Hasegawa H, Yamazaki S, Makuuchi M, Elias D
Service de Chirurgie Hepato-Biliaire, National Cancer Center Hospital,Tokyo, Japan.
J Chir (Paris). 1987 Aug-Sep;124(8-9):425-31.
Among more than 450 hepatectomies performed in the National Cancer Center Hospital of Tokyo from the beginning of 1977 to the end of 1986, 204 were performed for excision of an hepatocarcinoma on cirrhotic liver. The post-operative mortality (determined until the exit of the patient out of the hospital) was 7.8%. It was rather high at the beginning (20% of the first 30 cases) and progressively decreased with experience, to be only 2.8% of the last 70 cases. According to this experience the authors recommend a decisional diagram which appreciate the quantity of functional liver parenchyma which must be resected (depending on the tumor's characteristics) and the quantity of functional liver parenchyma which can be resected without major operative risk (depending on the gravity of the cirrhosis). They expose their attitude with oesophageal varix, the operative techniques and the peri-operative cares they have trained to decrease dramatically the post-operative complications.
1977年初至1986年底，东京国立癌症中心医院共进行了450余例肝切除术，其中204例是在肝硬化肝脏上切除肝癌。术后死亡率（确定至患者出院）为7.8%。起初相当高（前30例中的20%），随着经验的积累逐渐下降，最后70例仅为2.8%。根据这一经验，作者推荐了一种决策图，该图可评估必须切除的功能性肝实质数量（取决于肿瘤特征）以及在无重大手术风险情况下可切除的功能性肝实质数量（取决于肝硬化的严重程度）。他们阐述了对食管静脉曲张的处理态度、手术技巧以及为显著减少术后并发症而采用的围手术期护理措施。
