Wake M, Okamoto Y, Sanagawa Y
Department of Anesthesia, St. Mary's Hospital, Himezi.
Masui. 1998 Nov;47(11):1344-9.
A 63-year-old woman presenting with thrombocytepenia and signs of intravascular coagulation (prothronbin time, 59%: FDP, 100 micrograms.ml-1) due to a giant hemangioma of the liver (Kasabach-Merritt syndrome) was scheduled for the resection of the right lobe of the liver. In order to protect the liver on occlusion of the right hepatic artery and portal vein, we induced mild hypothermia technique with vasodilation and surface cooling by convecting warming device together with hepatoprotective agents of PGE1 and ulinastatin. Severe, acute massive bleeding occurred due to the injury of the middle hepatic vein and from the resected surface of the liver. Her rectal temperature was 31.9 degrees C during massive bleeding. Her hemoglobin decreased to 3.9 g.dl-1. Total estimated blood loss was 22,000 ml. The weight of the resected liver was 2.5 kg. The maximum postoperative levels of T-Bil and GOT were 2.47 mg.dl-1 and 171 IU.l-1, respectively. The liver seemed to have been well preserved and no other complications were observed. The hemangioma was completely removed by excision of the right lobe of the liver. Subsequently, all coagulation parameters returned to normal, indicating a complete reversibility of the coagulopathy. Surface-induced mild hypothermia is a useful and valuable method for protecting the liver during severe massive bleeding.
一名63岁女性因肝脏巨大血管瘤（卡萨巴赫-梅里特综合征）出现血小板减少及血管内凝血迹象（凝血酶原时间，59%；纤维蛋白降解产物，100微克·毫升-1），计划行肝右叶切除术。为在阻断肝右动脉和门静脉时保护肝脏，我们采用了轻度低温技术，通过对流式加温装置进行血管扩张和体表降温，并联合使用前列腺素E1和乌司他丁等肝保护剂。术中因肝中静脉损伤及肝脏切除创面出现严重急性大出血。大出血时她的直肠温度为31.9摄氏度。血红蛋白降至3.9克·分升-1。估计总失血量为22000毫升。切除肝脏重量为2.5千克。术后总胆红素和谷草转氨酶的最高值分别为2.47毫克·分升-1和171国际单位·升-1。肝脏似乎保存良好，未观察到其他并发症。通过切除肝右叶完全切除了血管瘤。随后，所有凝血参数恢复正常，表明凝血病完全可逆。体表诱导轻度低温是在严重大出血时保护肝脏的一种有用且有价值的方法。
