Mullin Emma J, Metcalfe Matthew S, Maddern Guy J
University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia.
Am J Surg. 2005 Jul;190(1):87-97. doi: 10.1016/j.amjsurg.2005.01.043.
Hepatic failure occurring after liver resection carries a poor prognosis and is a complication dreaded by surgeons. Inadequate reserve in the remaining parenchyma leads to a steady decrease in liver function, inability to regenerate, and progression to liver failure. For this reason, many methods to quantify functional hepatic reserve have been developed.
This article reviews the main methods used in the assessment of hepatic reserve in patients undergoing hepatectomy and their use in operative decision making.
A range of methods to categorically quantify the functional reserve of the liver have been developed, ranging from scoring systems (such as the Child-Pugh classification) to tests assessing complex hepatic metabolic pathways to radiological methods to assess functional reserve. However, no one method has or is ever likely to emerge as a single measure with which to dictate safe limits of resectability.
In the future, the role of residual liver function assessment may be of most benefit in the routine stratification of risk, thus enabling both patient consent to be obtained and surgical procedure to be performed, with full information and facts regarding operative risks. However, there is no one single test that remains conclusively superior.
肝切除术后发生的肝衰竭预后较差，是外科医生惧怕的一种并发症。剩余肝实质储备不足会导致肝功能持续下降、无法再生，并进展为肝衰竭。因此，人们开发了许多量化功能性肝储备的方法。
本文综述了肝切除患者肝储备评估中使用的主要方法及其在手术决策中的应用。
已经开发出一系列对肝脏功能储备进行分类量化的方法，从评分系统（如Child-Pugh分级）到评估复杂肝代谢途径的检测，再到评估功能储备的放射学方法。然而，没有一种方法已经或可能成为决定可切除性安全限度的单一指标。
未来，残余肝功能评估在常规风险分层中可能最有用，从而在充分了解手术风险信息的情况下，既能获得患者同意，又能进行手术操作。然而，没有一种单一检测方法始终具有绝对优势。
