肝癌切除手術之麻醉

ANESTHESIA FOR HEPATOMA RESECTION

陳應輝(Ying-Fai Chan) ； 伍乙棠(Yuet-Tong Ng) ； 胡玉旺(Yuk-Wong Wu) ； 許汝寧(Yu-Ling Hui)

《Acta Anaesthesiologica Sinica》 28卷1期 (1990/03) Pp. 69-73

摘要

基隆長庚醫院，在四年內有21位肝癌病患接受外科切除治療，其中11位病人有肝硬化，另外10病人沒有肝硬化現象。在這些病人之中，有4位併有高血壓，一位有糖尿病，4位病人凝血時間延長。所有病人均採用全身麻醉，並置上心電圖，動脈導管，中央靜脈壓及尿排出量等監察。誘導麻醉採用Thiopental，Succinylcholine及Fentanyl，維持麻醉用Isoflurane，N_2O及O_2的混合氣體。手術結束後，大部份病患被送至加護病房作呼吸治療及加強護理。手術中併發症主要為代謝性酸血症及低血壓，手術後除呼吸治療外並無其他特異困難，只有一位病患發生肺水腫現象。在肝功能方面，手術後30天的數據顯示與手術前無明顯差異。此外其中一位病人在手術後二個月內死亡，死亡原因為肝功能衰竭併肺部合併症，其餘20位病人存活均在二個月以上。

關鍵字

Hepatoma resection ； Metabolic acidosis ； Hypotension

並列摘要

Hepatocellular carcinoma is one of the leading cancers in Taiwan and is responsible for 20% of cancer deaths. Since long-term survival of hepatocellular carcinoma patients cannot be expected with any treatment other than surgery, the therapeutic value of hepatic resection has become more important than ever before. In Keelung Chang Gung Memorial Hospital, twenty-one patients with hepatoma recieved hepatic resection during the period of August 1985 to July 1989 were reviewed. These patients were induced for anesthesia with thiopental, succinylcholine and fentanyl; maintenance of anesthesia with isoflurane, N_2O and O_2. Four of them have abnormal coagulopathy preoperatively. Common intraoperative problems were metabolic acidosis and hypotension. Estimated blood loss showed great variety among these patients. Eighteen patients needed respiratory support and intensive care postoperatively. One patient was noted to have pulmonary edema. Otherwise, the overall procedure was smooth and satisfactory. In addition, there is no significantly difference in liver function test after a month of hepatoma resection. All the patients survived except one who died within two months after surgery.