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KMID : 0371319950490040590
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Journal of the Korean Surgical Society
1995 Volume.49 No. 4 p.590 ~ p.597
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Packingk and Planned Re-exploration for Hepatic Vein Injury: Experience of 2 cases
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Abstract
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Injuries to the juxtahepatic vena cava and hepatic vein tributaries are notoriously difficult to control and repair. Control of hemorrhage is at times unsuccessful and exsanguination results. Although severl techniques have been suggested to
solve
this
problem, the mortality is reported still high.
Authors successfully treated two cases of hepatic vein injury using the perihepatic packing and planned re-exploration. The first case revealed complete disconnection of the right hepatic vein and partial disconnection of the middle hepatic vein
with
severe parenchymal disruption of the right lobe. The second case revealed complete disconnection of the right hepatic vein with partial parenchymal disruption of the right lobe and severe parenchymal disruption of the left lateral segment. At the
time
of re-exploration, they were treated with right lobectomy-right hepatic vein ligation and left lateral segmentectomy-repair of right hepatic vein, respectively. Access to the hepatic vein through the plane of lateral segmentectomy with some
careful
perivascular dissection afforded good exposure of both left and right hepatic veins in case 2.
Authors conclude that ①transient perihepatic packing and re-exploratory parenchymal dissection or resection of the destroyed part of the liver should be considered as one of the preferred treatment modalities for hepatic venous injuries, ②in
the
case
of hepatic venous injury not associated with parenchymal damage, parenchymal dissection through the plane of lateral segmentectomy with or without resection may provide good exposure of retrohepatic vein tributaries.
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