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一時的 (常溫下, 38分間) 肝門血流遮斷下, 實施된 肝左葉切除術의 1例

A Case of Left Heparic Lobectomy fobectomy Temporary Occlusion of Hepatic Circulation at Porta Hepatic under Normothermic Condition

대한외과학회지 1964년 6권 4호 p.193 ~ 197
張起呂, 尹世榮,
소속 상세정보
張起呂 (  ) - 서울대학교 醫科大學 外科學敎室
尹世榮 (  ) - 서울대학교 醫科大學 外科學敎室

Abstract


We have encountered a case of primary hepatoma associated with cirrhois of the liver in which the portal vein branched into left and right within the liver substance. The tumor was seen to be infiltrating into the left portal vein with resulting deformity of the vein making the structural dissection of the vessels rather difficult at the porta hepatis.
Accordingly, the hepatic circulation was temporarily occluded for a period of 38 minutes at the porta hepatis during which time the left lobe of the liver and the quadrate lobe with tumor tissue was removed on block. The amputation was carried out in guillotine type, and bleeding and bile leakage was controlled by individual ligation under normothermic condition.
Hepatic functional profile, pre-and post operative.
Albumin: 4,5gm pre op but at 24 hours post op, it was 3.5gm. The lowest value was obtained at the 6 th post op day when it dipped to 2.5gm. It returned gradually to normal.
Prothrombine time: Preoperatively, the prothrombine content was 70% of normal. It was 30% on the 2nd day, and 25% the following day. It returned to the preoperative level on the 11th day. Parenteral Vitamin-K was maintained throughout.
Total Bilirubin: Preoperatively, it was 0.4㎎%. At 24hours post-op, it rose to 1.3㎎ %, and to 1.4㎎% by the following day. It returned to preoperative level by the second week.
Alkaline Phosphatase: Preoperatively, 9.2 Bodansky unit. At 24 hours post-op. 15 units, and at 3rd post-op day, it reached 17 units. Thereafter, it returned to normal by the second week.
Cholesterol and Esterified Cholesterol: Preoperative determination was not done. At 24 hours post-op, it was 160㎎%, The value was the lowest on the 3rd and 5th post-op day, but rose to 120㎎% total and 70㎎% esters by the second week.
Serum Ammonia: There waa no significant change at 24 hours. On the 2nd post-op day, it was 110 r, and by the third post-op day it reached 180 r at which point 3 ampules of 20% L-Arginine(20㏄) and 30gm of Sodium Glutamic Acid was given along with broad spectrum antitiotics. On the 5th day, the value returned and was normal at the secound week.
Serum Transaminase: 2nd As is shown in the following chart, there was remarkable increase on the 2 ndand 3rd postoperative day, but the value had returned to normal on the 4 th day.
Summary: Comparison of liver function tests, pre- and post-op, did not show any great alteration in liver function despite total circulatory occlusion of the liver for a period of 38 minutes at the porta hepatis, under normothermic conditio n.

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