Kaibori Masaki, Matsui Kosuke, Shimada Mitsuo, Kubo Shoji, Hasegawa Kiyoshi
Department of Surgery Kansai Medical University Osaka Japan.
Department of Surgery Tokushima University Tokushima Japan.
Ann Gastroenterol Surg. 2021 Dec 15;6(3):344-354. doi: 10.1002/ags3.12529. eCollection 2022 May.
Hepatocellular carcinoma is often accompanied by chronic hepatitis or cirrhosis. Preoperative evaluation of liver function and postoperative nutritional management are critical in patients with hepatocellular carcinoma who undergo liver surgery. Although the incidence of postoperative complications and death has declined in Japan over the last 10 years, postoperative complications have not been fully overcome. Therefore, surgical procedures and perioperative management must be improved. Accurate preoperative evaluations of liver function, nutrition, inflammation, and body skeletal muscle are required. Determination of the optimal surgical procedure should consider not only tumor characteristics but also the physical reserve of the patient. Nutritional management of chronic liver disorders, especially maintaining protein synthesis for postoperative protein/energy, is important. Prophylactic antibiotics are recommended for short-term use within 24 hours after surgery. Abdominal drainage is recommended for patients with cirrhosis who may develop large amounts of ascites, who are at risk of postoperative bleeding, or who may have bile leakage due to a large resection area. Postoperative exercise therapy may improve insulin resistance in patients with chronic liver damage. Implementation of an early/enhanced recovery after surgery program is recommended to reduce biological invasive responses and achieve early independence of physical activity and nutrition intake. We review the latest information on the perioperative management of patients undergoing liver resection for hepatocellular carcinoma.
肝细胞癌常伴有慢性肝炎或肝硬化。对于接受肝脏手术的肝细胞癌患者，术前肝功能评估和术后营养管理至关重要。尽管在过去10年里日本术后并发症和死亡的发生率有所下降，但术后并发症仍未得到完全解决。因此，手术操作和围手术期管理必须加以改进。需要对肝功能、营养、炎症和身体骨骼肌进行准确的术前评估。确定最佳手术方式不仅应考虑肿瘤特征，还应考虑患者的身体储备。慢性肝脏疾病的营养管理，尤其是维持术后蛋白质/能量的蛋白质合成，非常重要。建议术后24小时内短期使用预防性抗生素。对于可能出现大量腹水、有术后出血风险或因切除面积大可能发生胆漏的肝硬化患者，建议进行腹腔引流。术后运动疗法可能改善慢性肝损伤患者的胰岛素抵抗。建议实施术后早期/强化康复计划，以减少生物侵袭反应，并实现身体活动和营养摄入的早期独立。我们回顾了肝细胞癌肝切除患者围手术期管理的最新信息。
