肝细胞癌肝切除术后肝功能衰竭的防治

目的 探讨肝细胞癌肝切除术后肝功能衰竭的原因和防治方法.方法 回顾性分析2000年7月至2008年6月收治的手术切除并病理证实的1000例肝细胞癌患者的临床资料.其中男性922例,女性78例;年龄21～89岁,平均55岁.结果 术后发生肝功能衰竭18例,发生率为1.8%.18例肝功能衰竭患者中,老年患者(>65岁)13例,吲哚氰绿15 min潴留率(ICGR15)>20%者14例,术中出血量>1000 ml 14例,术中输血量>1000 ml 13例,肝纤维化程度Metavir评分中,最严重肝硬化(F4)和严重纤维化(F3)6例(6/7),肝脏余肝体积<40.0%9例(75.0%,9/12).结论 余肝体积过小、术中失血和输血过多、ICGR15>20%、肝纤维化程度Metavir评分F4和F3的肝细胞癌患者较易发生术后肝功能衰竭,人工肝或联合肝移植在治疗术后肝功能衰竭方面有着极其重要的作用.

The prevention and treatment of post-resectional liver failure for hepatocellular carcinoma

Objective To investigate the cause of liver failure after hepatectomy for hepatocellular carcinoma and explore its prevention and treatment. Methods The clinical data of 1000 patients with hepatocellular carcinoma undergone hepatectomy from July 2000 to June 2008 were retrospectively analyzed. There were 922 male and 78 female, aging from 21 to 89 years old. Results Among the 1000 patients,there were 18 patients with liver failure after hepatectomy(1.8%). Among the 18 patients with liver failure,13 patients were more than 65 years old,14 patients were with more than 20% of indocyanine green retention rate at 15 minutes, 14 patients were with more than 1000 ml blood loss during operation,6 patients were with F4/F3 liver fibrosis(Metavir Scores), and 9 patients were with less than 40.0% liver volume of residue liver. Conclusions Patients with hepatocelluar carcinoma with less than volume of residue liver,much more blood loss or transfusion,more than 20% of ICGR15,F4/F3 liver cirrhosis are prone to be with liver failure after hepatectomy. Artificial liver or liver transplantation may be the important alternative for liver failure after hepatectomy.