Hwang Shin, Na Byeong-Gon, Kim Minjae, Won Dae-Hyeon
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Hepatobiliary Pancreat Surg. 2021 Nov 30;25(4):517-522. doi: 10.14701/ahbps.2021.25.4.517.
Various topical hemostatic agents can help induce coagulation at the liver cut surface. However, hemostasis is usually ineffective in controlling bleeding. We present a case of rescue fibrin glue-infiltrating hemostasis combined with hepatorrhaphy to manage intractable postoperative bleeding from the liver cut surface. The case was a 56-year-old male patient with hepatocellular carcinoma in hepatitis B virus-associated cirrhotic liver. The patient was administered warfarin because of graft replacement of the ascending aorta and hemi-arch one year earlier. After warfarin was discontinued, segment VII partial hepatectomy was performed according to standard procedures. However, considerable bleeding occurred during and after hepatectomy. Bleeding from the liver cut surface was controlled over one hour using surface coagulation and topical application of four kinds of hemostatic agents. However, active abdominal bleeding led to reoperation soon after the hepatectomy. During the reoperation, we identified diffuse oozing from the edge of the liver cut surface which was difficult to control. Thus, we performed direct parenchymal injection of fibrin glue at the bleeding points using 12 fibrin glue kits which induced complete hemostasis. Because the patient would undergo anticoagulation again soon after the operation, we also performed hepatorrhaphy. The patient recovered uneventfully after the reoperation. He has been doing well for six months without complications. In conclusion, fibrin glue-infiltrating hemostasis effectively controlled intractable bleeding from the hepatic cut surface in our case. Thus, it can be considered as an optional method for rescue hemostasis.
各种局部止血剂可有助于在肝脏切面诱导凝血。然而，止血通常在控制出血方面效果不佳。我们报告一例采用纤维蛋白胶浸润止血联合肝缝合术治疗肝脏切面术后顽固性出血的病例。该病例为一名56岁男性患者，患有乙型肝炎病毒相关性肝硬化肝脏的肝细胞癌。该患者因一年前升主动脉和半弓移植而服用华法林。停用华法林后，按照标准程序进行了Ⅶ段部分肝切除术。然而，肝切除术中及术后发生了大量出血。使用表面凝血和局部应用四种止血剂对肝脏切面出血进行了一个多小时的控制。然而，肝切除术后不久，活跃的腹腔出血导致再次手术。再次手术期间，我们发现肝脏切面边缘弥漫性渗血，难以控制。因此，我们使用12套纤维蛋白胶试剂盒在出血点进行了直接实质内注射纤维蛋白胶，实现了完全止血。由于患者术后不久将再次接受抗凝治疗，我们还进行了肝缝合术。再次手术后患者恢复顺利。他已经顺利度过六个月，没有并发症。总之，在我们的病例中，纤维蛋白胶浸润止血有效地控制了肝脏切面的顽固性出血。因此，它可被视为一种抢救止血的可选方法。
