Ston M E, Rehman S U, Conaway G, Sardi A
Department of Surgery, St. Agnes HealthCare, Baltimore, MD 21229, USA.
J Gastrointest Surg. 2000 Jul-Aug;4(4):349-53; discussion 353-4. doi: 10.1016/s1091-255x(00)80011-6.
Hepatic resection remains the "gold standard" in the primary management of primary and metastatic tumors to the liver. Advanced surgical techniques along with more modern and sophisticated equipment have led to an increasing number of hepatic resections being performed with a concomitant decrease in morbidity and mortality. We followed prospectively 18 consecutive hepatic resections performed over a period of approximately 2.5 years. The setting was a community teaching hospital with a low volume of referrals for hepatic resection. Sixteen (88%) had metastatic disease and two had primary liver disease. There were four trisegmentectomies, four lobectomies, four segmentectomies, and six large wedge re-sections. Average estimated blood loss was 608 ml. Seven patients required transfusions. Complications occurred in five patients (27%). In-hospital mortality was 0%. Our experience suggests that liver resections in a low-volume community hospital can be performed safely provided an experienced surgical team with familiarity of advanced surgical techniques and sophisticated equipment used in hepatic resection is readily available.
肝切除术仍然是肝脏原发性和转移性肿瘤主要治疗方法中的“金标准”。先进的手术技术以及更现代、更精密的设备使得肝切除手术的数量不断增加，同时发病率和死亡率也有所下降。我们前瞻性地跟踪了在大约2.5年的时间里连续进行的18例肝切除术。手术地点是一家社区教学医院，肝切除转诊量较低。其中16例（88%）为转移性疾病，2例为原发性肝脏疾病。有4例三段切除术、4例肝叶切除术、4例肝段切除术和6例大楔形切除术。平均估计失血量为608毫升。7例患者需要输血。5例患者（27%）出现并发症。住院死亡率为0%。我们的经验表明，在社区医院，如果有经验丰富、熟悉肝切除先进手术技术和精密设备的手术团队，低转诊量的肝切除术也可以安全进行。
