Usami M, Ohyanagi H, Nishimatsu S, Kasahara H, Shiroiwa H, Ishimoto S, Ueda T, Saitoh Y
First Department of Surgery, Kobe University School of Medicine, Japan.
ASAIO Trans. 1989 Jul-Sep;35(3):564-7. doi: 10.1097/00002480-198907000-00127.
Therapeutic plasmapheresis (PP) for liver failure following the resection of primary liver cancer was evaluated retrospectively. PP was repeated two to three times per week using plasma exchange (PE) with fresh frozen plasma as a substitution fluid in all eight cases and direct hemoperfusion (DHP) in two cases. PE effectively decreased serum bilirubin and/or improved hepatic encephalopathy in six of eight patients and prolonged survival time (p less than 0.05, chi-square test). DHP was not effective. Liver failure following the resection of damaged liver differs from acute liver failure in both the condition itself and the reaction to PP. Fractionation of serum bilirubin using high performance liquid chromatography showed differences in the ratio of delta bilirubin in one survivor versus two who died and was effective in selecting a patient who would respond to PE. In conclusion, PE is effective in prolonging survival time after liver failure in hepatectomized patients compared to conventional therapy.
对原发性肝癌切除术后肝衰竭进行治疗性血浆置换（PP）的疗效进行了回顾性评估。8例患者均采用新鲜冷冻血浆作为置换液进行血浆置换（PE），每周重复2至3次，2例采用直接血液灌流（DHP）。8例患者中有6例PE有效降低了血清胆红素和/或改善了肝性脑病，并延长了生存时间（P<0.05，卡方检验）。DHP无效。受损肝脏切除术后的肝衰竭在病情本身和对PP的反应方面均与急性肝衰竭不同。使用高效液相色谱法对血清胆红素进行分级显示，1例幸存者与2例死亡者的δ胆红素比例存在差异，这对于选择对PE有反应的患者有效。总之，与传统治疗相比，PE可有效延长肝切除术后肝衰竭患者的生存时间。
