腹腔镜肝切除术中肝静脉出血的原因分析及防治原则

目的总结腹腔镜肝切除术中肝静脉出血的原因及防治原则。方法检索关于腹腔镜肝切除术中肝静脉出血的原因及防治相关文献,结合自身临床经验进行综述。结果术中肝静脉出血作为腹腔镜肝切除术中最危险的并发症之一,其发生的主要原因包括主观和客观两方面的因素,通过术前的精确评估,术中严谨的态度和精湛的手术技巧,以及术中控制静脉内外压力差可明显降低术中静脉出血的发生率。对已发生的肝静脉出血,术中正确的评估和处理能够将对手术疗效的不良影响降至最低。结论正确理解和认识腹腔镜肝切除术中肝静脉出血的原因,术前及术中做好各项预防和处理技术,才能更安全地开展腹腔镜肝切除手术。

Causes and coping principles of hepatic vein hemorrhage in laparoscopic hepatectomy

Objective To analyze the causes and prevention principles of hepatic venous hemorrhage during laparoscopic hepatectomy.Method Literatures about the causes and prevention of hepatic venous hemorrhage during laparoscopic hepatectomy were collected,and then made an review with our own clinical experience.Results Intraoperative hepatic venous hemorrhage was one of the most dangerous complications during laparoscopic hepatectomy.The main reasons for its occurrence included subjective and objective factors.Through accurate preoperative assessment,rigorous attitude during operation and superb surgical skills,intraoperative control of the prsessure difference between the internal and external veins,could significantly reduce the incidence of intraoperative venous bleeding.For the hepatic vein bleeding that had occurred,the correct evaluation and treatment during the operation could reduce the adverse effect on the surgical efficacy.Conclusion Correctly understand the causes of hepatic venous hemorrhage during laparoscopic hepatectomy,prevent and manage various techniques before and during operation can carry out laparoscopic hepatectomy more safely.