劇症肝炎急性期の腹腔鏡検査--内視鏡所見と肝生検組織所見による予後推定

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We studied 6 patients with fulminant hepatitis by laparoscopy during acute stage of the illness. Three patients were noted to have severe liver atrophy in laparoscopy and massive necrosis in liVer biopsy. All died within 9 days following the examinations. The remaining three had milder degree of liver atrophy. Two of them survived, but another died presumably of acute necrotic pancreatitis which was diagnosed by laparoscopy done during acute stage. Important laparoscopic findings for evaluating the prognosis were the degree of liver atrophy and the extent of residual parenchyma on the liver surface. The values of HVF (hepatocyte volume fraction) obtained from the biopsy specimens were less than 10 precent in the three dead and 45, 70 percent each in the two survived. In one patient dying with complicating pancreatitis HVF was estimated as 40 percent. There were no major accident during the examinations. In conclusion, laparoscopy during acute stage of fulminant hepatitis is a safe and valuable method in predicting the clinical course and prognosis of the illness.
社団法人日本肝臓学会の論文