摘要
目的 分析肝切除术中大出血的原因并探讨其防治策略。 方法 以术中出血量达到或超过 10 0 0ml为大出血标准 ,回顾性分析 195 5～ 2 0 0 0年 436 8例肝切除术大出血的原因及处理。结果 436 8例肝切除术中 ,2 86例 ( 6 5 %)发生术中大出血。主要原因是大血管损伤、肝硬化门静脉高压症、肝功能不良及肿瘤与周围脏器的广泛粘连等。处理方法 :修补、缝扎损伤的血管 ;缝扎或离断出血的曲张静脉 ;彻底结扎肝断面血管并褥式缝合肝断面 ;阻断肝门 ,快速切除破裂的肿瘤等。术中输注纤维蛋白原、创面热盐水湿敷和 (或 )涂抹生物胶以及氩气刀热凝、纱布填塞压迫等。 结论 轻柔操作、避免强力牵拉肝脏可减少损伤大血管或肿瘤破裂所致的大出血 ;常温下第一肝门阻断可有效减少切肝时的出血量 ;癌肿与周围器官或组织广泛粘连者宜采用原位肝切除术 ;凝血机制异常而致的创面广泛渗血 ,大纱布填塞压迫仍是一种有效的止血方法。
Objective To analyse the causes and the management of massive hemorrhage in hepatectomy. Methods With over 1 000 ml of bleeding, 4 368 patients with hepatectomy between 1955 and 2000 were analysed retrospectively. Results Among 4 368 patients receiving hepatectomy, 286 (6.5%) had massive hemorrhage because of damage to the major hepatic veins, portal hypertesion, hepatic insufficiency, and the extensive adhesion around the tumor. Massive hemorrhage was managed by repair and transfixation of the damaged vessels; transfixation or devascularization of variceal bleeding; complete vessels ligation of the hepatic section with mattress suture; resection of the ruptured tumor after temporary occlusion of the porta hepatis; fibrinogen infusion; hot saline compression of the surface of the wound and/or daub biological glue; argon beam coagulation and packs placement. Conclusions Light performance and nonforce dragging of liver can reduce massive hemorrhage caused by major vessel injury or tumor rupture. Normothetic occlusion of porta hepatis can reduce blood loss effectively when liver resection. In situ hepatectomy must be adopted if there is extensive adhesion around the tumor. Packs placement is still an effective measure to stop bleeding caused by defective coagulation and extensive blood oozing of wound surface.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2003年第3期172-174,共3页
Chinese Journal of Surgery
