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中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (02): 197 -200. doi: 10.3877/cma.j.issn.2095-3232.2021.02.016

所属专题: 文献

临床研究

腹腔镜肝切除术中CO2气体栓塞发生危险因素及临床处理
李嘉1,(), 邓靖单2, 李舒凡1, 刘高敏1, 徐继威1, 张彩云1   
  1. 1. 514031 广东省梅州市人民医院(中山大学附属梅州医院)肝胆一科
    2. 514031 广东省梅州市人民医院(中山大学附属梅州医院)麻醉科
  • 收稿日期:2021-01-08 出版日期:2021-04-10
  • 通信作者: 李嘉
  • 基金资助:
    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)

Risk factors and clinical management of CO2 gas embolism in laparoscopic hepatectomy

Jia Li1,(), Jingdan Deng2, Shufan Li1, Gaomin Liu1, Jiwei Xu1, Caiyun Zhang1   

  1. 1. Department Ⅰ of Hepatobiliary Surgery, Meizhou People's Hospital Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, China
    2. Department of Anesthesiology, Meizhou People's Hospital Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, China
  • Received:2021-01-08 Published:2021-04-10
  • Corresponding author: Jia Li
目的

探讨腹腔镜肝切除术中CO2 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CO2 气体栓塞发生情况。采用Logistic回归分析CO2 气体栓塞发生危险因素。

结果

CO2 气体栓塞发生率为20%(8/40),8例CO2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 cmH2O(1 cmH2O=0.098 kPa)是腹腔镜肝切除术中CO2 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CO2 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 CO2 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 CO2 gas embolism. The risk factors of CO2 gas embolism were identified by Logistic regression analysis.

Results

The incidence of CO2 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 cmH2O=0.098 kPa) were the independent risk factors for CO2 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 CO2 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.

表1 腹腔镜肝切除术患者术中发生CO2气体栓塞危险因素Logistic回归分析
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