肝胆膵手術における肝予備能の再評価

In the present study, liver function at pre-operative and postoperative period was evaluated by various examinations. Patients with obstructive jaundice (n=14) and liver tumor (n=6) often have complications such as postoperative hepatic failure (n=4). They were divided into 3 groups: group A (n=7) had postoperative complications, group B (n=13) had uneventful postoperative course and group C (n=4) had postoperative hepatic failure. Liver function had significant correlations with levels of total bilirubin max (T-Bil max), hepaplastin tests (HPT) and ALPratio (post ope/pre-ope). Group C had T-Bil max≧30 mg/dl, HPT≦60% (54.4±14.7), ALPratio≧1.5, and admission ALP≧3000.
We determined the level of bilirubin per day in drained blie (V-Bil) in 14 patients who underwent biliary drainage to ensure precise evalution of preoperative liver function. V-Bil was 332.9±140.0 mg/day on average, showing a close correlation with the serum bilirubin decreasing rate "b" and ICG R 15 (p<0.05). V-Bil is useful for evaluation of liver function in patients with malignant obstructive jaundice.
In 6 patients without cirrhosis undergoing partial hepatectomy for liver tumor, ALPratio (≧1.5), a blood loss during operation (≧500), and operating time were related to the onset of postoperative hepatic failure.