Kohno T, Yamamoto M, Sugahara K
First Department of Surgery, Yamanashi Medical College, Japan.
Nihon Geka Gakkai Zasshi. 1991 May;92(5):513-25.
To analyze relating factors to early repairment of the surgical margin of the remnant liver we measured plasma fibronectin (FN), coagulation factor XIII (XIII), polymorphonuclear leukocyte elastase (PMNE), platelet counts (Plt), prothrombin time (PT%) before and at the first, third, 7th and 14th days after liver resection in 25 patients. Changes in these factors (1) were compared with their clinical status, such as liver cirrhosis, high fever, abscess formation, duration of drainage and use of microwave tissue coagulator (MTC) (2). The multivariate analysis about the factors influencing the duration of hospital stay (3) were carried out. (1) In the all cases FN, XIII (14th), PT%, Plt decreased and PMNE increased significantly versus pre-operative data. There were significant correlations between FN and XIII, FN and PMNE. (2) In the cirrhotic group FN, XIII, PT% and Plt were significantly lower than those of non cirrhotic group. In the abscess formation group PT% was significantly lower than the no abscess formation group. In the MTC group XIII, PT% and Plt were significantly lower than those of the no-MTC group. In conclusion, FN, XIII, Plt and PT% in the cirrhotic, high fever, abscess formation or longer drainage group were in lower levels compared with the each control group. (3) By the multivariate analyses, abscess formation, high fever and liver cirrhosis were the most influencing factors for the duration of hospital stay.
为分析与残余肝手术切缘早期修复相关的因素,我们对25例患者在肝切除术前以及术后第1天、第3天、第7天和第14天测定了血浆纤维连接蛋白(FN)、凝血因子 XIII(XIII)、多形核白细胞弹性蛋白酶(PMNE)、血小板计数(Plt)、凝血酶原时间(PT%)。将这些因素的变化(1)与他们的临床状况进行比较,如肝硬化、高热、脓肿形成、引流持续时间以及微波组织凝固器(MTC)的使用情况(2)。对影响住院时间的因素进行多变量分析(3)。(1)在所有病例中,与术前数据相比,FN、XIII(第14天)、PT%、Plt均显著下降,而PMNE显著升高。FN与XIII、FN与PMNE之间存在显著相关性。(2)在肝硬化组中,FN、XIII、PT%和Plt显著低于非肝硬化组。在脓肿形成组中,PT%显著低于无脓肿形成组。在MTC组中,XIII、PT%和Plt显著低于无MTC组。总之,肝硬化、高热、脓肿形成或引流时间较长组中的FN、XIII、Plt和PT%水平低于各自的对照组。(3)通过多变量分析,脓肿形成、高热和肝硬化是影响住院时间的最主要因素。