomy, which could be prevented and treated by having an intimate knowledge of the indications of hepatectomy, controlling the size of resected hepatic tissue, strengthening the liverprotecting therapy before and after the operations, ehosing the appropriate therapy according to the volume of pleural effusion and complications.