The Department of General Surgery, Hokkaido University, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan.
J Hepatobiliary Pancreat Sci. 2011 Sep;18(5):724-30. doi: 10.1007/s00534-011-0394-5.
To further improve the outcomes of liver resection, it is important to identify and prevent the causes of the hyperbilirubinemia occurring after hepatectomy and postoperative liver failure.
Between 2004 and 2009, 591 consecutive patients underwent a hepatectomy at our center. Twenty-two patients who developed hyperbilirubinemia (postoperative total bilirubin over 5 mg/dL) after hepatectomy were classified as Hi-Bi group and another 569 whose total bilirubin did not increase beyond 5 mg/dL were classified as non-Hi-Bi group.
A preoperative prothrombin test of less than 80% and a blood loss of more than 1000 mL were identified as independent risk factors for the Hi-Bi group by multivariate analysis. The hyperbilirubinemia of 16 cases improved, while that of 6 cases was prolonged. One of these patients died of liver failure without responding to treatment. The mortality rate for postoperative liver failure in this study was 0.16% (1/591).
It is important to reduce the length of surgery and intraoperative blood loss to prevent hyperbilirubinemia after hepatectomy. Additionally, decision-making using our algorithm and full examination of the accurate evaluation results, including those for prothrombin time, residual liver function and liver damage, can help reduce the development of hyperbilirubinemia.
为了进一步提高肝切除术后的疗效，重要的是要识别和预防肝切除术后及术后肝功能衰竭发生高胆红素血症的原因。
2004 年至 2009 年间，我院中心对 591 例患者进行了肝切除术。22 例肝切除术后发生高胆红素血症（术后总胆红素超过 5mg/dL）的患者被分为高胆红素血症组（Hi-Bi 组），另外 569 例总胆红素未超过 5mg/dL 的患者分为非高胆红素血症组（non-Hi-Bi 组）。
多因素分析显示，术前凝血酶原试验低于 80%和出血量超过 1000ml 是 Hi-Bi 组的独立危险因素。16 例高胆红素血症患者病情好转，6 例患者病情延长。其中 1 例患者死于肝功能衰竭，治疗无效。本研究术后肝功能衰竭的死亡率为 0.16%（1/591）。
减少手术时间和术中出血量对于预防肝切除术后高胆红素血症非常重要。此外，使用我们的算法进行决策，并对包括凝血酶原时间、剩余肝功能和肝损伤在内的准确评估结果进行全面检查，可以帮助减少高胆红素血症的发生。
