肝・胆道癌治療における術後肝不全の発生と対策(<特集>がん疾患とアフェレシス)

概要

論文の詳細を見る
Between January 2003 and November 2008, we performed 557 cases of hepatic resection for hepato-biliary carcinoma, including Hepatocellular carcinoma (HCC) in 378 cases, liver metastasis in 103 cases, Cholangiocellular carcinoma (CCC) in 39 cases, and biliary carcinoma in 37 cases. Postoperative liver failure occurred in 9 cases (1.6%), including 4 cases (0.8%) of HCC, CCC, and liver metastasis, and 5 cases (13.5%) of biliary carcinoma. Overall postoperative mortality within 6 months was 5 cases (0.9%). Over the past decade, the rates of mortality and liver failure in the patients with HCC, CCC, and liver metastasis have been dramatically improved to less than 2% in high-volume centers in Japan, while they were 0-8% and 0-16%, respectively in the patients with biliary carcinoma, which were higher than those of HCC, CCC, and liver metastasis. The mortality rate for postoperative liver failure is still high (18-67%) even in these days; however, there has been a decline in the rate of hepatic failure, mortality, and blood transfusion. It is important for the strategy of postoperative liver failure to evaluate liver functional reserve, to examine the anatomical individual variation using 3 D-CT preoperatively, to conduct preoperative portal vein embolization in the case of extended hepatectomy, and to determine the adequate selection of surgical candidates and operative procedures.
日本アフェレシス学会の論文
2009-05-31