目的：总结肝癌切除术中防治大出血的经验，提高手术安全性和彻底性。方法：对本院近１０年３６例手术中和术后并发大出血病例进行总结，对其发生的原因、出血部位和应急处理及如何预防等进行分析和讨论。结果：大出血的常见原因：①术野显露差；②过度牵拉肝脏撕破大血管；③肝内解剖不熟判断失误；④术野粘连严重和操作粗疏；⑤创面处理不当等。损伤血管多发部位依次为：肝短静脉（１９．０％）、肝右静脉（１６．７％）、肝中静脉（１４．３％）、瘤体破裂（１１．９％）、下腔静脉和右肾上腺静脉（各９．５％）、肝创面（７．１％）、肝动脉或门静脉支（４．８％）、左肝静脉（２．４％）、其他（４．８％）；术中出血２６例，平均出血量１８９６．５ｍｌ； １３例术后继发出血（其中３例术中止血，术后再继发出血），９例再手术的平均出血量为１１２０ｍｌ，４例继发出血保守疗法治愈。本组无术中死亡，术后１个月内死亡４例。结论：应重视难治性肝癌手术切除的适应证选择、手术操作技术、应急处理措施和围手术期监护处理等，其是保证手术安全性的重要因素。 Objective: To summarize the experience of prevention and treatment of hemorrhage during resection of liver cancer so as to improve the safety and thoroughness of the operation. Methods: To summarize 36 cases of intraoperative and postoperative hemorrhage in our hospital in recent 10 years, and to analyze and discuss the causes, bleeding site and emergency treatment and how to prevent them. Results: The common causes of hemorrhage were as follows: (1) the operative field was poorly exposed; (2) the liver was torn excessively to rupture the large blood vessels; (3) the intrahepatic anatomy was unfamiliar and the judgment was wrong; (4) the surgical field was seriously damaged and the operation was undue; The regions with multiple vascular lesions were: short hepatic vein (19.0%), right hepatic vein (16.7%), middle hepatic vein (14.3%), ruptured tumor (11.9%), inferior vena cava And the right adrenal vein (9.5% each), hepatic wound (7.1%), hepatic artery or portal vein branch (4.8%), left hepatic vein (2.4%) and others ; Intraoperative bleeding in 26 cases, the average amount of bleeding 1896.5ml; 13 cases of secondary bleeding after surgery (3 cases of intraoperative hemostasis, bleeding after surgery), 9 cases of reoperation bleeding was 1120ml, 4 cases Secondary hemorrhage conservative treatment cure. No intraoperative death in this group, 4 patients died within 1 month after surgery. Conclusion: It is important to ensure the safety of operation for hepatocarcinoma patients with surgical indications, surgical techniques, emergency measures and perioperative surveillance.