Strategies for a Safe Cirrhotic Liver Resection

肝切除目前仍屬於複雜的外科手術，此手術若施行於肝硬化病人，則危險性更大，爲了增進肝切除的成果，建立肝硬化病人安全的肝切除模式是必要的。對肝硬化病人肝切除前必需好好控制此等病人所伴隨的合併疾患。使其符合美國麻醉學會所規定的第一或二級狀態。術前以胃鏡檢查有否合併胃食道靜脈瘤。若有腎衰竭病患，則週手術期間應以不含肝素之溶液作血液透析。手術中應用術中超音波以得知肝內脈管走向。肝切除過程中應減少中心靜脈壓及應用間歇性的肝門阻血法。肝切除範圍則由吲哚氰綠的滯留率高低而定，術中輸血量則儘可能保守。有血小板減少時（小於8萬／立方公厘），則於術中則同時切除腫大的脾臟。術後則給予低劑量的dopamine，得以保持肝血流量，在腸胃道功能未回復前，則建議輸以富含枝鏈胺基酸的溶液，一旦有手術合併症時，應及早對應。基於以上的策略，目前肝切除已相當安全，手術死亡率應在1%以下，甚至爲0%。

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並列摘要

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 ＞3g/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.

並列關鍵字

liver resection ； liver cirrhosis ； operative safety

國際替代計量

Strategies for a Safe Cirrhotic Liver Resection

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