摘要
目的探讨腹腔镜肝切除术中CO_(2)气体栓塞发生的危险因素及临床处理。方法回顾性分析2017年1月至2018年12月在广东省梅州市人民医院行腹腔镜肝切除术的40例患者临床资料。其中男21例,女19例;平均年龄(53±3)岁。患者均签署知情同意书,符合医学伦理学规定。术中采用经食管超声心动图(TEE)监测CO_(2)气体栓塞发生情况。采用Logistic回归分析CO_(2)气体栓塞发生危险因素。结果 CO_(2)气体栓塞发生率为20%(8/40),8例CO_(2)气体栓塞患者均经有效的抢救措施治愈,其中3例经腹腔镜下缝合静脉小破口,5例中转开腹缝合肝静脉破口。多因素Logistic回归分析结果显示,气腹压力>12 mmHg(1 mmHg=0.133 kPa)、术中肝静脉破裂、中心静脉压<2 cmH_(2)O(1 cmH_(2)O=0.098 kPa)是腹腔镜肝切除术中CO_(2)气体栓塞发生的独立危险因素(OR=31.089,22.241,16.116;P<0.05)。结论高气腹压力、肝静脉破裂、低中心静脉压是腹腔镜肝切除术中CO_(2)气体栓塞发生的危险因素。术中采用TEE动态观察气体栓塞情况,控制合适的气腹压力和中心静脉压,及时修补肝静脉破裂是避免致死性气体栓塞的关键。
Objective To explore the risk factors and clinical treatments of CO_(2) gas embolism during laparoscopic hepatectomy.Methods Clinical data of 40 patients who underwent laparoscopic hepatectomy in Meizhou People’s Hospital from January 2017 to December 2018 were retrospectively analyzed.Among them,21 patients were male and 19 female,aged(53±3)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.Intraoperatively,transesophageal echocardiography(TEE)was used to monitor the incidence of CO_(2) gas embolism.The risk factors of CO_(2) gas embolism were identified by Logistic regression analysis.Results The incidence of CO_(2) gas embolism was 20%(8/40),and all 8 cases were treated by effective rescue measures.Among them,3 cases underwent laparoscopic suturing of small vein rupture,and 5 cases were converted to open suturing for hepatic vein rupture.Multivariate Logistic regression analysis showed that pneumoperitoneal pressure>12 mmHg(1 mmHg=0.133 kPa),intraoperative hepatic vein rupture and central venous pressure<2 cmH2O(1 cmH_(2)O=0.098 kPa)were the independent risk factors for CO_(2) gas embolism during laparoscopic hepatectomy(OR=31.089,22.241,16.116;P<0.05).Conclusions High pneumoperitoneal pressure,hepatic vein rupture and low central venous pressure are the risk factors for CO_(2) gas embolism during laparoscopic hepatectomy.Intraoperative application of TEE to dynamically observe the gas embolism,proper control of the pneumoperitoneal pressure and central venous pressure and timely repair of hepatic vein rupture are the critical interventions to avoid fatal gas embolism.
作者
李嘉
邓靖单
李舒凡
刘高敏
徐继威
张彩云
Li Jia;Deng Jingdan;Li Shufan;Liu Gaomin;Xu Jiwei;Zhang Caiyun(DepartmentⅠof Hepatobiliary Surgery,2Department of Anesthesiology,Meizhou People's Hospital Meizhou Hospital Affiliated to Sun Yat-sen University,Meizhou 514031,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2021年第2期197-200,共4页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
广东省医学科研基金项目(B2018042)
梅州市社会发展科技计划项目(2018B012)。
