A Case of Hepatic Failure after Right Hepatic Lobectomy for Hepatocellular Carcinoma with Chronic Active Hepatitis

Kenji Fukuhara, Kiyoaki Ouchi, Shuji Matsubara, Masanori Suzuki, Junichi Mikuni, Seiki Matsuno

First Department of Surgery, Tohoku University School of Medicine

A 59-year-old man with a diagnosis of hepatocellular carcinoma, in whom preoperative hepatic function tests did not disclose liver cirrhosis, developed liver failure after right hepatic lobectomy. Examination of the resected specimen revealed chronic active hepatitis (CAH). It is difficult to determine if chronic hepatitis is active or inactive by using only a routine liver function test. To estimated the activity of chronic hepatitis, the following methods are necessary: needle biopsy guided by echo or by laparoscopy and intraoperative liver wedge biopsy. This case suggests that resection of the liver with severe CAH could precipitate hepatic failure. Sometimes, in spite of the administration of hepatoprotector agents, activity of CAH does not decrease. In these cases, it is recommended to reduce the extent of the resection or to use non-surgical therapeutic modalities that do not worsen the already altered hepatic function, such as TAE (transcatheter arterial embolization) or PEIT (percutaneous ethanol injection therapy).

Key words
hepatocellular carcinoma, chronic active hepatitis, postoperative liver failure

Reprint requests
Kenji Fukuhara First Department of Surgery, Tohoku University School of Medicine
1-1 Seiryou-machi, Aoba-ku, Sendai, 980 JAPAN

Accepted
October 7, 1992

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