Uetsuji S, Komada Y, Kwon A H, Imamura A, Takai S, Kamiyama Y
First Department of Surgery, Kansai Medical University, Osaka, Japan.
Int Surg. 1994 Apr-Jun;79(2):135-7.
Retention of pleural effusion after hepatectomy is an important complication that may affect the postoperative course. However, there are few reports on its pathogenesis or preventive measures. We evaluated the mechanism of the development of this complication and preventive measures against it. During the past 4-year period, hepatectomy was performed in 77 patients, of whom 64 underwent liver mobilization by transecting the hepatic ligaments. A fibrin sealant was sprayed on the cut surface of the hepatic ligaments in randomly selected 25 of the 64 patients to determine whether this application can prevent postoperative retention of pleural effusion. Post-operative pleural effusion was not observed in any patient treated by fibrin sealant spraying but was observed in 13 (30%) of the other 39 patients treated with this sealant (p < 0.05). In addition, none of the 23 patients in whom the liver was not mobilized during hepatectomy showed postoperative pleural effusion. These results suggest that severance of the hepatic ligaments is a major cause of pleural effusion, and application of a fibrin sealant to the undersurface of the diaphragm around the insertion of the liver ligaments is useful for preventing this complication.
肝切除术后胸腔积液的潴留是一种可能影响术后病程的重要并发症。然而，关于其发病机制或预防措施的报道很少。我们评估了这种并发症的发生机制及预防措施。在过去4年期间，对77例患者实施了肝切除术，其中64例通过切断肝韧带进行肝脏游离。在64例患者中随机选取25例，在肝韧带的切面喷洒纤维蛋白封闭剂，以确定这种应用是否能预防术后胸腔积液的潴留。喷洒纤维蛋白封闭剂治疗的患者均未观察到术后胸腔积液，而在未使用该封闭剂治疗的其他39例患者中有13例（30%）出现了术后胸腔积液（p<0.05）。此外，在肝切除术中未进行肝脏游离的23例患者中，无一例出现术后胸腔积液。这些结果表明，肝韧带的切断是胸腔积液的主要原因，在肝脏韧带附着处周围的膈肌下面应用纤维蛋白封闭剂有助于预防这种并发症。
