Kawarada Y, Mizumoto R
Nihon Geka Gakkai Zasshi. 1983 Sep;84(9):899-903.
Liver failure is a major cause of death after hepatectomy in cirrhosis. Therefore, an accurate indication for hepatectomy should be estimated preoperatively. By using multiple regression analysis of liver function, we could accurately select any one of five possibilities in hepatic surgery: 1) trisegmentectomy , 2) lobectomy, 3) segmentectomy, 4) partial hepatectomy, and 5) no surgery, without severe postoperative complications. Furthermore, the functional reserve of the remnant liver after hepatectomy should be estimated preoperatively. We measured ICG Rmax of the remnant liver, from both the effective liver volume rate obtained by the uptake of radioisotope on a liver scan and ICG Rmax of the whole liver. If it is above 0.4 mg/kg/min, any type of hepatic resection may by possible. On postoperative management, it is also important to estimate function of the reticuloendothelial system, blood clotting mechanism, and cardio-pulmonary and renal function. ICG Rmax per unit liver volume in the remnant liver after proposed hepatectomy can be calculated preoperatively from volume of the remnant liver on CT scan and ICG Rmax of the remnant liver. If it is above 0.8 microgram/kg/min/cm3, regeneration and function of the remnant liver will remain good without any late postoperative complications after hepatectomy.
肝衰竭是肝硬化患者肝切除术后的主要死亡原因。因此，术前应准确评估肝切除的指征。通过对肝功能进行多元回归分析，我们能够准确地在肝脏手术的五种可能性中做出选择：1）三段切除术；2）肝叶切除术；3）肝段切除术；4）部分肝切除术；5）不进行手术，且不会出现严重的术后并发症。此外，术前应评估肝切除术后残余肝脏的功能储备。我们通过肝脏扫描中放射性同位素摄取获得的有效肝体积率以及全肝的吲哚菁绿最大清除率（ICG Rmax）来测量残余肝脏的ICG Rmax。如果该值高于0.4mg/kg/min，则任何类型的肝切除都有可能。在术后管理方面，评估网状内皮系统功能、凝血机制以及心肺和肾功能也很重要。拟行肝切除术后残余肝脏的单位肝体积ICG Rmax可根据CT扫描上残余肝脏的体积以及残余肝脏的ICG Rmax术前计算得出。如果该值高于0.8μg/kg/min/cm³，则残余肝脏的再生和功能将保持良好，肝切除术后不会出现任何晚期并发症。
