Erasmus University Medical Center, Department of Surgery, Medical Center, Rotterdam, The Netherlands.
Best Pract Res Clin Gastroenterol. 2012 Feb;26(1):47-59. doi: 10.1016/j.bpg.2012.01.010.
The aim of this study is to review systematically morbidity and mortality after non-hepatic surgery in patients with liver cirrhosis.
Comprehensive searches were conducted in PubMed, Embase and the Cochrane Library for articles using the words: liver failure, hepatic insufficiency, liver cirrhosis, cirrhosis, cirrhotic, surgical procedures, operative complications, operative mortality, postoperative complications, surgical complication, surgical risk, hernia.
Forty-six articles were selected from 5247 included after the initial search. Level of evidence provided in the articles varied greatly. Non-hepatic surgery of patients with cirrhosis resulted in increased postoperative morbidity and mortality compared to similar surgery for non-cirrhotic patients. Cholecystectomy and umbilical and inguinal hernia correction were associated with the lowest increased morbidity and mortality while pancreatic surgery, cardiovascular, and trauma surgery correlated with the highest. The preoperative model for end stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores appeared to be predictive of postoperative risks. Portal hypertension and surgery in the emergency setting were associated with extra increased mortality and morbidity rates.
This systematic review of the literature showed that in patients with liver cirrhosis who undergo non-hepatic surgery, postoperative morbidity and mortality rates varied greatly depending on severity of the cirrhosis and the surgical procedure. However, the majority of procedures can be safely performed in patients with low MELD scores or CTP A cirrhosis without portal hypertension.
本研究旨在系统回顾肝硬化患者非肝脏手术后的发病率和死亡率。
在 PubMed、Embase 和 Cochrane 图书馆中，使用“肝衰竭、肝功能不全、肝硬化、肝硬化、肝硬变、手术程序、手术并发症、手术死亡率、术后并发症、手术并发症、手术风险、疝”等词进行全面检索。
初次搜索后，从 5247 篇文章中选择了 46 篇文章。文章提供的证据水平差异很大。与非肝硬化患者相似的手术相比，肝硬化患者的非肝脏手术导致术后发病率和死亡率增加。胆囊切除术和脐疝和腹股沟疝修补术与最低的发病率和死亡率相关，而胰腺手术、心血管手术和创伤手术则与之相关。术前终末期肝病模型（MELD）和Child-Turcotte-Pugh（CTP）评分似乎可以预测术后风险。门静脉高压和急诊手术与额外增加的死亡率和发病率有关。
对文献的系统回顾表明，在接受非肝脏手术的肝硬化患者中，术后发病率和死亡率因肝硬化严重程度和手术程序而异。然而，大多数手术可以在低 MELD 评分或 CTP A 肝硬化且无门静脉高压的患者中安全进行。
