[Estimation of operative risk in cirrhotic patients, from the aspects of both functional reserve and morphological findings in the liver].

In order to evaluate the operative risk in cirrhotic patients, the total risk is measured from the multivariant analyses of 10 useful liver function tests, such as ICG Rmax, LCAT and normotest, etc, and this is very useful on selection of the appropriate operative procedures and on evaluation of the prognosis. In the cases of hepatectomy, however, it is very useful on evaluation of the prognosis, if the functional reserve of the remnant liver could be estimate preoperatively. ICG Rmax of the remnant liver, estimated by our own method using Emission CT, may be the most valuable parameter of the functional reserve of the remnant liver. If ICG Rmax of the remnant liver is over 0.4 mg/kg/min, any types of hepatectomy could be performed with good results. Furthermore, if ICG Rmax of unit liver volume is over 0.8 microgram/kg/min/cm3, the remnant liver regenerates well with good recovering of the functional reserve, following long-term survival. The function of coagulation and reticuloendothelial system, and morphological findings of the liver are also significantly related to the operative results. Therefore, in surgery for cirrhotic patients, especially in hepatectomy, it is necessary to estimate the exact operative risk preoperatively, based on not only hepatic function tests but also coagulation profiles, RES function and morphological findings of the liver, and to select the adequate operative procedures, depending on the operative risk, in order to the excellent operative results.