Shahid G Farid, Department of General Surgery, Northampton General Hospital, Northampton, NN1 5BD, United Kingdom.
World J Gastrointest Surg. 2013 May 27;5(5):146-55. doi: 10.4240/wjgs.v5.i5.146.
Outcomes in hepatic resectional surgery (HRS) have improved as a result of advances in the understanding of hepatic anatomy, improved surgical techniques, and enhanced peri-operative management. Patients are generally cared for in specialist higher-level ward settings with multidisciplinary input during the initial post-operative period, however, greater acceptance and understanding of HRS has meant that care is transferred, usually after 24-48 h, to a standard ward environment. Surgical trainees will be presented with such patients either electively as part of a hepatobiliary firm or whilst covering the service on-call, and it is therefore important to acknowledge the key points in managing HRS patients. Understanding the applied anatomy of the liver is the key to determining the extent of resection to be undertaken. Increasingly, enhanced patient pathways exist in the post-operative setting requiring focus on the delivery of high quality analgesia, careful fluid balance, nutrition and thromboprophlaxis. Complications can occur including liver, renal and respiratory failure, hemorrhage, and sepsis, all of which require prompt recognition and management. We provide an overview of the relevant terminology applied to hepatic surgery, an approach to the post-operative management, and an aid to developing an awareness of complications so as to facilitate better confidence in this complex subgroup of general surgical patients.
肝切除术 (HRS) 的疗效因对肝脏解剖学认识的提高、手术技术的改进和围手术期管理的加强而得到改善。患者通常在专科高级病房接受治疗，并在术后初期接受多学科的治疗，但对 HRS 的更大接受和理解意味着治疗通常在 24-48 小时后转移到标准病房环境。外科受训者可能会在选择性肝肠固定术期间或在服务轮班时遇到此类患者，因此了解 HRS 患者的管理要点非常重要。了解肝脏的应用解剖学是确定要进行的切除范围的关键。在术后环境中，越来越多的增强型患者途径需要关注高质量镇痛、谨慎的液体平衡、营养和血栓预防。可能会发生并发症，包括肝、肾和呼吸衰竭、出血和脓毒症，所有这些都需要迅速识别和管理。我们提供了与肝外科相关的术语概述、术后管理方法以及对并发症的认识的帮助，以便为这组复杂的普通外科患者提供更好的信心。
