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Lifrarúrnám vegna æxla í lifur : reynsla af notkun hljóðbylguhnífs

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Authors
Drífa Freysdóttir
Jón Níelsson
Jónas Björn Magnússon
Issue Date
1994-11-01

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Other Titles
Hepatic resections. The results of using CUSA
Citation
Læknablaðið 1994, 80(9):465-70
Abstract
Hepatic tumours, both primaries and secondaries, are common. They are seldom operable, but curative resections are sometimes possible. The aims of the study were to present the result and experience of liver operations (primaries, secondaries and benign lesions) and to present the result of using CUSA in these operations. A retrospective study was carried out to evaluate the result of elective hepatic resections in Iceland between 1986-1993 with the aid of CUSA. The type of tumour and resection, operative bleeding, transfusions, hospital stay and complications were noted. Kaplan-Meyer lifetable was used to estimate survival. Fourteen patients underwent fifteen operations, followed by six complications which resulted in five reoperations and one percutaneous drainage. Bleeding was 3000 ml (median, range 350-10.600 ml), transfusion was 3000 ml (median, range 0-12.000 ml) and hospital stay was 24 days (range 9-108 days). There was no operative mortality. Four of nine patients operated for secondaries are living (44%), 15, 41, 46 og 72 months postoperatively (two with recurrence). Two patients were operated for hepatomas, and one of those is alive 86 months postoperatively and is considered to be cured. We conclude that hepatic resection can be carried out in small centers with comparable results to large published series. The ultrasonic scalpel CUSA seems to make the resection tecnically easier and to diminish the amount of bleeding.
Æxli í lifur, bæði frumæxli og meinvörp, eru algeng. Þótt sjaldnast séu þau skurötæk, eru læknandi aðgerðir stundum mögulegar. Tilgangur rannsóknar okkar var tvíþættur, annars vegar að gera grein fyrir árangri og reynslu af aðgerðum á lifur vegna frumæxla og meinvarpa og hins vegar að kynna árangur af notkun hljóðbylgjuhnífs (CUSA). Gerð var afturskyggn rannsókn á öllum sjúklingum, sem gengust undir valaðgerð (elective) á lifraræxli með hjálp hljóðbylgjuhnífs á Borgarspítala og Landspítala á árunum 1986-1993, alls 14 sjúklingar. Sérstaklega var athuguð tegund æxlis, hvaða hlutar lifrar voru fjarlægðir, blæðing í aðgerð, blóðgjöf, legutími og fylgikvillar. Lífslíkur voru metnar með líftöflu að hætti Kaplan-Meyer. Einnig var athugað hve langur tími leið þar til sjúkdómur tók sig upp aftur. Fjórtán sjúklingar. gengust undir fimmtán aðgerðir, sex fengu fylgikvilla sem leiddu til fimm opinna enduraðgerða og einu sinni var stungið á kýli. Miðtala blæðingar var 3000 ml (350-10.600 ml), miðtala blóðgjafar var 3000 ml (0-12.000 ml), miðtala legu var 24 dagar (9-108 dagar). Skurðdauði var enginn. Af níu sjúklingum sem skornir voru vegna meinvarpa í lifur, eru fjórir (44%) á lífi 15, 41, 46 og 72 mánuðum eftir aðgerð en hjá tveimur þeirra hefur sjúkdómur tekið sig upp. Tveir sjúklingar voru skornir vegna lifraræxlis og er annar á lífi 86 mánuðum eftir aðgerð og telst læknaður. Við ályktum að einnig hér á landi sé lifrarúrnám (resection) vegna meinvarpa eða frumæxlis í lifur álitlegur valkostur, þar eð annarri meðferð er ekki til að dreifa og niðurstöður okkar eru sambærilegar við það sem best gerist erlendis. Hljóðbylgjuhnífur virðist gera þessar aðgerðir tæknilega auðveldari og minnka hættu á blæðingu.
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