| 摘要 |
Liver resection remains a complex surgical procedure. This procedure is more risky
when performed on cirrhotic patients. To improve the results of liver resection,
strategies for a safe cirrhotic liver resection should be worked out. Preoperative
assessments include control of associated comorbidities to fulfill ASA class I and II,
gastroduodenal endoscopy to detect the associated gastroesophageal varices and
perioperative heparin-free hemodialysis in patients with end-stage renal diseases.
The extent of liver resection is based on the indocyanine-green retention rate.
Intraoperative assessments include routine use of intraoperative ultrasonography,
liver parenchymal transaction under low central venous pressure and intermittent
hepatic inflow blood occlusion, and a restrictive policy of blood transfusion.
Concomitant splenectomy may be suggested in patients with hypersplenic
thrombocytopenia. After operation, intravenous low-dose dopamine or dobutamine
is recommended. Fresh frozen plasma or albumin may be infused to keep serum
albumin level > 3 g/dl. A branch-chain amino-acid enriched solution is suggested
after liver resection for positive nitrogen balance. Based on these strategies, the
mortality of cirrhotic liver resection can be reduced to < 1%, and even 0%. Liver
resection in a cirrhotic patient is no longer a risky operation. The indication for
cirrhotic liver resection may be extended. |
