title: [Massive hemorrhage in hepatectomy: causes and management].
abstract: OBJECTIVE
  To analyse the causes and the management of massive hemorrhage in hepatectomy.
  
  
  METHODS
  With over 1 000 ml of bleeding, 4 368 patients with hepatectomy between 1955 and 2000 were analysed retrospectively.
  
  
  RESULTS
  Among 4 368 patients receiving hepatectomy, 286 (6.5%) had massive hemorrhage because of damage to the major hepatic veins, portal hypertension, hepatic insufficiency, and the extensive adhesion around the tumor. Massive hemorrhage was managed by repair and transfixation of the damaged vessels; transfixation or devascularization of variceal bleeding; complete vessels ligation of the hepatic section with mattress suture; resection of the ruptured tumor after temporary occlusion of the porta hepatis; fibrinogen infusion; hot saline compression of the surface of the wound and/or daub biological glue; argon beam coagulation and packs placement.
  
  
  CONCLUSIONS
  Light performance and nonforce dragging of liver can reduce massive hemorrhage caused by major vessel injury or tumor rupture. Normothetic occlusion of porta hepatis can reduce blood loss effectively when liver resection. In situ hepatectomy must be adopted if there is extensive adhesion around the tumor. Packs placement is still an effective measure to stop bleeding caused by defective coagulation and extensive blood oozing of wound surface.
authors.affiliation: Institute of Hepatobiliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
authors.forename: Xiao-ping
authors.initials: XP
authors.lastname: Chen
authors.forename: Fa-zu
authors.initials: FZ
authors.lastname: Qiu
authors.forename: Zai-de
authors.initials: ZD
authors.lastname: Wu
authors.forename: Zhi-wei
authors.initials: ZW
authors.lastname: Zhang
authors.forename: Yi-fa
authors.initials: YF
authors.lastname: Chen
authors.forename: Bi-xiang
authors.initials: BX
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D006488:Hemostasis, Surgical; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged