目的 分析肝癌术中大出血的常见原因并提出相应的处理措施。方法 分析总结14例原发性肝癌患者术中出现大出血的临床资料,归纳可能引起术中大出血的原因。结果 分离肿瘤过程中较易发生肝短静脉(5例)和下腔静脉(1例)损伤,以及肝右静脉的(2例)损伤;切除肿瘤过程中较易损伤肝内较大静脉分支出现大出血(6例)。结论 对于右肝及中肝较大肿瘤的切除,术前应尽可能做好预案,仔细操作,避免损伤;如术中出现大出血,不可胡乱钳夹,尽可能在直视下(或在全肝血流阻断后)缝扎处理。
Objective To analyze common causes and corresponding treatments of massive haemorrhage in the operation for primary liver cancer.Methods Based on 14 cases of primary liver cancer with intraoperative massive haemorrhage,we summarized possible causes of intraoperative massive haemorrhage.Results Damages to hepatic short vein (5 cases),inferior vena cava (1 case),and right hepatic vein (2 cases) occurred during the separation of liver cancer.Damages to large intrahepatic venous branches (6 cases) occurred during hepatecomy.Conclusion Operation plans help avoid damages during the resection of large tumors in right liver and middle liver.In addition,ligating under direct vision (or after hepatic blood occlusion) rather than random clamp is recommended for intraoperative massive haemorrhage.
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