臨床外科72巻6号

2017年06月発行

特集 術後重大合併症—これだけは知っておきたい緊急処置法

各論

肝不全

著者： 渡邊秀一¹ 赤星径一¹ 小倉俊郎¹ 小川康介¹ 小野宏晃¹ 光法雄介¹ 伴大輔¹ 工藤篤¹ 田中真二² 田邉稔¹

所属機関： ¹東京医科歯科大学肝胆膵外科学分野 ²東京医科歯科大学分子腫瘍医学分野

ページ範囲：P.725 - P.729

文献概要

【ポイント】
◆術後肝不全はISGLSにより「術後5日目以降でプロトロンビン時間延長かつ血清総ビリルビン高値がみられるもの」と定義されている．
◆術後肝不全の代表的な危険因子として肝機能障害，残肝容積の不足，門脈圧亢進症，術後の感染合併が挙げられる．
◆術後肝不全は特異的な治療に乏しく，発症時には支持療法で状態悪化を防ぎつつ，増悪因子の除去や肝再生による状態好転を待つことになる．

参考文献

1）Paugam-Burtz C, Wendon J, Belghiti J, et al：Case scenario：postoperative liver failure after liver resection in a cirrhotic patient. Anesthesiology 116：705-711, 2012

2）Rahbari NN, Garden OJ, Padbury R, et al：Posthepatectomy liver failure：a definition and grading by the International Study Group of Liver Surgery（ISGLS）. Surgery 149：713-724, 2011

3）Makuuchi M, Sano K：The surgical approach to HCC：Our progress and results in Japan. Liver Transplant 10：S46-S52, 2004

4）Furuyama T, Kudo A, Matsumura S, et al：Preoperative direct bilirubin to prothrombin time ratio index to prevent liver failure after minor hepatectomy. J Hepatobiliary Pancreat Sci 23：763-770, 2016

5）Schindl MJ, Redhead DN, Fearon KC, et al；Edinburgh Liver Surgery and Transplantation Experimental Research Group（eLISTER）：The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 54：289-296, 2005

6）Boleslawski E, Petrovai G, Truant S, et al：Hepatic venous pressure gradient in the assessment of portal hypertension before liver resection in patients with cirrhosis. Br J Surg 99：855-863, 2012

7）Capussotti L, Viganò L, Giuliante F, et al：Liver dysfunction and sepsis determine operative mortality after liver resection. Br J Surg 96：88-94, 2009

8）Hoekstra LT, van Lienden KP, Doets A, et al：Tumor progression after preoperative portal vein embolization. Ann Surg 256：812-818, 2012

9）Pandanaboyana S, Bell R, Hidalgo E, et al：A systematic review and meta-analysis of portal vein ligation versus portal vein embolization for elective liver resection. Surgery 157：690-698, 2015

10）Schnitzbauer AA, Lang SA, Goessmann H, et al：Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 255：405-414, 2012

11）van Mierlo KMC, Schaap FG, Dejong CHC, et al：Liver resection for cancer：new developments in prediction, prevention and management of postresectional liver failure. J Hepatol 65：1217-1231, 2016

12）Gurusamy KS, Nagendran M：Methods of preventing bacterial sepsis and wound complications after liver transplantation. Cochrane Database Syst Rev. 2014 Mar 5；（3）：CD006660

13）Onodera K, Sakata H, Yonekawa M, et al：Artificial liver support at present and in the future. J Artif Organs 9：17-28, 2006

14）Tsipotis E, Shuja A, Jaber BL：Albumin Dialysis for Liver Failure：A Systematic Review. Adv Chronic Kidney Dis 22：382-390, 2015

15）Otsuka Y, Duffy JP, Saab S, et al：Postresection hepatic failure：successful treatment with liver transplantation. Liver Transpl 13：672-679, 2007

16）Squires RH, Alonso EM, et al：Acute liver failure in children. in：Suchy FJ, Sokol RJ, Balistreri WF（eds）：Liver Disease in Children, 4th ed, Cambridge University Press, New York, 2012