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巨大右半肝肿瘤切除过程中的出血量是决定手术能否成功的关键因素,控制手术过程中出血的技术也是右半肝切除术中的最重要的技术,有效控制术中出血的方法贯穿于整个手术过程中:良好的术前评估,术中于第一肝门处选择性阻断支配右半肝的入肝血流,于第二肝门处切断肝右静脉,于第三肝门处切断肝短静脉,在无血条件下用超声吸引刀切除预定的右半肝以及肝断面的处理等。此方法能有效控制手术过程中出血,保证左半肝血液供应,减轻肝脏缺血/再灌注损伤,减少术后肝功能不全的发生,保证了胃肠道血流的通畅,避免了黏膜屏障受损,全身血流动力学平稳,对其他脏器功能影响小,缩短了手术时间,极大地提高了手术的安全性。
The huge amount of bleeding during the resection of a huge right hepatic tumor is the key factor that determines the success of the operation. The technique of controlling bleeding during surgery is also the most important technique in right hemihepatectomy. The method of effectively controlling intraoperative bleeding runs through Throughout the operation: a good preoperative assessment, during the operation in the first portal to selectively block the right hepatic duct dominated the blood flow in the second hepatic portal at the right hepatic vein, at the third hepatic portal Cut off the short hepatic vein, and under the condition of no blood, use the ultrasonic aspiration knife to remove the scheduled right hemiliver and the treatment of liver section. This method can effectively control bleeding during surgery, to ensure that the left hepatic blood supply, reduce liver ischemia / reperfusion injury and reduce the incidence of postoperative liver insufficiency, to ensure the gastrointestinal tract blood flow, to avoid the mucosal barrier by Loss, systemic hemodynamics smooth, little effect on the function of other organs, shortening the operation time, greatly improving the safety of surgery.