Hofland Jan, Henny C Pieter
Departments of Anesthesiology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
Dig Surg. 2007;24(4):265-73. doi: 10.1159/000103657. Epub 2007 Jul 27.
BACKGROUND/AIMS: An increasing amount of literature concerning blood conservation, restrictive transfusion strategies, pharmacological manipulation of the hemostatic and fibrinolytic systems, minimal invasive surgery, local hemostatic agents and guidelines for blood transfusion, is being published each year. Is 'bloodless (liver) surgery' or rather minimization of perioperative blood loss and transfusion requirement necessary?
To answer this question, we studied key articles and checked cross-references with the support of PubMed and the Cochrane Database of systematic reviews.
At present there is still a need to reduce the use of blood. Pre-donation, set of transfusion triggers, (non-)pharmacological approaches to decrease surgical blood loss, hemodilution techniques, peri- and postoperative cell salvage and postoperative re-transfusion can contribute to the success of a bloodless (liver) surgery program.
We conclude that a multidisciplinary effort has to be made through the entire chain, from the outpatient clinic through discharge from the hospital, with the utmost exertion of all team members in which surgeons play a key role in the adaptation of a bloodless (liver) surgery program to the specific needs of patients.
背景/目的：每年都有越来越多关于血液保护、限制性输血策略、止血和纤溶系统的药理学调控、微创手术、局部止血剂以及输血指南的文献发表。“无血（肝脏）手术”，或者更确切地说，将围手术期失血和输血需求降至最低是否必要？
为回答这个问题，我们在PubMed和Cochrane系统评价数据库的支持下研究了关键文章并检查了交叉引用。
目前仍有必要减少血液使用。术前献血、输血触发阈值、减少手术失血的（非）药理学方法、血液稀释技术、围手术期和术后细胞回收以及术后再输血有助于无血（肝脏）手术计划的成功。
我们得出结论，必须通过整个流程进行多学科协作，从门诊到出院，所有团队成员都要尽最大努力，其中外科医生在根据患者的具体需求调整无血（肝脏）手术计划方面发挥关键作用。
