Tjandra J J, Fan S T, Wong J
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Aust N Z J Surg. 1991 Mar;61(3):201-6. doi: 10.1111/j.1445-2197.1991.tb07592.x.
The operative results of hepatic resections (n = 67) during the past 28 months are reported. Major hepatic resection (lobectomy, extended lobectomy) was performed in 78% of patients with hepatocellular carcinoma (HCC) and in 24% of patients with non-HCC diseases. The overall operative mortality was 10%: 15% for HCC and 0% for non-HCC diseases. The operative mortality in the HCC group occurred exclusively in patients who had undergone right or extended right lobectomy. The operative mortality of right or extended right lobectomy in patients with HCC increased considerably with the presence of cirrhosis (32% vs 0%) and a liver function worse than Child's A (60% vs 17%). In HCC, the incidence of operative mortality (47%) and postoperative hepatic failure (73%) was higher when there had been massive operative blood loss (greater than or equal to 4.0 L) and/or persistent postoperative haemorrhage, compared with 0% and 24% respectively in cases without massive peri-operative bleeding. While postoperative hepatic failure was present in 5 of 7 fatalities, it was not an independent prognostic factor, but was dependent on the presence of massive peri-operative blood loss.
报告了过去28个月内67例肝脏切除术的手术结果。78%的肝细胞癌（HCC）患者和24%的非HCC疾病患者接受了大肝切除术（叶切除术、扩大叶切除术）。总体手术死亡率为10%：HCC患者为15%，非HCC疾病患者为0%。HCC组的手术死亡仅发生在接受右叶或扩大右叶切除术的患者中。HCC患者右叶或扩大右叶切除术的手术死亡率在存在肝硬化（32%对0%）和肝功能比Child A级差（60%对17%）时显著增加。在HCC中，与围手术期无大量出血病例分别为0%和24%相比，当出现大量手术失血（大于或等于4.0 L）和/或持续性术后出血时，手术死亡率（47%）和术后肝衰竭发生率（73%）更高。虽然7例死亡中有5例出现术后肝衰竭，但它不是一个独立的预后因素，而是取决于围手术期大量失血的存在。
