PDF(Pubmed)
Abstract：
Significant advances in surgical techniques and relevant medium- and long-term outcomes over the past two decades have led to a substantial expansion in the indications for major liver resections. To support these outstanding results and to reduce perioperative complications, anesthesiologists must address and master key perioperative issues (preoperative assessment, proactive intraoperative anesthesia strategies, and implementation of the Enhanced Recovery After Surgery approach). Intensive care unit monitoring immediately following liver surgery remains a subject of active and often unresolved debate. Among postoperative complications, posthepatectomy liver failure (PHLF) occurs in different grades of severity (A-C) and frequency (9%-30%), and it is the main cause of 90-d postoperative mortality. PHLF, recently redefined with pragmatic clinical criteria and perioperative scores, can be predicted, prevented, or anticipated. This review highlights: (1) The systemic consequences of surgical manipulations anesthesiologists must respond to or prevent, to positively impact PHLF (a proactive approach); and (2) the maximal intensive treatment of PHLF, including artificial options, mainly based, so far, on Acute Liver Failure treatment(s), to buy time waiting for the recovery of the native liver or, when appropriate and in very selected cases, toward liver transplant. Such a clinical context requires a strong commitment to surgeons, anesthesiologists, and intensivists to work together, for a fruitful collaboration in a mandatory clinical continuum.
摘要：
在过去的二十年中，外科技术的显着进步以及相关的中长期结果已导致重大肝切除适应症的大幅扩大。为了支持这些出色的结果并减少围手术期并发症，麻醉医师必须解决和掌握围手术期的关键问题(术前评估，术中主动麻醉策略，并实施增强的手术后恢复方法)。肝脏手术后立即进行重症监护病房监测仍然是一个活跃且经常未解决的辩论主题。在术后并发症中，术后肝功能衰竭（PHLF）发生在不同的严重程度（A-C）和频率（9％-30％），是导致术后90d死亡的主要原因。PHLF,最近用实用的临床标准和围手术期评分重新定义，可以预测,阻止,或预期。这篇综述强调：（1）手术操作的系统性后果，麻醉师必须应对或预防，积极影响PHLF(一种积极的方法)；和(2)PHLF的最大强化治疗，包括人工选择，主要基于，到目前为止,关于急性肝衰竭治疗，争取时间等待本地肝脏的恢复，在适当的情况下，在非常有选择的情况下，肝移植。这样的临床背景需要对外科医生的坚定承诺，麻醉师,和强化主义者一起工作，在强制性临床连续体中进行富有成效的合作。
