Department of Gastroenterology and Hepatology, Royal Melbourne hospital, Parkville, Victoria, Australia.
J Gastroenterol Hepatol. 2012 Oct;27(10):1569-75. doi: 10.1111/j.1440-1746.2012.07205.x.
Surgery in the patient with cirrhosis is problematic, as encephalopathy, ascites, sepsis and bleeding are common in the postoperative period. Accurate preoperative assessment and planning, and careful postoperative management have the potential to reduce the frequency and severity of such complications, and reduce the length of hospital stay, but there is little literature evidence to prove this. Operative mortality and other risks correlate with the severity of the liver disease, co-morbidities and the type of surgery. The Child-Turcott-Pugh (CTP) score or model for end-stage liver disease (MELD) score may be used to determine the severity of the liver disease, but must also take into account recent changes in the patient's condition. Surgery that does not involve opening the peritoneum may have slightly better outcomes, as the risk of ascitic leak, sepsis and difficult fluid management are reduced. Mortality rates range from 10% in CTP-A patients to 82% in CTP-C patients. The presence of portal hypertension is an important negative predictor, especially in abdominal surgery, as refractory ascites may occur. Careful monitoring in the postoperative period and early intervention of complications are essential. Hepatic resections in cirrhosis are associated with other considerations such as leaving sufficient liver tissue to prevent liver failure, and are beyond the scope of this review.
肝硬化患者的手术存在问题，因为肝性脑病、腹水、感染和出血在术后很常见。准确的术前评估和计划，以及仔细的术后管理，有可能减少这些并发症的频率和严重程度，并缩短住院时间，但几乎没有文献证据可以证明这一点。手术死亡率和其他风险与肝病的严重程度、合并症以及手术类型有关。Child-Turcott-Pugh (CTP) 评分或终末期肝病模型 (MELD) 评分可用于确定肝病的严重程度，但还必须考虑到患者近期的病情变化。不涉及腹膜切开的手术可能会有更好的结果，因为这样可以降低腹水漏出、感染和液体管理困难的风险。CTP-A 患者的死亡率范围为 10%，而 CTP-C 患者的死亡率为 82%。门静脉高压的存在是一个重要的负面预测因素，尤其是在腹部手术中，因为可能会出现难治性腹水。术后期间的仔细监测和对并发症的早期干预至关重要。肝硬化肝切除术还涉及其他考虑因素，例如留下足够的肝组织以防止肝功能衰竭，这些都超出了本综述的范围。
