|Budget Amount *help
¥2,200,000 (Direct Cost : ¥2,200,000)
Fiscal Year 1998 : ¥600,000 (Direct Cost : ¥600,000)
Fiscal Year 1997 : ¥1,600,000 (Direct Cost : ¥1,600,000)
[Purpose] In order to draw up a nursing plan designed to improve the quality of life (QOL) of hepatectomy patients, we retrospectively investigated the hepatectomy patients 10 years ago and recently, and assessed changes from the standpoint of perioperative management and related factors.
[ Methods] Subjects : Group A consisted of 96 hepatectomy patients operated on 10 years previously(1985-1988), and Group B consisted of 109 hepatectomy patients operated on recently (1995-1998).Parameters : 1) Patient background ; underlying disease, preoperative condition, etc. 2) Surgical factors ; extent of hepatectomy, blood loss, whether a drain was used, etc. 3) Perioperative management ; percutaneous transhepatic biliary drainage (PTBD) and autologous bile ingestion, preoperative percutaneoustranshepatic portal vein embolization (PTPE), blood transfusions, start of postoperative oral feeding andambulation, etc. 4) Surgical results ; hospital deaths, postoperative complications.
[Results] 1) There
were no differences between the two groups in patient background or extent of hepatectomy. In Group B, however, preoperative autologous bile ingestion and PTPE were performed, and the thoracoabdominal approach, microwave coagulation therapy, autologous transfusion were used, and in Group B it was possible to shorten postoperative drainage time, and start oral feeding and ambulation earlier. 2.) In Group B, hospital deaths and postoperative complications decreased, but the results in the patients with preoperative obstructive jaundice could hardly be described as satisfactory.
Conclusion] It has been possible to reduce postoperative complications and operative deaths in recent hepatectomy patients, compared with 10 years previously. The factors responsible for these changes seem to have been : (1) reduced surgical invasiveness as a result of preoperative PTPE, the thoracoabdominal approach, reduced blood loss, autologous transfusions, and (2) the advances and innovations inperioperative management, including minimal insertion and early withdrawal of catheters and drains. However, perioperative management of hepatectomy in cases associated with preoperative obstructive jaundice has sometimes been problematic, and that will be a future task. Less