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Blood loss during laparoscopic cholecystectomy Control Measures

. Because intraoperative cystic artery of ectopic origin of lack of knowledge, not been effectively dealt with the damage caused by bleeding, is a common cause of cystic artery bleeding. Therefore, the cystic duct and Calot triangle dissection, particular attention should be as close as possible free of cystic duct gallbladder neck, cystic artery to avoid injury; cut off when the cystic duct with titanium clips at the same level, and preferably to see the tip scissors Department; on the Calot triangle anomaly Running fiber cord-like tissues do not easily cut off power to the titanium clip and then pour off; if the cystic artery and cystic duct in close proximity, without separation, large titanium clip can be clipped ; the treatment of cystic artery can not be too omission can also result in bleeding off; treatment as close as possible when the cystic artery cystic titanium clip on the side, so the gallbladder artery and bile duct between the liver long enough distance, once the cystic artery bleeding,[link widoczny dla zalogowanych], treatment is not to damage the liver bile duct. In addition, the technique used to attract positive suction blood or blood product with a swab when the cystic artery careful not to draw down on the titanium clip cause further bleeding. Pulsatile cystic artery often has jet-like bleeding, bleeding volume, bleeding should be promptly once found living with a separate clamp the bleeding sites, blood clots around the net absorption, and then further confirmed bleeding, bleeding with a titanium clip occlusion. Can also be caught in the extrahepatic bile duct is not clear, the direct use of forceps to the separation of coagulation coagulation. If you can not effectively control the bleeding, should prompt laparotomy to stop bleeding. The group of cystic artery bleeding in 5 cases, 4 cases of this method successfully to stop bleeding, 1 case was converted to laparotomy to stop bleeding. 2.2 Prevention of the gallbladder bed bleeding: bleeding more common in the gallbladder bed or atrophic cholecystitis acute cholecystitis, gallbladder and liver bed close adhesion, caused when the level of a confusion of gallbladder dissection, to find the interface difficult to make fiber membrane is torn or errors caused by human liver hemorrhage; the liver itself,[link widoczny dla zalogowanych], factors such as cirrhosis, portal hypertension caused by blood coagulation dysfunction is a common cause of gallbladder bed bleeding; some of the gallbladder through vessel damage can also cause bleeding. Therefore,[link widoczny dla zalogowanych], when the spin-off gallbladder gallbladder and liver can find the best bed, bleeding. Acute gangrenous suppurative cholecystitis, gallbladder wall and liver bed without any gaps, particularly difficult to separate those, subtotal cholecystectomy or gall bladder can be anterior part of the surgical resection to prevent errors caused by human liver intrahepatic vein Damage caused by bleeding. Of the gallbladder bed of blood vessels larger than 1mm. For pulsatile bleeding,[link widoczny dla zalogowanych], titanium clip should be on the bleeding, in the case of non-pulsatile bleeding, liver damage or gallbladder bed bleeding, gelatin sponge may be electrocautery to stop bleeding. Can also be used gauze to stop bleeding,[link widoczny dla zalogowanych], generally about ten minutes, bleeding can be stopped; if the conditions can also be used to stop bleeding argon 【3; cut the gallbladder, the liver bed should be hemorrhage, hepatic vein injury can not be ruled out of blood and large, should be converted to laparotomy to stop bleeding. The group, hepatic parenchymal bleeding in 2 cases laparotomy hemostasis. 2.3 gallbladder puncture hole and the surrounding tissue adhesion prevention and treatment of bleeding: bleeding puncture blood vessels on the abdominal wall due to damage caused by surgery if caught early can expand the incision to stop bleeding. Set aside to pay special attention to check the puncture hole after casing is bleeding, to prevent postoperative bleeding caused reoperation. Application of gallbladder dissection blunt dissection around the organization or Organization of retinal bleeding can stop bleeding coagulation or titanium clips; can not rule out the possibility of bleeding in the gastrointestinal tissues, not electric coagulation, can be isolated occlusion clamp punctate bleeding points, and then stop the bleeding with a titanium clip, brought up small beam will not be thick adhesive tissue colon loop, even if one intestinal loop, a small titanium clip is not completely clamped thick bowel caliber, so this method is safe. Laparoscopic cholecystectomy in surgical bleeding and surgery has a lot of skills and experience, in the event of hemorrhage, to stay calm and noted in different situations using different approaches, should not blindly in the hematoma, or coagulation on the titanium clip in order to avoid greater damage to other organs, such as bleeding invalid, should be bold and abdominal bleeding.
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