Literature
首页合作平台在线期刊中华现代临床医学杂志2004年第2卷第5B期

手术中围肝门部血管急症的治疗要点

来源:中华现代临床医学杂志
摘要:【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。手术中围肝门部血管急症属医源性12例(85。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......

点击显示 收起

【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%),创伤性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。

关键词 围肝门部 血管急症 治疗

The therapeutic main points of vascular emergencies in

 hepatic perihilar regions during operations

 Bai Weiye,Zhao Jianmin,Zhou Kun,et al.

Department of General Surgery,Shanghai Municipal Corps Hospital,

 Chinese People’s Armed Police Forces,Shanghai201103. 

【Abstract】 Objective Vascular emergencies(VE)in perihilar regions(PR)of liver is rarely described durˉing operations,but the factors associated with its treatment and the clinical outcomes are poorly characterized.Methods Case logs ofsurgeonsfrom1992to2003were retrospetively reviewed VE in PR during operations.Results Fourˉteen patients of VE in PR during operations were malignant tumor(n=7;50.0%)and benign pathologic change(n=7;50.0%).There were iatrogenicvascular 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 ofⅦsegment of liver and right hepatic vein(n=1;7.1%),irregularityhepatectomy for right three lobes and hepatectomy for part caudate lobe to be ligated right hepatic vein and retainedⅦsegment of liver complicated hypostasis of HV ofⅦsegˉment(n=1;7.1%).The therapeutic methods of VE were venous repair(7of14),arteriorrhaphy(1of14),ligationof hepatic artery(1of14),portoembolectomy(1of14),sutured biliary tract and pylic branch and hemostasis by comˉpression(1of14),cholecystectomy addition intra-outer-injection-arterially of liver(1of14),suture foⅦsegˉment of liver and right hepatic vein(1of14),to retain theⅦsegment of liver to be ligated right hepatic vein(1of14).Eleven patients(78.6%)had been cured and three patients(21.4%)died.The curative effect in the postoperaˉtion 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 morˉbidity 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.

Key words hepatic perihilar region vascular emergency treatment 

It is the important region that perihilar regions(PR)of liver is often involved operations or therapies and trauma in the epigastrium region.Blood vessel in the PR is large and complex.Because of anatomic and pathologic characters of the PR,causes of vascular emerˉgencies(VE)are manifold,suddenly,hided,diffcultly treated need to cooperate branches of learning(such as elect anesthesia or use technique of vascular shunt)and patients’safety can be directly threatened.When both VE in the PR need to be treated and the predetermine operation have to complete,a strategic decision is.In the past few years,some operations or malignant tumors that were difficultly resected has been successfully resectedand treatment of trauma in the PR through advances of surgical basic studied and technique,but VE in the PR during operations has been increasingly reported.This problem is being more and more to be followed with inˉterest by surgeons ofhepatobiliary surgery.It is reported that fourteen patients had been treated from1992to2003.

1 Patients and methods

There were fourteen patients(11men and3wowen;mean age,46.9years;age range,7to68years)with VE in the PR during operations.Ten patients were our hospitaland four patients treated by the authors on operating consultation in outer hospital,which the causes were manifold and the therapies or prognosis were differˉent(see table1).

2 Results

The group 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 TP(n=2;14.3%)and the third PR(n=4,28.6%).There were phleborrhesis were(n=8;57.1%),arteriorrhesis(n=2;14.3%),acute emˉbolism of hepatic artery(AEHA)(n=1;7.1%),acute embolism of portal vein(AEPV)(n=1;7.1%),rupture ofⅦsegment of liver and right hepatic vein(n=1;7.1%),irregularity hepatectomy for right three lobes and hepatectomy for part of caudate lobe tobe ligated right hepatic vein andretainedⅦsegment of liver complicatˉed hypostasis of HV ofⅦsegment(n=1;7.1%).

The therapeutic methods of VE were venous repair(7or14)and arteriorrhaphy(1of14),ligation of hepˉatic artery(1of14),pylic embolectomy(1of14),suˉtured biliary tract and pylic branch and hemostasis by compression(1of14),cholecystectomy addition intra-outer-injection-arterially of liver(1of14),sutureofⅦsegment of liver and right hepatic vein(1of14),to be retain theⅦsegmentof liver to be ligated right hepˉatic vein(1of14).

Eleven patients(78.6%)who were in the first PR(n=8)and in the second PR(n=2)and in the third PR(n=1)had been cured and three patients(21.4%)that were rupture of retrohepatic inferior vena cave(RRIVC)in the third PR died(see table1).The curaˉtive effect in the postoperation near future is well for eleven patients.

Table1 Conditions table of fourteen patients with VE in PR during operations略

 3 Comments

3.1 VE of the first PR The first PR is the combinaˉtion site of liver,biliary tract and pancreas.It is the imˉportant channel that is modern surgical technics or new therapies in clinic,which morbidity of IVE in the first PR is the highest among the PR.Operation

作者: 白伟业赵建民周坤史伟民 2005-9-22
医学百科App—中西医基础知识学习工具
  • 相关内容
  • 近期更新
  • 热文榜
  • 医学百科App—健康测试工具