Rees M, Plant G, Wells J, Bygrave S
Hepatobiliary Unit, North Hampshire Hospital, Basingstoke, UK.
Br J Surg. 1996 Nov;83(11):1526-9. doi: 10.1002/bjs.1800831110.
A technique of hepatic resection is described and the results of 150 resections are reviewed. Hepatic transection was performed, under intermittent portal inflow occlusion, using ultrasonic aspiration to skeletonize portal branches and venous tributaries. Control of venous haemorrhage during resection was optimized by argon beam coagulation and lowering central venous pressure to between 0 and 4 cmH2O by extradural blockade and systemic nitroglycerine infusion. One patient with jaundice died in hospital, giving a mortality rate of 0.7 per cent. There were no deaths in patients without jaundice and cirrhosis. Fifteen patients (10.0 per cent) had significant complications, nine medical and six surgical, including three bile leaks (2.0 per cent). Mean blood loss was 814 ml for the whole study but only 434 ml in the last 4 years. During this latter period mean blood transfusion in hospital was 0.5 units and mean postoperative haemoglobin value fell by 0.7 g per 100 ml. Hepatic resection can be performed with the same degree of confidence and similar low morbidity as any other major surgical procedure.
本文描述了一种肝切除术技术，并回顾了150例肝切除术的结果。在间歇性门静脉血流阻断下，采用超声吸引法将门静脉分支和静脉属支骨骼化，进行肝实质离断。通过氩离子束凝固以及硬膜外阻滞和静脉输注硝酸甘油将中心静脉压降至0至4 cmH₂O，优化了肝切除术中静脉出血的控制。1例黄疸患者死于医院，死亡率为0.7%。无黄疸和肝硬化的患者无死亡病例。15例患者（10.0%）出现严重并发症，其中9例为内科并发症，6例为外科并发症，包括3例胆漏（2.0%）。整个研究期间平均失血量为814 ml，但最近4年仅为434 ml。在此期间，住院期间平均输血量为0.5单位，术后血红蛋白值平均每100 ml下降0.7 g。肝切除术可与其他任何大型外科手术一样，以相同的信心程度和相似的低发病率进行。
