Abstract: Risk factors and countermeasures of intraoperative bleeding during laparoscopic hepatectomy        ZHENG Shu-guo*，WANG Bao-lin. *Institute of Hepatobiliary Surgery of PLA, Southwest Hospital, the Army Military Medical University, Chongqing 400038，China
Corresponding author：ZHENG Shu-guo, E-mail: shuguozh@163.com
Abstract    Bleeding is a difficult problem that must be faced in laparoscopic hepatectomy, and it is also an important factor that restricts the popularization of laparoscopic hepatectomy. Moreover, bleeding and blood transfusion increase the risk of postoperative complications and tumor recurrence. The risk factors of hemorrhage during laparoscopic hepatectomy include background of basic liver diseases, tumor size, location and character, surgical approaches and operation skills, intraoperative fluid, and anesthesia management. Prevention of intraoperative bleeding during laparoscopic hepatectomy should be emphasized. Strictly control of the surgical indications, selecting the correct surgical approach and navigation method based on the three-dimensional visualization evaluation and surgical planning, and taking the countermeasures such as delicate surgical operation, hepatic blood flow occlusion and controlling low CVP can significantly reduce the risk of intraoperative bleeding. Proficient endoscopic suture technique and competent assistant cooperation are the ultimate means to control the bleeding during laparoscopic hepatectomy.

Key words: laparoscopy hepatectomy, bleeding

摘要： 出血是腹腔镜肝切除术中须面对的难题，也是限制腹腔镜肝切除术推广普及的重要因素，且出血和输血增加了术后并发症发生和肿瘤复发的风险。腹腔镜肝切除术中出血的风险因素包括：肝脏基础疾病背景，肿瘤大小、部位、性质，手术路径及操作技巧，术中液体及麻醉管理等。腹腔镜肝切除术中出血重在预防，严格把控手术适应证，基于三维可视化评估及手术规划，选择正确手术路径及导航方法，通过精细手术操作、肝血流阻断及控制性低中心静脉压（CVP）等对策能显著降低术中出血风险。娴熟的腹腔镜缝合技术及得力的助手配合是处理腹腔镜肝切除术中出血的终极手段。

关键词: 腹腔镜肝切除术, 出血