Wu C C, Yang M D, Liu T J
Department of Surgery, Taichung Veterans General Hospital, Taiwan.
Jpn J Clin Oncol. 1992 Apr;22(2):107-12.
From September, 1989, to December, 1990 (late period), intraoperative ultrasonography (IOU) and intermittent hepatic inflow blood occlusion were introduced in hepatectomy. Compared with the early period from January, 1983, to August, 1989, the resectability of hepatocellular carcinoma (HCC) increased from 12.1 to 62.1% (P less than 0.0001). More resections on cirrhotic patients (P less than 0.05) and more combined resections with other organs (P less than 0.005) were carried out. Although the operation time was longer (P less than 0.01), less blood loss during surgery and fewer perioperative blood transfusions (P less than 0.001) were found during the late period. Since the rate at which classical resections were performed has reduced (P less than 0.001), postoperative morbidity has also decreased (P less than 0.05). Although the surgical mortality did not differ between the two periods, most deaths in the early period were caused by postoperative hepatic failure which was not found in the late period. Since IOU can clarify the intrahepatic vasculature and identify impalpable and invisible tumors, more precise resections can now be carried out. Intermittent hepatic inflow occlusion reduces blood loss during surgery without increasing risk. We suggest both techniques should be mandatory in hepatectomy for HCC in order for the safety range of resections to be broadened.
从1989年9月至1990年12月（后期），肝切除术中引入了术中超声检查（IOU）和间歇性肝血流阻断。与1983年1月至1989年8月的前期相比，肝细胞癌（HCC）的可切除率从12.1%提高到62.1%（P<0.0001）。对肝硬化患者进行了更多的切除术（P<0.05），并对更多的其他器官进行了联合切除术（P<0.005）。虽然手术时间更长（P<0.01），但后期手术中失血更少，围手术期输血也更少（P<0.001）。由于经典切除术的实施率有所降低（P<0.001），术后发病率也有所下降（P<0.05）。虽然两个时期的手术死亡率没有差异，但前期大多数死亡是由术后肝衰竭引起的，而后期未发现这种情况。由于IOU可以明确肝内血管系统并识别触诊不到和不可见的肿瘤，现在可以进行更精确的切除术。间歇性肝血流阻断可减少手术中的失血而不增加风险。我们建议在HCC肝切除术中这两种技术都应成为必需，以便扩大切除的安全范围。
