Matsumata T, Taketomi A, Fujiwara Y, Shimada M, Takenaka K, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Hepatogastroenterology. 1996 May-Jun;43(9):602-7.
BACKGROUND/AIMS: Although morbidity and mortality associated with liver surgery has declined, in particular operative death from liver failure, accumulation of fluid in the peritoneal or pleural cavities after hepatic resection is still the most common post-operative complication and it often decreases the patient's quality of life. The purpose of this retrospective review is to discuss the effect of renal dysfunction following hepatic resection on ascites formation in patients who underwent hepatic resection.
The patients who underwent hepatectomy were assigned to two groups; Group A patients (n = 119) had some form of ascites or pleural effusion, either intractable or easily controlled, while Group B patients (n = 178) had neither ascites nor pleural effusion. We compared the clinical and laboratory data, operative risk factors, and the post-operative renal as well as hepatic functions of the two groups.
In addition to ordinary risk factors associated with ascites formation such as decreased plasma oncotic pressure due to hypoalbuminemia along with increased hydrostatic pressure in the portal circulation, renal dysfunction after hepatic resection might be the primary cause of fluid accumulation in the peritoneal cavity.
As one of the mechanisms of ascites formation following hepatic resection, we must consider the presence of renal dysfunction and protect against ascites formation and treat refractory ascites after hepatic resection not only by such traditional methods such as water and salt restriction, the use of diuretics, and the infusion of albumin products, but also by preserving the renal function after hepatectomy.
背景/目的：尽管肝手术相关的发病率和死亡率有所下降，尤其是肝衰竭导致的手术死亡，但肝切除术后腹腔或胸腔积液仍是最常见的术后并发症，且常降低患者生活质量。本回顾性研究的目的是探讨肝切除术后肾功能不全对接受肝切除术患者腹水形成的影响。
将接受肝切除术的患者分为两组；A组患者（n = 119）有某种形式的腹水或胸腔积液，无论是难治性的还是易于控制的，而B组患者（n = 178）既无腹水也无胸腔积液。我们比较了两组患者的临床和实验室数据、手术风险因素以及术后肾功能和肝功能。
除了与腹水形成相关的常见风险因素，如低白蛋白血症导致血浆胶体渗透压降低以及门静脉循环静水压升高外，肝切除术后肾功能不全可能是腹腔积液的主要原因。
作为肝切除术后腹水形成的机制之一，我们必须考虑肾功能不全的存在，预防腹水形成，并不仅通过限水限盐、使用利尿剂和输注白蛋白制品等传统方法，还通过肝切除术后保护肾功能来治疗肝切除术后的难治性腹水。
