本文選題：腹腔鏡 + 肝切除術(shù)��； 參考：《中國(guó)實(shí)用外科雜志》2017年05期

【摘要】：肝靜脈系統(tǒng)出血是腹腔鏡肝切除術(shù)面臨的難題之一,其處理重在預(yù)防,通過(guò)精確術(shù)前影像學(xué)評(píng)估和精細(xì)規(guī)范的術(shù)中鏡下操作主動(dòng)防范出血,盡可能避免出血后的被動(dòng)處理。強(qiáng)化麻醉管理,采用控制性低中心靜脈壓技術(shù),加強(qiáng)氣腹條件下對(duì)CO_2氣體栓塞的認(rèn)知、預(yù)防和緊急處理。術(shù)中若遭遇肝靜脈血管破裂出血,應(yīng)及時(shí)準(zhǔn)確判斷嚴(yán)重程度及出血是否在可控范圍內(nèi)。在控制、減少出血條件下,顯露確認(rèn)出血的來(lái)源血管,及其管徑、走行,破裂口位置、大小等,根據(jù)靜脈血管損傷的類型及嚴(yán)重程度,采取相應(yīng)措施進(jìn)行迅速有效止血,必要時(shí)及時(shí)果斷中轉(zhuǎn)開腹處理。近年來(lái),隨著對(duì)肝臟影像及鏡下解剖認(rèn)識(shí)的深入、腹腔鏡技術(shù)水平的提高、手術(shù)經(jīng)驗(yàn)的積累及手術(shù)器械的不斷更新,腹腔鏡肝切除術(shù)肝中靜脈系統(tǒng)出血的控制和處理水平及手術(shù)安全性已得到明顯提升。
[Abstract]:Hemorrhage of the hepatic venous system is one of the difficult problems facing laparoscopic hepatectomy. Its treatment is to prevent bleeding by accurate preoperative imaging evaluation and fine standardized operation under the intraoperative mirror. It is possible to avoid passive treatment after bleeding. The management of anesthesia is strengthened, controlled low central venous pressure is used to strengthen the pneumoperitoneum condition. The cognition, prevention and emergency treatment of CO_2 gas embolism. If the hepatic vein ruptured bleeding is encountered during the operation, it should be timely and accurate to determine whether the severity and bleeding are in the controllable range. Under the control and reduction of bleeding conditions, the blood vessels that confirm the bleeding, its diameter, the position of the rupture, the size of the rupture, and so on, according to the vascular injury of the veins. In recent years, with the deep understanding of the imaging and microscopic anatomy of the liver, the improvement of the technical level of the laparoscopy, the accumulation of surgical experience and the non break up of the surgical instruments, and the hemorrhage of the middle hepatic vein in the laparoscopic hepatectomy. The level of control and treatment and surgical safety have been significantly improved.
【作者單位】： 第三軍醫(yī)大學(xué)西南醫(yī)院全軍肝膽外科研究所;
【基金】：國(guó)家衛(wèi)計(jì)委公益性行業(yè)科研專項(xiàng)(No.2015SQ00170) 第三軍醫(yī)大學(xué)西南醫(yī)院重大領(lǐng)域技術(shù)創(chuàng)新項(xiàng)目(No.SWH2016ZDCX2015)
【分類號(hào)】：R657.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 夏穗生;創(chuàng)制臨床肝切除術(shù)第一頁(yè)的歷程紀(jì)實(shí)[J];臨床外科雜志;2001年01期

2 芮靜安,周立,劉馥迪,褚慶福,王少斌,陳曙光,曲強(qiáng),魏學(xué),韓凱,楊欣,張寧,趙海濤;不輸血的大型肝切除術(shù)(附51例報(bào)告)[J];中華肝膽外科雜志;2003年04期

3 孟興凱;張俊晶;岳根全;鐘海燕;喬建梁;;多功能手術(shù)解剖器在肝切除術(shù)中的應(yīng)用[J];內(nèi)蒙古醫(yī)學(xué)院學(xué)報(bào);2007年02期

4 毛長(zhǎng)坤;趙紅川;;大范圍肝切除術(shù)的標(biāo)準(zhǔn)定義:四段或四段以上的肝切除[J];肝膽外科雜志;2011年04期

5 李廣華;姜洪池;夏穗生;;肝切除術(shù)后腹腔感染(文獻(xiàn)綜述)[J];國(guó)外醫(yī)學(xué).外科學(xué)分冊(cè);1989年01期

6 ;有關(guān)肝切除術(shù)的技術(shù)問(wèn)題[J];國(guó)外醫(yī)學(xué).外科學(xué)分冊(cè);1997年03期

7 ;肝切除術(shù)[J];國(guó)外醫(yī)學(xué).外科學(xué)分冊(cè);1997年04期

8 范上達(dá),張志偉;如何做好肝切除術(shù)[J];肝膽外科雜志;2000年02期

9 周信達(dá),余耀復(fù);如何降低肝切除術(shù)后的并發(fā)癥[J];外科理論與實(shí)踐;2000年04期

10 楊廣順,吳孟超,毛平傳,董秀芬,于布為;半離體無(wú)血肝切除術(shù)的實(shí)驗(yàn)研究[J];中華肝膽外科雜志;2000年01期

相關(guān)會(huì)議論文 前10條

1 蔡柳新;方哲平;王愛(ài)東;張法標(biāo);杜學(xué)峰;陳斌;李劍鋒;;腹腔鏡肝切除術(shù)95例[A];2009年浙江省外科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2009年

2 方河清;李江濤;唐U，

本文編號(hào)：2118546