Abbas Naeem, Makker Jasbir, Abbas Hafsa, Balar Bhavna
Divisions of Gastroenterology and Hepatology, Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY, USA.
Division of Gastroenterology, Bronx-Lebanon Hospital Center, Bronx, NY, USA.
Health Serv Insights. 2017 Feb 24;10:1178632917691270. doi: 10.1177/1178632917691270. eCollection 2017.
The incidence of cirrhosis is rising, and identification of these patients prior to undergoing any surgical procedure is crucial. The preoperative risk stratification using validated scores, such as Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease, perioperative optimization of hemodynamics and metabolic derangements, and postoperative monitoring to minimize the risk of hepatic decompensation and complications are essential components of medical management. The advanced stage of cirrhosis, emergency surgery, open surgeries, old age, and coexistence of medical comorbidities are main factors influencing the clinical outcome of these patients. Perioperative management of patients with cirrhosis warrants special attention to nutritional status, fluid and electrolyte balance, control of ascites, excluding preexisting infections, correction of coagulopathy and thrombocytopenia, and avoidance of nephrotoxic and hepatotoxic medications. Transjugular intrahepatic portosystemic shunt may improve the CTP class, and semielective surgeries may be feasible. Emergency surgery, whenever possible, should be avoided.
肝硬化的发病率正在上升，在进行任何外科手术前识别这些患者至关重要。使用经过验证的评分系统进行术前风险分层，如Child-Turcotte-Pugh（CTP）评分和终末期肝病模型，围手术期优化血流动力学和代谢紊乱，以及术后监测以尽量降低肝失代偿和并发症的风险，是医疗管理的重要组成部分。肝硬化晚期、急诊手术、开放性手术、老年以及合并内科疾病是影响这些患者临床结局的主要因素。肝硬化患者的围手术期管理需要特别关注营养状况、液体和电解质平衡、腹水控制、排除既往感染、纠正凝血功能障碍和血小板减少症，以及避免使用肾毒性和肝毒性药物。经颈静脉肝内门体分流术可能改善CTP分级，半选择性手术可能可行。尽可能避免急诊手术。
