Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Division of Acute Care Surgery, Birmingham, USA.
J Gastrointest Surg. 2019 Mar;23(3):634-642. doi: 10.1007/s11605-018-3991-7. Epub 2018 Nov 21.
Cirrhotic liver disease is an important cause of peri-operative morbidity and mortality in general surgical patients. Early recognition and optimization of liver dysfunction is imperative before any elective surgery. Patients with MELD <12 or classified as Child A have a higher morbidity and mortality than matched controls without liver dysfunction, but are generally safe for elective procedures with appropriate patient education. Patients with MELD >20 or classified as Child C should undergo transplantation before any elective procedure given mortality exceeds 40%. Laparoscopic procedures are feasible and safe in cirrhotic patients.
肝硬化是普通外科患者围手术期发病率和死亡率的重要原因。在进行任何择期手术前，必须早期识别和优化肝功能障碍。MELD<12 或分类为 A 级的患者比无肝功能障碍的匹配对照患者的发病率和死亡率更高，但经过适当的患者教育，一般可安全进行择期手术。MELD>20 或分类为 C 级的患者应在进行任何择期手术前进行移植，因为死亡率超过 40%。腹腔镜手术在肝硬化患者中是可行和安全的。
