目的　总结肝癌切除术中并发大出血的原因和处理中的经验与教训 ,提高手术的安全性和彻底性。方法　对 19992 0 0 2年 43例术中、术后并发大出血病例的病因、出血部位和应急处理以及预防进行分析讨论。结果　大出血的原因 :( 1)术野显露差 ;( 2 )过度牵拉肝脏撕裂大血管 ;( 3 )术野粘连 ,操作粗疏 ;( 4 )判断失误 ,误伤大血管 ;( 5 )创面处理不当。发生于肝短及肝后下腔静脉区域、肝右静脉为最多。发生率 :肝短静脉 2 2 4% ,肝右静脉18 4% ,肝创面 16 3 % ,肝中静脉 12 2 % ,肝后段腔静脉 10 2 % ,瘤体破裂 6 1% ,肝左静脉 6 1% ,门静脉支、肝动脉支 4 1% ,其他 4 1%。结论　对高难度肝癌的手术切除应重视适应证选择、手术操作技术 ,应急措施和围手术期处理等 ,这些是保证手术安全性的重要因素 Objective To summarize the causes of massive hemorrhage during liver resection and the experiences and lessons in the treatment, and to improve the safety and thoroughness of the operation. Methods The etiology, bleeding site, emergency management and prevention of 43 cases of postoperative intraoperative and postoperative bleeding were analyzed and discussed in 1999-2002. The results of bleeding causes: (1) surgical field showed poor; (2) excessive pulling the liver tearing of large blood vessels; (3) surgical adhesions, the operation of coarse; (4) misjudgment, accidental injury of large blood vessels; improper. Occurs in the liver short and after the inferior vena cava region, the right hepatic vein is the most. Incidence rate: 224% of the short hepatic vein, 18.4% of the right hepatic vein, 16.3% of the liver wound, 12.2% of the middle hepatic vein, 102% of the inferior vena cava of the liver, 61% of the tumor rupture, 6 1%, portal vein branch, hepatic artery branch 4 1%, the other 4 1%. Conclusion The surgical indications, operative techniques, emergency measures and perioperative management should be emphasized in the surgical resection of advanced hepatocellular carcinoma. These are the important factors to ensure the safety of surgical operation