手术中围肝门部血管急症的治疗要点
The therapeutic main points of vascular emergencies in hepatic perihilar regions during operations
白伟业 1赵建民 2周坤 1史伟民1
作者信息
- 1. 201103,上海,武警上海总队医院普通外科
- 2. 046000,山西,长治,解放军51272部队医院外科
- 折叠
摘要
目的研究手术中围肝门部血管急症的治疗方法和临床疗效.方法对10余年来笔者治疗的14例手术中围肝门部血管急症患者的临床资料进行了综合分析.结果本组中恶性肿瘤7例(50.0%),良性病变7例(50.0%).手术中围肝门部血管急症属医源性12例(85.7%),刨伤性2例(14.3%).发生在围第一肝门部8例(57.1%),围第二肝门部2例(14.3%),围第三肝门部4例(28.6%).发生静脉破裂8例(57.1%),动脉破裂2例(14.3%),发生肝动脉急性栓塞、门静脉急性栓塞、肝Ⅶ段和肝右静脉破裂、结扎肝右静脉致肝Ⅶ段血液回流障碍各1例.治疗方法为:行静脉修复7例,行肝动脉修复、肝动脉结扎、肝动脉腔内外药物注射加胆囊切除术、缝合胆总管和门静脉分支、门静脉切开取栓、缝合肝Ⅶ段并缝扎肝右静脉、缝扎肝右静脉保留肝Ⅶ段各1例.本组治愈11例(78.6%),死亡3例(21.4%).对11例近期随访疗效良好.结论围肝门部是上腹部手术、现代外科技术和创伤经常涉及的重要部位,手术中围肝门部血管急症的原因呈多样性,其发生带有突然性和隐匿性,如处理不及时或不得当,短时间内即可严重威胁患者生命.本组手术中围第一肝门部血管急症的发生率最高,是医源性血管急症的高发部位;围第二肝门部是手术中围肝门部创伤性血管急症的高发部位,多合并肝外伤;手术中围第三肝门部血管急症多为医源性,其处理困难,死亡率高,在手术中围肝门部血管急症中属重中之重.提高对手术中围肝门部血管急症的防范意识和处理水平,是改善手术疗效的关键.
Abstract
Objective Vascular emergencies(VE) in perihilar regions (PR) of liver is rarely described during operations, but the factors associated with its treatment and the clinical outcomes are poorly characterized. Methods Case logs of surgeons from 1992 to 2003 were retrospetively reviewed VE in PR during operations. Results Fourteen patients of VE in PR during operations were malignant tumor(n = 7 ;50.0% ) and benign pathologic change (n =7; 50.0% ). There were iatrogenic vascular emergencies (IVE) ( n = 12; 85.7 % ) and traumatic vascular emergencies (TVE)(n = 2;14.3%).VE were in the first PR (n = 8;57. 1%),the second PR(n = 2;14.3%) and the third PR (n = 4; 28.6 % ). Phleborrhesis ( n = 8; 57.1% ) and arteriorrhesis ( n = 2; 14.3 % ) and acute embolism of hepatic artery (AEHA) ( n = 1; 7.1% ) and acute embolism of portal vein (AEPV) ( n = 1; 7.1% ), ruputure of Ⅶ segnent of liver and right hepatic vein ( n = 1; 7.1% ), irregularity hepatectomy for right three lobes and hepatectomy for part caudate lobe to be ligated right hepatic vein and re tained Ⅶ segment of liver complicated hypostasis of HV of Ⅶ segment (n = 1;7.1% ). The therapeutic methods of VE were venous repair (7 of 14), arteriorrhaphy (1 of 14), ligation of hepatic artery (1 of 14), portoembolectomy (1 of 14), sutured biliary tract and pylic branch and hemostasis by compression ( 1 of 14), cholecystectomy addition intra - outer - injection - arterially of liver ( 1 of 14), suture fo Ⅶ segment of liver and right hepatic vein (1 of 14) ,to retain the Ⅶ segment of liver to be ligated right hepatic vein (1 of 14). Eleven parents(78.6% ) had been cured and three patients (21.4%) died. The curative effect in the postoperation near future is well for eleven patients. Conclusion It is the important region that PR is involved operations or therapies and trauma in the epigastrium region. VE in PR during operations had been increasingly reported. The morbidity of IVE in the first PR is the highest among PR, the morbidity of TVE complicated hepatic injury in the second PR is the highest,and the treatment of rupture of retrohepatic inferior vena cava (RRIVC) in the third PR is the most difficult problem of VE of the PR among hepatic surgery. This manuscript put forward the views about therapeutic main points to the VE in PR during operations.
关键词
围肝门部/血管急症/治疗Key words
hepatic perihilar region vascular emergency treatment引用本文复制引用
出版年
2004
NETL
NSTL
万方数据