Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
Hepatol Commun. 2023 Mar 30;7(4). doi: 10.1097/HC9.0000000000000086. eCollection 2023 Apr 1.
Patients with cirrhosis have an increased perioperative risk relative to patients without cirrhosis. This is related to numerous cirrhosis-specific factors, including severity of liver disease, impaired synthetic function, sarcopenia and malnutrition, and portal hypertension, among others. Nonhepatic comorbidities and surgery-related factors further modify the surgical risk, adding to the complexity of the preoperative assessment. In this review, we discuss the pathophysiological contributors to surgical risk in cirrhosis, key elements of the preoperative risk assessment, and application of risk prediction tools including the Child-Turcotte-Pugh score, Model for End-Stage Liver Disease-Sodium, Mayo Risk Score, and the VOCAL-Penn Score. We also detail the limitations of current approaches to risk assessment and highlight areas for future research.
肝硬化患者的围手术期风险相对于无肝硬化患者增加。这与许多肝硬化特异性因素有关，包括肝脏疾病的严重程度、合成功能受损、肌肉减少症和营养不良以及门脉高压等。非肝脏合并症和手术相关因素进一步改变了手术风险，增加了术前评估的复杂性。在这篇综述中，我们讨论了肝硬化手术风险的病理生理学因素、术前风险评估的关键要素以及风险预测工具的应用，包括 Child-Turcotte-Pugh 评分、终末期肝病模型钠、Mayo 风险评分和 VOCAL-Penn 评分。我们还详细说明了当前风险评估方法的局限性，并强调了未来研究的领域。
