【Abstract】ObjectiveTo investigate the perioperative management in hepatectomy using hepatic energy metabolisom for enhancing safety of and improving the survival in patients with primary liver cancer (PLC).
MethodsTwo thousands and one hundred fortythree patients with PLC were treated in this hospital from January 1990 to January 2004. The perioperative data, operative approach, postoperative treatment, postoperative clinical course and follow up data were retrospectively analyzed. All patients were divided into two groups: the early period group and the late period group(from January 1997 to January 2004) and comparison was taken between two groups. The preoperative redox tolerance index (RTI), intraoperative hepatopetal blood occlusion of half liver, and postoperative arterial ketone body ratio (AKBR) were investigated and evaluated.
Results①The proportion of small PLC and resection rate increased, the morbidity of complications and mortality after hepatectomy decreased, also the survival rate prolonged in the late period group. ②When using RTI as an indicator for selection of hepatectomy, the morbidity of complications decreased from 21.1% to 11.0%, the mortality form 1.6% to 0.3%. ③Comparising hepatopetal blood occlusion of total liver (n=476) with half liver (n=523),the postoperative morbidity of complications and mortality were 25.8% to 11.9% and 2.3% to 0.6% respectively. ④Postoperative AKBR measurements was a reliable indicator to assess the energy status of the liver and liver failure.
ConclusionRTI is of potential value in predicting preoperative hepatic functional reserve, hepatopetal blood occlusion of half liver could protect the residual liver function, and postoperative AKBR measuremeant is a simple and accurate means of determining the immediate state of metabolic dysfunctioning in liver resection. The authors propose that perioperative treatment is an important factor in decreasing operative complications and mortality rate after liver resection.
Citation：
YAN Lnan,CHEN Xiaoli,LI Zhihui,LI Bo,LU Shichun,WEN Tianfu,ZENG Yong,YIAO Huihua,YANG Jiayin,WANG Wentao,XU Mingqing.. Clinical Study of Perioperative Management in Hepatectomy for Primary Liver Cancer (Report of 2 143 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2005, 12(2): 162-166. doi:
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周伟平，陈汉，吴孟超. 术前评价肝脏储备功能的方法和意义 [J]. 肝胆外科杂志，2003； 11（4）245.
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文天夫，郑光琪，孟宪钦，等. 糖耐量和胰岛素分泌试验对预测肝癌手术风险的价值 [J]. 中华外科杂志，1989； 27（10）597.
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- 1. 汤钊猷. 汤钊猷临床肝癌学 [M]. 上海： 上海科技教育出版社，20015～6.
- 2. 吴孟超. 原发性肝癌外科综合治疗的现状和展望 [J]. 中华外科杂志，2004； 19（1）13.
- 3. 严律南，孟宪饮，吴言涛，等. 氧化还原耐受试验对评价肝癌患者肝储备功能的价值 [J]. 中华医学杂志， 1993； 73（3）175.
- 4. Yan LN, Li YL, Wu YT, et al. Redox tolerance test: an indicator of preoperative hepatic fouctional reserve in liver diseases [J]. J Hep Bilipancr Surg, 1997; 4249.
- 5. Mellamby J, Williamson DH. Acetoacetate. In: Bergmeyer HV(ed). Methods of enzymatic analysis [M]. New York: Academic Press, 19741840-1843.
- 6. 严律南. 肝叶切除术中显露门静脉左支的新途径 [J]. 四川医学， 1992； 13（1）59.
- 7. 严律南，袁朝新，张肇达，等. 应用半肝血流阻断行肝叶切除术29例报告 [J]. 中华外科杂志，1994； 32（1）35.
- 8. Yan LN, Ozawa K, Kobayashi N. Changes in hepatic energy metabolism in experimental acute pancreatitis [J]. Chin Med J (Engl)， 1992; 105(8)684.
- 9. Yan LN, Wu YT, Zheng GQ, et al. Analysis of postoperative prognosis in relation to blood ketone body ratio in surgical patients with liver disease [J]. Asian J Surg, 1994; 17(2)156.
- 10. 严律南，曾勇，文天夫，等. 1 038例原发性肝癌的外科治疗 [J]. 中华外科杂志， 2000； 38（7）520.
- 11. 陈孝平，吴在德，叶启发，等. 常温下阻断入肝血流行肝切除术81例临床观察 [J]. 中华外科杂志，1991； 29(2)84.
- 12. 周伟平，陈汉，吴孟超. 术前评价肝脏储备功能的方法和意义 [J]. 肝胆外科杂志，2003； 11（4）245.
- 13. 文天夫，郑光琪，孟宪钦，等. 糖耐量和胰岛素分泌试验对预测肝癌手术风险的价值 [J]. 中华外科杂志，1989； 27（10）597.
- 14. 严律南，小林展章，小泽和惠. 急性坏死性胰腺炎时肝脏能量代谢的动态观察 [J]. 中华外科杂志，1990； 28(5)295.
- 15. 黄志强. 肝切除术中的肝血流阻断术. 见： 黄志强主编. 肝脏外科手术学 [M]. 第1版. 北京： 人民军医出版社，199669.
- 16. 严律南，李晓武，刘占培，等. 半肝血流阻断下肝脏能量代谢变化的研究 [J]. 中华外科杂志，1995； 33（9）576.
- 17. Horgan PG, Leen E. A simple technique for vascular control during hepatectomy: the halfPringle [J]. Am J Surg， 2001; 182(3)265.
