Yamamoto K, Takenaka K, Matsumata T, Shimada M, Itasaka H, Shirabe K, Sugimachi K
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Hepatogastroenterology. 1997 Mar-Apr;44(14):514-8.
BACKGROUND/AIMS: The outcome of hepatectomy in elderly patients with hepatocellular carcinoma have been reported, however neither the morphological nor functional hepatic regeneration in elderly patients have been fully investigated.
Fifty-six patients with hepatocellular carcinoma, who underwent a right hepatic lobectomy over an 8-year period, were classified into three groups according to their age; group 1 (n = 7), more than 70 years of age; group 2 (n = 40), patients from 50 to 69 years of age and group 3 (n = 9), under 50 years of age. There were no significant differences regarding backgrounds or intra-operative parameters among the three groups. The perioperative hepatic function, postoperative complications and the regeneration rate of the remnant left lobe at 1 month after operation were compared.
No differences were found in the regeneration rate, however, the levels of the hepaplastin test and lecithin:cholesterol acyltransferase at 7 days after hepatectomy in group 1 (31.3%, 8.8 U) were significantly lower than those in groups 2 and 3 (37.4%, 18.4 U; 47.9%, 29.4 U, respectively). The incidence of hospital death due to hepatic failure in group 1 (42.9%) was also significantly higher than that of group 2 (5.0%) or group 3 (0%).
The decline of postoperative protein synthesis regardless of the voluminal regeneration is a characteristic of the elderly. This phenomenon might thus be an important promoter of postoperative hepatic failure which remains unpredictable using any type of examination. Therefore, at this time, a major hepatectomy is not recommended as a viable treatment alternative in the elderly.
背景/目的：已有关于老年肝细胞癌患者肝切除术后结局的报道，然而老年患者肝脏的形态学和功能性再生均未得到充分研究。
56例在8年期间接受右肝叶切除术的肝细胞癌患者，根据年龄分为三组；第1组（n = 7），年龄超过70岁；第2组（n = 40），年龄在50至69岁之间的患者；第3组（n = 9），年龄在50岁以下。三组患者的背景或术中参数无显著差异。比较围手术期肝功能、术后并发症以及术后1个月时残余左叶的再生率。
再生率未发现差异，然而，第1组肝切除术后7天时的肝促凝血酶原激酶试验水平和卵磷脂胆固醇酰基转移酶水平（分别为31.3%，8.8 U）显著低于第2组和第3组（分别为37.4%，18.4 U；47.9%，29.4 U）。第1组因肝衰竭导致的医院死亡率（42.9%）也显著高于第2组（5.0%）或第3组（0%）。
无论体积再生情况如何，术后蛋白质合成下降是老年人的一个特征。因此，这种现象可能是术后肝衰竭的一个重要促发因素，而使用任何类型的检查都无法预测。所以，目前不建议将大肝切除术作为老年患者可行的治疗选择。
