Littlewood K
Department of Anesthesiology, Virginia Commonwealth University, Richmond 23298-0459, USA.
Semin Surg Oncol. 1998 Mar;14(2):116-21. doi: 10.1002/(sici)1098-2388(199803)14:2<116::aid-ssu4>3.0.co;2-8.
The evolution of hepatic cryotherapy as an accepted treatment for patients with non-resectable hepatic malignancy has required concurrent evaluation and development of perioperative anesthetic management of these cases. Review of published and institutional experience demonstrates that hepatic cryotherapy presents the anesthesiologist with an array of challenges, all of which are not intuitively apparent. Specifically, such issues as management of coexisting physiologic perturbations of the oncology patient, heat conservation during the procedure, and readiness for a more extensive procedure would be readily anticipated by most clinicians. Description and reasonable management of problems ranging from mild or moderate postoperative thrombocytopenia to the so-called cryoshock syndrome with the possibility of severe postoperative coagulopathy, renal dysfunction, and pulmonary complications, however, could emerge only with the education of experience. The goal of this article is to address the key issues faced by anesthesiologists consulted in the perioperative care of patients undergoing hepatic cryotherapy.
肝冷冻疗法作为不可切除性肝恶性肿瘤患者的一种公认治疗方法，其发展需要同时对这些病例的围手术期麻醉管理进行评估和发展。对已发表的文献和机构经验的回顾表明，肝冷冻疗法给麻醉医生带来了一系列挑战，而这些挑战并非直观可见。具体而言，大多数临床医生很容易预见到诸如肿瘤患者并存生理紊乱的管理、手术过程中的热量保存以及为更广泛手术做好准备等问题。然而，从轻度或中度术后血小板减少到所谓的冷冻休克综合征，以及可能出现的严重术后凝血功能障碍、肾功能不全和肺部并发症等问题的描述和合理管理，只有通过经验积累才能实现。本文的目的是探讨在接受肝冷冻疗法患者的围手术期护理中咨询麻醉医生所面临的关键问题。
