臨牀透析 Vol.18 No.6(4-2)


特集名 透析患者の肝・胆・脾・膵の病変
題名 肝硬変・肝癌のある透析患者の治療 (2) 透析患者の肝癌に対する肝切除
発刊年月 2002年 06月
著者 佐々木 洋 大阪府立成人病センター外科
著者 山田 晃正 大阪府立成人病センター外科
著者 大東 弘明 大阪府立成人病センター外科
著者 土岐 祐一郎 大阪府立成人病センター外科
著者 亀山 雅男 大阪府立成人病センター外科
著者 平塚 正弘 大阪府立成人病センター外科
著者 石川 治 大阪府立成人病センター外科
著者 今岡 真義 大阪府立成人病センター外科
【 要旨 】 慢性腎不全のために血液透析を受けている肝疾患合併肝癌に対する肝切除例の背景と，周術期管理について，文献的に検討した．6施設から22例を選択したが，年齢の中央値55.5歳，男性が86％を占めた．半数が血液透析開始後1年以内に肝切除を受けていた．肝炎ウイルス(－)例が27％と多く，肝機能は比較的良好な症例が選択されていた．術中管理の要点は，循環動態の変動をきたさないことにつきる．外科サイドとしては，低侵襲手術を心がけ，麻酔科サイドからは，術中の循環動態のモニタリングと，低量catecholamineの持続注入，カリウムfree輸液の使用が挙げられる．術後晩期の合併症として，難治性感染症，消化管出血などがあり，予防的対策が重要である．
Theme Disease of Liver, Gallbladder, Spleen, and Pancreas in Dialysis Patients
Title Surgery for hepatocellular carcinoma in hemodialysis patients
Author Yo Sasaki Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
Author Terumasa Yamada Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
Author Hiroaki Ohigashi Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
Author Yuichiro Doki Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
Author Masao Kameyama Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
Author Masahiro Hiratsuka Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
Author Osamu Ishikawa Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
Author Shingi Imaoka Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases
[ Summary ] Backgrounds and perioperative management were evaluated for those patients with hepatocellular carcioma, who were receiring hemodialysis and undergone had surgery. 22 patients in 6 hospitals were selected from the literatures. The median age was 55.5 years, and the ratio of male patients was 86%. Half of the patients underwent surgery within one year from the start of hemodialysis. The frequency of patients without viral hepatitis was relatively high, 27%, and that of the patients with good liver functions was also relatively high. The most important point of intraoperative management is the stability of circulatory movement. From the standpoint of surgical sites, less invasive surgery is recommended, and from that of anesthetic sites, close monitoring, low-dose catecholamine and potassium-free infusion are done. Concerning the major complications in the days following surgery, persistent infections and gastrointestinal bleeding occur with high frequency. Prevention is more important than treatment for these complications.
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