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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Abstract Full text Figures/Tables Video References Cited by

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.	陳雪芳, 謝浩榮, 王愷, 等. 腹腔鏡與開腹再次肝切除術治療復發性肝細胞癌的安全性及療效對比. 中華肝膽外科雜志, 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.	張沖. 腹腔鏡肝切除術中預防和控制出血的策略. 中國普通外科雜志, 2017, 26(1): 96-101.
7.	梁霄, 陳國俊. 腹腔鏡肝切除術中出血的預防與處理. 肝膽外科雜志, 2017, 25(4): 249-251.
8.	安然, 張超. 腹腔鏡肝切除術中出血預防和控制. 中華肝臟外科手術學電子雜志, 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.	鄭樹國. 腹腔鏡肝切除術肝靜脈系統出血處理策略. 中國實用外科雜志, 2017, 37(5): 485-489.
11.	鄭成紅, 蔣曉忠, 余鈺. 三維可視化技術應用于腹腔鏡精準肝切除術的研究進展. 中國普外基礎與臨床雜志, 2019, 26(3): 364-368.
12.	張樹庚, 劉連新. 吲哚菁綠熒光融合影像引導技術在腹腔鏡肝切除中的應用及展望. 中華肝膽外科雜志, 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.	吳嘉, 張成武, 劉軍偉, 等. 近紅外成像聯合術中超聲在腹腔鏡肝腫瘤切除中的應用. 中華普通外科雜志, 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, 楊小敏, 周新文, 等. 陳氏簡易全肝血流阻斷技術的臨床應用: 附280例報道. 中國普通外科雜志, 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.	魏永剛, 張渝翰. 腹腔鏡肝臟切除術的肝門血流阻斷及斷肝技巧. 中國普外基礎與臨床雜志, 2019, 26(2): 137-140.
20.	蔡秀軍, 蔡柳新, 劉榮. 腹腔鏡肝切除術中血流控制技術及肝實質離斷技術. 中國實用外科雜志, 2017, 37(5): 505-508.
21.	劉連新, 梁英健. 腹腔鏡肝切除術肝實質離斷技巧及器械選擇. 中國實用外科雜志, 2017, 37(5): 473-476.
22.	勞誠毅, 林成新, 劉敬臣, 等. 不同水平低中心靜脈壓對豬血流動力學及肝靜脈損傷出血量影響的研究. 廣西醫科大學學報, 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.	楊祿坤, 范東毅, 孔凡根, 等. 低中心靜脈壓技術在肝硬化患者腹腔鏡肝切除術中的應用. 中華肝臟外科手術學電子雜志, 2019, 8(2): 139-142.
26.	趙欣, 雷澤華, 高峰畏, 等. 肝下下腔靜脈阻斷聯合Pringle阻斷在肝切除術中安全性及有效性的薈萃分析. 中華肝膽外科雜志, 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.	段云飛, 楊雨, 施龍青, 等. 腹腔鏡肝切除術中二氧化碳栓塞的原因與處理. 中華肝膽外科雜志, 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.	Mu?oz 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.	劉連新, 蔡建強, 曾勇, 等. 肝臟手術縫合技術與縫合材料選擇中國專家共識 (2018版). 中國實用外科雜志, 2019, 39(1): 11-14.
34.	趙玉沛, 張太平. 普通外科縫合技術的基本原則與縫合材料規范化使用. 中國實用外科雜志, 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. 陳雪芳, 謝浩榮, 王愷, 等. 腹腔鏡與開腹再次肝切除術治療復發性肝細胞癌的安全性及療效對比. 中華肝膽外科雜志, 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. 張沖. 腹腔鏡肝切除術中預防和控制出血的策略. 中國普通外科雜志, 2017, 26(1): 96-101.
7. 梁霄, 陳國俊. 腹腔鏡肝切除術中出血的預防與處理. 肝膽外科雜志, 2017, 25(4): 249-251.
8. 安然, 張超. 腹腔鏡肝切除術中出血預防和控制. 中華肝臟外科手術學電子雜志, 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. 鄭樹國. 腹腔鏡肝切除術肝靜脈系統出血處理策略. 中國實用外科雜志, 2017, 37(5): 485-489.
11. 鄭成紅, 蔣曉忠, 余鈺. 三維可視化技術應用于腹腔鏡精準肝切除術的研究進展. 中國普外基礎與臨床雜志, 2019, 26(3): 364-368.
12. 張樹庚, 劉連新. 吲哚菁綠熒光融合影像引導技術在腹腔鏡肝切除中的應用及展望. 中華肝膽外科雜志, 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. 吳嘉, 張成武, 劉軍偉, 等. 近紅外成像聯合術中超聲在腹腔鏡肝腫瘤切除中的應用. 中華普通外科雜志, 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, 楊小敏, 周新文, 等. 陳氏簡易全肝血流阻斷技術的臨床應用: 附280例報道. 中國普通外科雜志, 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. 魏永剛, 張渝翰. 腹腔鏡肝臟切除術的肝門血流阻斷及斷肝技巧. 中國普外基礎與臨床雜志, 2019, 26(2): 137-140.
20. 蔡秀軍, 蔡柳新, 劉榮. 腹腔鏡肝切除術中血流控制技術及肝實質離斷技術. 中國實用外科雜志, 2017, 37(5): 505-508.
21. 劉連新, 梁英健. 腹腔鏡肝切除術肝實質離斷技巧及器械選擇. 中國實用外科雜志, 2017, 37(5): 473-476.
22. 勞誠毅, 林成新, 劉敬臣, 等. 不同水平低中心靜脈壓對豬血流動力學及肝靜脈損傷出血量影響的研究. 廣西醫科大學學報, 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. 楊祿坤, 范東毅, 孔凡根, 等. 低中心靜脈壓技術在肝硬化患者腹腔鏡肝切除術中的應用. 中華肝臟外科手術學電子雜志, 2019, 8(2): 139-142.
26. 趙欣, 雷澤華, 高峰畏, 等. 肝下下腔靜脈阻斷聯合Pringle阻斷在肝切除術中安全性及有效性的薈萃分析. 中華肝膽外科雜志, 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. 段云飛, 楊雨, 施龍青, 等. 腹腔鏡肝切除術中二氧化碳栓塞的原因與處理. 中華肝膽外科雜志, 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. Mu?oz 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. 劉連新, 蔡建強, 曾勇, 等. 肝臟手術縫合技術與縫合材料選擇中國專家共識 (2018版). 中國實用外科雜志, 2019, 39(1): 11-14.
34. 趙玉沛, 張太平. 普通外科縫合技術的基本原則與縫合材料規范化使用. 中國實用外科雜志, 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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