Clinical Studies on the Factors of Massive Ascites in Early Postoperative Stage Following Hepatectomy for Hepatocellular Carcinoma

Masamitsu Harada, Shiro Yogita, Toshihide Takagi, Manabu Sakai, Takamasa Ohnishi, Hidenori Miyake, Masashi Ishikawa, Yoh Fukuda, Daisuke Wada, Seiki Tashiro

First Department of Surgery, The University of Tokushima, Shool of Medicine

Relationship between preoperative, intraoperative and postoperative factors and massive ascites was studied retrospectively in the early postoperative state following hepatectomy for hepatocellular carcinoma. Seventyseven patients were divided into two groups by amount of ascites postoperatively. Fiftythree patients had ascites of less than 500 ml/day from intraabdominal drains (group A), and 24 patients had ascites of more than 500 ml/day (group B). Preoperative cholinesterase (A; 0.58±0.21 vs B; 0.45±0.15 ΔpH), ICGRmax (A;1.15±1.01 vs B; 0.78±0.42 mg/ks/min), Total Risk ( A; 2.35±0.64 vs B; 2.65±0.43), operation time (A; 447±Il4 vs B; 553±114 min), amount of intraoperative bleeding (A; 892±873 vs B; 1895±1557 ml), blood transfusion volume (A; 427±780 vs B; 1122±1162 m1), infusion volume (A; 198±58 vs B; 243±74 ml/kd and histological degree of liver cirrhosis were significantly different between groups A and B. Approach method in operation, type of liver ischemia, ischemic time, liver mobilization, resected area and weight of resected specimen were not the main reason for massive ascites. Cholinesterase, ICGR max, Total Risk and histological findings were the main prognostic factors for massive ascites in the early postoperative state. Ascites were recognized in the cases with a long operation time, massive bleeding, massive blood transfusion and infusion. Good control of intake-output balance, protection of the liver function and careful management of postoperative complications were very important because ascites is liable to be haven after hepatectomy for hepatocellular carcinoma with liver cirrhosis.

Key words
hepatocellular carcinoma, postoperative massive ascites, hepatectomy

Reprint requests
Masamitsu Harada First Department of Surgery, The University of Tokushima, School of Medicine
2-50 Kuramotocho, Tokushima, 770 JAPAN

Accepted
February 14, 1996

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