Causes and coping principles of hepatic vein hemorrhage in laparoscopic hepatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GAO Fengwei ^1,2 ,  WU Hong ³ , ZHAO Xin ^1,2 , GONG Jie ^1,2

1. Department of HBP Surgery, Leshan People’s Hospital of Sichuan, Leshan, Sichuan 614000, P. R. China;
2. HBPS Diseases Center for Diagnosis and Treatment of Leshan City, Leshan, Sichuan 614000, P. R. China;
3. Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WU Hong, Email: Wuhong7801@163.com

Keywords：

hepatectomy; laparoscopy; hemorrhage; hepatic vein; hemostasis; review

DOI：

10.7507/1007-9424.202004088

Video：

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Objective To analyze the causes and prevention principles of hepatic venous hemorrhage during laparoscopic hepatectomy.Method Literatures about the causes and prevention of hepatic venous hemorrhage during laparoscopic hepatectomy were collected, and then made an review with our own clinical experience.Results Intraoperative hepatic venous hemorrhage was one of the most dangerous complications during laparoscopic hepatectomy. The main reasons for its occurrence included subjective and objective factors. Through accurate preoperative assessment, rigorous attitude during operation and superb surgical skills, intraoperative control of the prsessure difference between the internal and external veins, could significantly reduce the incidence of intraoperative venous bleeding. For the hepatic vein bleeding that had occurred, the correct evaluation and treatment during the operation could reduce the adverse effect on the surgical efficacy.Conclusion Correctly understand the causes of hepatic venous hemorrhage during laparoscopic hepatectomy, prevent and manage various techniques before and during operation can carry out laparoscopic hepatectomy more safely.

Citation： GAO Fengwei, WU Hong, ZHAO Xin, GONG Jie. Causes and coping principles of hepatic vein hemorrhage in laparoscopic hepatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(6): 675-678. doi: 10.7507/1007-9424.202004088 Copy

1.	Hibi T, Cherqui D, Geller DA, et al. International survey on technical aspects of laparoscopic liver resection: a web-based study on the global diffusion of laparoscopic liver surgery prior to the 2^nd International Consensus Conference on Laparoscopic Liver Resection in Iwate, Japan. J Hepatobiliary Pancreat Sci, 2014, 21(10): 737-744.
2.	Moris D, Vernadakis S. Laparoscopic hepatectomy for hepatocellular carcinoma: the opportunities, the challenges, and the limitations. Ann Surg, 2018, 268(1): e16.
3.	陈雪芳, 谢浩荣, 王恺, 等. 腹腔镜与开腹再次肝切除术治疗复发性肝细胞癌的安全性及疗效对比. 中华肝胆外科杂志, 2019, 25(3): 175-178.
4.	Goh EL, Chidambaram S, Ma S. Laparoscopic vs open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a meta-analysis of the long-term survival outcomes. Int J Surg, 2018, 50: 35-42.
5.	Xiang L, Xiao L, Li J, et al. Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments. World J Surg, 2015, 39(5): 1202-1209.
6.	张冲. 腹腔镜肝切除术中预防和控制出血的策略. 中国普通外科杂志, 2017, 26(1): 96-101.
7.	梁霄, 陈国俊. 腹腔镜肝切除术中出血的预防与处理. 肝胆外科杂志, 2017, 25(4): 249-251.
8.	安然, 张超. 腹腔镜肝切除术中出血预防和控制. 中华肝脏外科手术学电子杂志, 2020, 9(2): 123-126.
9.	Kawaguchi Y, Nomi T, Fuks D, et al. Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss. Surg Endosc, 2016, 30(6): 2543-2551.
10.	郑树国. 腹腔镜肝切除术肝静脉系统出血处理策略. 中国实用外科杂志, 2017, 37(5): 485-489.
11.	郑成红, 蒋晓忠, 余钰. 三维可视化技术应用于腹腔镜精准肝切除术的研究进展. 中国普外基础与临床杂志, 2019, 26(3): 364-368.
12.	张树庚, 刘连新. 吲哚菁绿荧光融合影像引导技术在腹腔镜肝切除中的应用及展望. 中华肝胆外科杂志, 2019, 25(2): 129-131.
13.	Kobayashi Y, Omichi K, Kawaguchi Y, et al. Intraoperative real-time tissue elastography during laparoscopic hepatectomy. HPB (Oxford), 2018, 20(1): 93-99.
14.	Cipriani F, Ratti F, Catena M, et al. Pure laparoscopic right hepatectomy: a risk score for conversion for the paradigm of difficult laparoscopic liver resections. HPB, 2018, 20(Suppl2): S293.
15.	吴嘉, 张成武, 刘军伟, 等. 近红外成像联合术中超声在腹腔镜肝肿瘤切除中的应用. 中华普通外科杂志, 2018, 33(9): 742-746.
16.	Wang XY, Gao Q, Zhu XD, et al. Laparoscopic anatomical hepatectomy with ICG fluorescence staining by lap-ultrasound and 3D visualization guided portal branch puncture approach. HPB, 2019, 21(Suppl2): S299.
17.	周存才, 杨小敏, 周新文, 等. 陈氏简易全肝血流阻断技术的临床应用: 附280例报道. 中国普通外科杂志, 2014, 23(1): 6-12.
18.	Liu F, Wei Y, Li H, et al. LigaSure versus CUSA for parenchymal transection during laparoscopic hepatectomy in hepatocellular carcinoma patients with cirrhosis: a propensity score-matched analysis. Surg Endosc, 2018, 32(5): 2454-2465.
19.	魏永刚, 张渝翰. 腹腔镜肝脏切除术的肝门血流阻断及断肝技巧. 中国普外基础与临床杂志, 2019, 26(2): 137-140.
20.	蔡秀军, 蔡柳新, 刘荣. 腹腔镜肝切除术中血流控制技术及肝实质离断技术. 中国实用外科杂志, 2017, 37(5): 505-508.
21.	刘连新, 梁英健. 腹腔镜肝切除术肝实质离断技巧及器械选择. 中国实用外科杂志, 2017, 37(5): 473-476.
22.	劳诚毅, 林成新, 刘敬臣, 等. 不同水平低中心静脉压对猪血流动力学及肝静脉损伤出血量影响的研究. 广西医科大学学报, 2011, 28(6): 826-829.
23.	Pan YX, Wang JC, Lu XY, et al. Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: a double-blind randomized clinical trial. Surgery, 2020, [Epub ahead of print].
24.	Kobayashi S, Honda G, Kurata M, et al. An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy. Ann Surg, 2016, 263(6): 1159-1163.
25.	杨禄坤, 范东毅, 孔凡根, 等. 低中心静脉压技术在肝硬化患者腹腔镜肝切除术中的应用. 中华肝脏外科手术学电子杂志, 2019, 8(2): 139-142.
26.	赵欣, 雷泽华, 高峰畏, 等. 肝下下腔静脉阻断联合Pringle阻断在肝切除术中安全性及有效性的荟萃分析. 中华肝胆外科杂志, 2019, 25(10): 728-732.
27.	Liu L, Lv N, Hou C. Effects of a multifaceted individualized pneumoperitoneum strategy in elderly patients undergoing laparoscopic colorectal surgery: a retrospective study. Medicine (Baltimore), 2019, 98(14): e15112.
28.	段云飞, 杨雨, 施龙青, 等. 腹腔镜肝切除术中二氧化碳栓塞的原因与处理. 中华肝胆外科杂志, 2018, 24(2): 79-82.
29.	Nomi T, Fuks D, Govindasamy M, et al. Risk factors for complications after laparoscopic major hepatectomy. Br J Surg, 2015, 102(3): 254-260.
30.	de Jong KIF, de Leeuw PW. Venous carbon dioxide embolism during laparoscopic cholecystectomy a literature review. Eur J Intern Med, 2019, 60: 9-12.
31.	Muñoz C, Hessheimer A, Molina V, et al. Lessons learned from 40 major laparoscopic hepatectomies. HPB, 2018, 20(Suppl 2): S473.
32.	Cheek SM, Geller DA. The learning curve in laparoscopic major hepatectomy: what is the magic number? JAMA Surg, 2016, 151(10): 929.
33.	刘连新, 蔡建强, 曾勇, 等. 肝脏手术缝合技术与缝合材料选择中国专家共识 (2018版). 中国实用外科杂志, 2019, 39(1): 11-14.
34.	赵玉沛, 张太平. 普通外科缝合技术的基本原则与缝合材料规范化使用. 中国实用外科杂志, 2019, 39(1): 3-5.
35.	Mathis R, Watanabe Y, Ghaderi I, et al. What are the skills that represent expert-level laparoscopic suturing? A Delphi study. Surg Endosc, 2020, 34(3): 1318-1323.
36.	Terzi H, Biler A, Turkay U, et al. A comparison of novel laparoscopic suturing techniques in single-port surgery. Minim Invasive Ther Allied Technol, 2019, 28(6): 338-343.

1. Hibi T, Cherqui D, Geller DA, et al. International survey on technical aspects of laparoscopic liver resection: a web-based study on the global diffusion of laparoscopic liver surgery prior to the 2^nd International Consensus Conference on Laparoscopic Liver Resection in Iwate, Japan. J Hepatobiliary Pancreat Sci, 2014, 21(10): 737-744.
2. Moris D, Vernadakis S. Laparoscopic hepatectomy for hepatocellular carcinoma: the opportunities, the challenges, and the limitations. Ann Surg, 2018, 268(1): e16.
3. 陈雪芳, 谢浩荣, 王恺, 等. 腹腔镜与开腹再次肝切除术治疗复发性肝细胞癌的安全性及疗效对比. 中华肝胆外科杂志, 2019, 25(3): 175-178.
4. Goh EL, Chidambaram S, Ma S. Laparoscopic vs open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a meta-analysis of the long-term survival outcomes. Int J Surg, 2018, 50: 35-42.
5. Xiang L, Xiao L, Li J, et al. Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments. World J Surg, 2015, 39(5): 1202-1209.
6. 张冲. 腹腔镜肝切除术中预防和控制出血的策略. 中国普通外科杂志, 2017, 26(1): 96-101.
7. 梁霄, 陈国俊. 腹腔镜肝切除术中出血的预防与处理. 肝胆外科杂志, 2017, 25(4): 249-251.
8. 安然, 张超. 腹腔镜肝切除术中出血预防和控制. 中华肝脏外科手术学电子杂志, 2020, 9(2): 123-126.
9. Kawaguchi Y, Nomi T, Fuks D, et al. Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss. Surg Endosc, 2016, 30(6): 2543-2551.
10. 郑树国. 腹腔镜肝切除术肝静脉系统出血处理策略. 中国实用外科杂志, 2017, 37(5): 485-489.
11. 郑成红, 蒋晓忠, 余钰. 三维可视化技术应用于腹腔镜精准肝切除术的研究进展. 中国普外基础与临床杂志, 2019, 26(3): 364-368.
12. 张树庚, 刘连新. 吲哚菁绿荧光融合影像引导技术在腹腔镜肝切除中的应用及展望. 中华肝胆外科杂志, 2019, 25(2): 129-131.
13. Kobayashi Y, Omichi K, Kawaguchi Y, et al. Intraoperative real-time tissue elastography during laparoscopic hepatectomy. HPB (Oxford), 2018, 20(1): 93-99.
14. Cipriani F, Ratti F, Catena M, et al. Pure laparoscopic right hepatectomy: a risk score for conversion for the paradigm of difficult laparoscopic liver resections. HPB, 2018, 20(Suppl2): S293.
15. 吴嘉, 张成武, 刘军伟, 等. 近红外成像联合术中超声在腹腔镜肝肿瘤切除中的应用. 中华普通外科杂志, 2018, 33(9): 742-746.
16. Wang XY, Gao Q, Zhu XD, et al. Laparoscopic anatomical hepatectomy with ICG fluorescence staining by lap-ultrasound and 3D visualization guided portal branch puncture approach. HPB, 2019, 21(Suppl2): S299.
17. 周存才, 杨小敏, 周新文, 等. 陈氏简易全肝血流阻断技术的临床应用: 附280例报道. 中国普通外科杂志, 2014, 23(1): 6-12.
18. Liu F, Wei Y, Li H, et al. LigaSure versus CUSA for parenchymal transection during laparoscopic hepatectomy in hepatocellular carcinoma patients with cirrhosis: a propensity score-matched analysis. Surg Endosc, 2018, 32(5): 2454-2465.
19. 魏永刚, 张渝翰. 腹腔镜肝脏切除术的肝门血流阻断及断肝技巧. 中国普外基础与临床杂志, 2019, 26(2): 137-140.
20. 蔡秀军, 蔡柳新, 刘荣. 腹腔镜肝切除术中血流控制技术及肝实质离断技术. 中国实用外科杂志, 2017, 37(5): 505-508.
21. 刘连新, 梁英健. 腹腔镜肝切除术肝实质离断技巧及器械选择. 中国实用外科杂志, 2017, 37(5): 473-476.
22. 劳诚毅, 林成新, 刘敬臣, 等. 不同水平低中心静脉压对猪血流动力学及肝静脉损伤出血量影响的研究. 广西医科大学学报, 2011, 28(6): 826-829.
23. Pan YX, Wang JC, Lu XY, et al. Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: a double-blind randomized clinical trial. Surgery, 2020, [Epub ahead of print].
24. Kobayashi S, Honda G, Kurata M, et al. An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy. Ann Surg, 2016, 263(6): 1159-1163.
25. 杨禄坤, 范东毅, 孔凡根, 等. 低中心静脉压技术在肝硬化患者腹腔镜肝切除术中的应用. 中华肝脏外科手术学电子杂志, 2019, 8(2): 139-142.
26. 赵欣, 雷泽华, 高峰畏, 等. 肝下下腔静脉阻断联合Pringle阻断在肝切除术中安全性及有效性的荟萃分析. 中华肝胆外科杂志, 2019, 25(10): 728-732.
27. Liu L, Lv N, Hou C. Effects of a multifaceted individualized pneumoperitoneum strategy in elderly patients undergoing laparoscopic colorectal surgery: a retrospective study. Medicine (Baltimore), 2019, 98(14): e15112.
28. 段云飞, 杨雨, 施龙青, 等. 腹腔镜肝切除术中二氧化碳栓塞的原因与处理. 中华肝胆外科杂志, 2018, 24(2): 79-82.
29. Nomi T, Fuks D, Govindasamy M, et al. Risk factors for complications after laparoscopic major hepatectomy. Br J Surg, 2015, 102(3): 254-260.
30. de Jong KIF, de Leeuw PW. Venous carbon dioxide embolism during laparoscopic cholecystectomy a literature review. Eur J Intern Med, 2019, 60: 9-12.
31. Muñoz C, Hessheimer A, Molina V, et al. Lessons learned from 40 major laparoscopic hepatectomies. HPB, 2018, 20(Suppl 2): S473.
32. Cheek SM, Geller DA. The learning curve in laparoscopic major hepatectomy: what is the magic number? JAMA Surg, 2016, 151(10): 929.
33. 刘连新, 蔡建强, 曾勇, 等. 肝脏手术缝合技术与缝合材料选择中国专家共识 (2018版). 中国实用外科杂志, 2019, 39(1): 11-14.
34. 赵玉沛, 张太平. 普通外科缝合技术的基本原则与缝合材料规范化使用. 中国实用外科杂志, 2019, 39(1): 3-5.
35. Mathis R, Watanabe Y, Ghaderi I, et al. What are the skills that represent expert-level laparoscopic suturing? A Delphi study. Surg Endosc, 2020, 34(3): 1318-1323.
36. Terzi H, Biler A, Turkay U, et al. A comparison of novel laparoscopic suturing techniques in single-port surgery. Minim Invasive Ther Allied Technol, 2019, 28(6): 338-343.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Causes and coping principles of hepatic vein hemorrhage in laparoscopic hepatectomy

Abstract Full text Figures/Tables Video References Cited by

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