J.Jpn. Surg. Soc.. 91(9): 1125-1128, 1990
Report on the annual meeting
CURRENT PROBLEMS IN LIVER SURGERY
|
First Department of Surgery, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan Junichi Uchino |
The segments and vascular systems of the liver are essential. Variation of the vascular systems is common and preoperative assessment is important. Intrahepatic portal vesn is also variable and sometimes a branch of the segment comes from the other segments and these may cause metastases to the segment.
More than 70% of the hepatocellular carcinoma are associated with liver cirrhosis or chronic hepatitis. So preoperative evaluation of the residual liver function is required. ICG R15, cholineesterase, hepaplastin test, serum bilirubin and OGTT are reliable indices. Keton body ratio is recently adopted to be the indicator of the liver viability.
Artificial liver support system is indispensable for the treatment of liver insufficiency and failure but we have not yet an useful device. We designed a hybrid bioartificial liver with multiplated cultured liver cells, which prolonged the survival period of the dogs from 1 to 3 days after total hepatectomy.
Liver transplantation is the only method of choice for unresectable liver diseases and widely carried out in U.S.A. and Europe. Obstacles including the consensus of the brain death in Japan are expected to be cleared in the near future.
To read the PDF file you will need Adobe Reader installed on your computer.