关键词: 腹腔镜, 肝切除术, 出血, 肝静脉

Abstract:

Management strategy of hepatic venous system bleeding in laparoscopic hepatectomy        ZHENG Shu-guo.Institute of Hepatobiliary Surgery of PLA, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
Abstract    Hepatic vein bleeding is one of the problems faced in laparoscopic liver resection. It’s important that active prevention of bleeding through accurate preoperative imaging evaluation and meticulous laparoscopic operation, as far as possible to avoid the passive treatment after hemorrhage. Intensive anesthesia management as well as controlled low central venous pressure is necessary for successful operation. Emphasis should be put on the diagnosis, prevention and emergency treatment of CO2 gas embolism in the pneumoperitoneum conditions. During the operation, if the hepatic veins injury and bleeding occurred, the severity of bleeding and if it can be controlled laparoscopically should be timely and accurately determined. Once the bleeding has been controlled or reduced, the injured vessel should be isolated, and its diameter, direction and the size and location of the split must be confirmed. Corresponding measures should be applied to make hemostasis rapidly and effectively according to the type and severity of the venous vascular injury, when necessary, conversion to open surgery should be taken rapidly. In recent years, with the accumulation of surgical experiences, the understanding of laparoscopic anatomy of the liver and the constantly updated surgical instruments, the technical level of hepatic vein system bleeding control and treatment during laparoscopic liver resection as well as the safety of the operation has been improved significantly.

Key words: laparoscopy, hepatectomy, hemorrhage, hepatic vein