Ekberg H, Tranberg K G, Andersson R, Jeppsson B, Bengmark S
Surgery. 1986 Jul;100(1):1-8.
This report investigates the perioperative course in 81 consecutive major liver resections, performed mainly because of primary liver cancer or colorectal liver secondaries. The liver was resected transabdominally with or without prior ligation of hilar structures. Intravenous nutrition consisted of 10% dextrose alone and was started preoperatively. Albumin or plasma was used rarely and only in conjunction with massive intraoperative transfusion of blood. Major complications, including four operative deaths (4.9%), consisted of bleeding and/or infection in eight (10%) patients and overt liver failure in two patients (2%) and occurred only after right and extended right lobectomies. Intraoperative blood loss was significantly larger in patients with postoperative complications than in patients with an uneventful postoperative course. The direct parenchymal approach was associated with a shorter operative time and an unchanged intraoperative bleeding. Coagulopathy and hypoalbuminemia did not cause any problems. Blood glucose levels were stable, and no patient suffered from hypoglycemia. It is concluded that major liver resection should be based on prevention of intraoperative bleeding and that preresection ligation of hilar structures offers no advantage in this respect. Infusion of hypocaloric glucose solutions should be started the day before operation, and routine administration of other nutrients does not seem necessary.
本报告调查了连续81例主要因原发性肝癌或结直肠癌肝转移而进行的大型肝切除术的围手术期过程。肝脏经腹部切除，术前可结扎或不结扎肝门结构。静脉营养仅包括10%葡萄糖，术前开始使用。白蛋白或血浆很少使用，仅在术中大量输血时联合使用。主要并发症包括4例手术死亡（4.9%），8例（10%）患者出现出血和/或感染，2例患者（2%）出现明显肝功能衰竭，且仅发生在右半肝切除和扩大右半肝切除术后。术后有并发症的患者术中失血量明显多于术后过程顺利的患者。直接实质入路与较短的手术时间和术中出血量不变相关。凝血功能障碍和低白蛋白血症未引起任何问题。血糖水平稳定，无患者发生低血糖。结论是，大型肝切除术应基于预防术中出血，术前结扎肝门结构在这方面并无优势。应在手术前一天开始输注低热量葡萄糖溶液，常规给予其他营养物质似乎没有必要。
