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首页> 外文期刊>Journal of hepato-biliary-pancreatic surgery >Assessment of hepatic reserve for indication of hepatic resection: how I do it.
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Assessment of hepatic reserve for indication of hepatic resection: how I do it.

机译：评估肝储备以指示肝切除的方法：我该怎么做。

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摘要

The perioperative outcome of hepatic resection has improved remarkably in recent years with improved surgical techniques and perioperative care. As a result, the indications of hepatic resection have been extended to include patients with borderline liver function, especially those with associated cirrhosis. For such patients, proper preoperative assessment of liver function reserve is essential to ensure a low incidence of postoperative liver failure and mortality. In our center, routine preoperative assessment of hepatic function reserve in all patients includes clinical assessment, liver biochemistry, coagulation profile, platelet count, and Child-Pugh classification. The indocyanine green clearance test is routinely performed for patients with chronic liver disease. For patients with cirrhosis undergoing major hepatectomy, computed tomography volumetry and laparoscopy are helpful in evaluating whether the remnant liver volume is adequate. In selected patients with small remnant liver, preoperative portal vein embolization can be employed to induce hypertrophy of the remnant liver even in the presence of chronic hepatitis and mild cirrhosis. Careful assessment of comorbid conditions of patients and meticulous surgical techniques to reduce bleeding and hypoxic injury to the remnant liver are complementary to the selection of patients with adequate liver function reserve, to minimize operative mortality.
机译：近年来，随着外科技术和围手术期护理的改善，肝切除术的围手术期效果显着改善。结果，肝切除的适应症已扩大到包括边缘性肝功能的患者，尤其是伴有肝硬化的患者。对于此类患者，正确的术前肝功能储备评估对于确保术后肝衰竭和死亡率的低发生率至关重要。在我们中心，常规术前评估所有患者的肝功能储备包括临床评估，肝生化，凝血特性，血小板计数和Child-Pugh分类。吲哚菁绿清除试验通常对患有慢性肝病的患者进行。对于接受大肝切除术的肝硬化患者，计算机断层扫描容量和腹腔镜检查有助于评估残余肝脏容量是否足够。在选定的具有小残留肝的患者中，即使在存在慢性肝炎和轻度肝硬化的情况下，术前门静脉栓塞术也可用于诱导残留肝肥大。仔细评估患者合并症的状况以及采用细致的手术技术以减少对残余肝的出血和低氧损伤，这与选择具有足够肝功能储备的患者相辅相成，可以最大程度地降低手术死亡率。

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