一位42歲男性接受兩階段肝切除術後發燒表現

A 42-Year-Old Man With Postoperative Fever After Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy

肝癌為國人不可忽視的重要健康議題，其治療方式包括手術治療及非手術治療。接受肝臟切除手術常見的併發症有肝衰竭、出血、急性腎損傷、膽汁滲漏及肋膜積液等，若介入治療時機適當，能減少嚴重併發症而降低生命危險，故術後的照護為重要的目標。本個案是一位42歲男性，為B型肝炎帶原，因診斷為巨大肝臟腫瘤接受兩階段肝切除手術，於第二階段術後第13天出現高燒、引流液呈黃褐色液，相關臆測診斷有腹內感染及肋膜積水等，一一排除後，經由腹部超音波及胸部X光檢查，確立有膽汁滲漏及肋膜積液等複雜性併發症，透過給予胸腔穿刺、腹部引流管置放及抗生素治療一週後病情穩定且併發症獲得控制，照護期間為2020年7月11日至2020年8月10日，期望藉此經驗能做為日後照護此類個案之參考。

 

Hepatocellular carcinoma is undoubtedly a significant health issue. The medical treatments of the dis­ease include operative and non-operative management. The most common complications after hepatic resection are liver failure, hemorrhage, acute kidney injuries, bile leakage, and pleural effusion. How­ever, the possibility of severe complications could be decreased if proper postoperative care is provid­ed. This can, meanwhile, reduce the threats to lives. Thus, careful postoperative care plays a vital role. The case in this study is a forty-two-year-old male hepatitis B carrier. He was diagnosed with giant hepatocellular carcinoma after clinical physical examinations and imaging tests and then received a two-stage hepatectomy. He had a postoperative fever on the thirteenth day after liver resection with brownish-yellow fluid from drainage. Therefore, postoperative intra-abdominal infection with pleural effusion were suspected. After receiving an abdominal ultrasound and chest X-ray, it was confirmed that he had complications of bile leakage and pleural effusion. His condition was well-controlled after a week under the treatment of thoracentesis, abdominal drainage as well as antibiotics. The period of postoperative care was provided from July 11 to August 10, 2020. This case could be a reference for taking care of patients with similar issues.