New possibilities for major liver surgery in patients with Klatskin tumors or primary hepatocellular carcinoma--an old problem revisited.
New possibilities for major liver surgery in patients with Klatskin tumors or primary hepatocellular carcinoma--an old problem revisited.
复制标题
克拉茨金瘤或原发性肝细胞癌患者进行大型肝脏手术的新可能性——一个老问题的重新审视。
作者：
M. Makuuchi;T. Kosuge;Lygidakis Nj
继发于肝脏疾病的肝功能受损被认为是广泛肝切除术的禁忌症，因为有肝衰竭的风险。术前3 - 4周，对考虑切除的肝脏部位对应的门静脉分支进行选择性栓塞，据报道，栓塞部分肝脏萎缩，未栓塞部分肝脏肥大。该策略在46例扩大肝切除术患者中显示出满意的早期结果。一名严重胆管炎患者在头30天死亡。7例患者出现轻微并发症，保守治疗效果良好（膈下脓肿3例，伤口感染3例，肺部感染1例）。选择性门静脉栓塞的耐受性良好，并伴有暂时的轻微副作用。栓塞前后肝功能恢复到栓塞前水平。目前的结果支持选择性门静脉栓塞对肝功能受损患者的政策，在广泛的肝切除是必要的。栓塞是一种很有前途的辅助术前选择。
An impaired liver function secondary to liver disease is considered a contra-indication for extensive liver resection because of the risk of liver failure. Selective embolization of the portal branch corresponding to the part of the liver that is considered for resection, carried out three to four weeks before surgery, reportedly induced atrophy of the embolized part of the liver with hypertrophy of the nonembolized part. This policy showed satisfactory early results in 46 patients who had extended liver resection. One patient with severe cholangitis died in the first 30 days. Seven patients had minor complications, which responded well to conservative management (subphrenic abscesses 3, wound infections 3, pulmonary infection 1). Selective portal embolization was well tolerated and was associated with temporary mild side effects. Liver functions before and after embolization returned to pre-embolization values. The present results support the policy of selective portal embolization in patients with impaired liver function in whom extensive liver resection is necessary. Embolization is a promising ancillary preoperative alternative.