腹腔镜胆囊切除术中肝中静脉属支损伤的预防及处理

腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中手术区域的出血是困扰外科医生的一个重要问题.除了胆囊动脉破裂之外,由胆囊床引发的出血也是LC术中常见的出血原因之一,而其中位于胆囊床后方肝中静脉属支的破裂所导致的胆囊床出血则更是术中非常棘手的问题,这不仅会使原本简单的手术复杂化,模糊手术区域的解剖结构,还往往可导致严重的手术并发症,是构成Lc术中转开腹的主要因素之一.本文就肝中静脉属支的局部解剖、损伤后的处理及损伤的预防进行综述.

Prevention and management to the injure of the branches of the middle hepatic vein during laparoscopic cholecystectomy

The hemorrhage during laparoscopic cholecystectomy (LC) in operating field is a significant puzzle worries the surgeon. Besides disrupting the cystic artery hemorrhage originating from the gallbladder bed also plays a frequent role in the cause of bleeding in LC. The gallbladder bed bleeding which results from the disrupt of the branches of the middle hepatic vein is a ticklish problem in the operation. It will complicate the surgical operation, confuse the anatomic structttre, cause serious complications and is a main reason for conversion. Thus, we compose this review to expound the topographic anatomy of the branches of the middle hepatic vein as well as the prevention and treatment to the injure of the branches of the middle hepatic vein.