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目的 探讨原发性肝癌术中肝后段下腔静脉损伤的原因、修复及预防。方法 从 1 991年 1月至 2 0 0 0年 1 2月间为 32 7例原发性肝癌实施了肝切除术 ,损伤肝后段下腔静脉 1 6例(4 89% ) ,其中 1 2例在全肝血流阻断下行裂口修补术 ,4例未行全阻断修补。结果 所有血管损伤病例均为巨块型肝癌病人。 1 2例行全肝血流阻断裂口修补术的病人 ,1 0例痊愈出院 ,1例术中大出血 ,修补失败死亡 ,1例于术后 4h死于不可逆休克 ;而 4例未行全阻断修补术的病人 ,1例痊愈 ,2例术中大出血死亡 ,1例术后 6h死亡。结论 巨块型肝癌致深部术野显露受限 ,术中过度牵拉肝脏 ,是造成静脉壁撕裂的重要原因。全肝血流阻断对修复肝后段下腔静脉损伤是一种切实可行的办法。对贴近第二、第三肝门的巨块型肝癌 ,切肝前酌情在常温下预置全肝血流阻断带 ,不失为一种安全有效的预防措施。
Objective To investigate the causes, repair and prevention of inferior vena cava injury in the liver segment of primary liver cancer. Methods From January 1991 to January 2010, 32 7 cases of primary liver cancer underwent hepatectomy and 16 cases (4 89%) of the inferior vena cava of the liver segment were injured. Among them, 12 For example, in the whole liver blood flow to cut down the gap repair, 4 cases did not completely block repair. Results All the cases of vascular injury were massive liver cancer patients. One hundred and two patients who underwent complete hepatic blood flow occlusion repair were discharged from hospital, one case had intraoperative hemorrhage, the patient died of repair failure, and one died of irreversible shock at 4 hours after operation. One patient was repaired, 2 died of intraoperative hemorrhage, and 1 patient died 6 hours after operation. Conclusion The deep operative field of bulky hepatocellular carcinoma is limited and the excessive pulling of the liver during operation is an important reason for the tear of the vein wall. Whole liver blood flow blocking repair of inferior vena cava after liver injury is a viable approach. Close to the second and third hysterical giant liver cancer, liver perfusion, as appropriate, at room temperature, pre-placed whole blood flow blocking zone, after all, a safe and effective preventive measures.