To explore the risk factors and clinical treatments of CO₂ gas embolism during laparoscopic hepatectomy.

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.

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).

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.