[Preoperative estimation of liver injury and operative risk].
We report on preoperative estimation of operative risk, principally rating liver injury in chronic liver disease, c.g., chronic hepatitis and cirrhosis, for liver resection and general surgery. Regarding general surgery, elective and standard operation are possible in Child A and operations with measures to lessen intraoperative blood loss and lymphadenectomy in Child B, but in Child C, surgery is limited to emergency palliative operations, and conservative treatment methods must chosen. In liver resection and major surgery it is important to estimate extent of liver resection and operative risk, primarily by R15 and KICG, and make an overall judgment based on fibronectin, hyaluronic acid, sinusoidal endothelial cell function measured by thrombomodulin, sigma IRI in the 75g OGTT, Fischer's ratio and other indices of lipid metabolism. Generally, surgery limits are: KICG, </ = 0.04/min; serum bilirubin, </- 3.0 mg/dl; prothrombin time, < 50%; R15, =/> 40%. Conventional indices of hepatic reserve should be reviewed. Indices recently attracting interest in liver resection cases are quantitative 99mTC-galactosyl human serum albumin scintigraphy using liver cell surface asialoglycoprotein receptor, and functional hepatic resection rate using 99mTC-GSA SPECT images, which is important in estimating liver regeneration after percutaneous trashepatic portal embolization.
Yamagiwa
K
K
First Department of Surgery, Mie University School of Medicine, Tsu, Japan.
Kawarada
Y
Y
D002908:Chronic Disease; D006498:Hepatectomy; D006505:Hepatitis / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000503:physiopathology; D008111:Liver Function Tests; D008115:Liver Regeneration; D012449:Safety; D013514:Surgical Procedures, Operative