摘要
PHLF is the status of disfunction in synthesis,excretion and detoxication.According to International Study Group of Liver Surgery(ISGLS),PHLF is defined by an increased bilirubin level and international normalized ratio(INR)on or after postoperative 5 days,and is graded by clinical severity from grades A to C(1,2).Grade A is the condition without any treatment.Grade B deviates from normal postoperative management and requires blood products,diuretics,oxygen administration,and so on.Grade C is the status with multiple organ failure which requires intensive management including respirator,dialysis,and liver transplantation,etc.Perioperative mortality rates in A,B and C were estimated 0%,12%,and 54%,respectively(1).Although PHLF has decreased due to extensive studies of risk factors for PHLF and improvements in surgical techniques,it remains high for several types of procedures.According to a nationwide survey of board-certified training institutions by the Japanese Society of Hepato-Biliary-Pancreatic Surgery,90-day mortality rates is 10.3%and 6.7%after left trisectionectomy and hepatopancreatectomy,respectively(3).Further,the mortality rates after associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)was reported over 5%(4).
