对肝癌术后肝衰竭的再认识

Reconsideration of liver failure after liver cancer surgery

肝切除术后较高的病死率以及并发症发生率与术后肝衰竭密切相关,由于目前肝衰竭的研究仍然有限,肝切除术后肝衰竭的定义尚未统一。总结了术后肝衰竭的定义、发病机制、危险因素、肝功能评估方法及预防措施。分析表明应重视术前肝功能储备并充分评估,术中采取有效方法控制出血,缩短手术时间,尽可能多保留功能性肝组织,围手术期采取及时有效的诊治预防,均可降低术后肝衰竭的发生率,进一步改善患者预后,使患者收益最大化。

High mortality and incidence rate of complications after hepatectomy are closely associated with postoperative liver failure. Due to limited research on liver failure at present,no consensus has been reached on the definition of liver failure after hepatectomy. This article summarizes the definition,pathogenesis,risk factors,liver function assessment methods,and preventive measures of postoperative liver failure. It is pointed out that adequate preoperative assessment of liver function reserve,effective methods for bleeding control,shortening time of operation,preservation of functional liver tissue as much as possible,and timely and effective diagnosis/treatment and prevention during the perioperative period can reduce the incidence rate of liver failure,improve patient prognosis,and maximize the benefits of patients.