[The rationale of treatment after hepatectomy for primary cancer of the liver].

During a period of ten years ranging from January 1973 to February 1983, a total of 51 patients with primary cancer of the liver underwent hepatic resection at the Keio University Hospital. Thirty five of 51 patients were cirrhotic and two were jaundiced. Six cirrhotic patients died of liver failure within one month following hepatic resection. In order to minimize the postoperative death, it is mandatory to maintain the integrity of circulatory dynamics and microcirculation. Monitoring of circulatory dynamics with the use of Swan-Ganz catheter is very useful for managing the patients with massive transfusion, copious production of ascites and adult respiratory distress syndrome and is indispensable for hepatic resection using vascular exclusion technique. Disseminated intravascular coagulation occurs frequently after hepatic resection. It will cause hepatic failure due to microthrombi, unless prompt treatment is instituted. Score count was designed to facilitate diagnosis using platelet count, fibrinogen level, quantity of fibrin degradation product and protamine sulfate test as parameters. It is difficult to determine the optimal dose of heparin because of decreased antithrombin III and metabolism in the liver due to loss of hepatic parenchyma. Gabexate mesilate (FOY) is very effective and safe agent, since it works without antithrombin III.