Major liver resections,perioperative issues and posthepatectomy liver failure:A comprehensive update for the anesthesiologist  

作　　者：Andrea De Gasperi Laura Petrò Ombretta Amici Ilenia Scaffidi Pietro Molinari Caterina Barbaglio Eva Cibelli Beatrice Penzo Elena Roselli Andrea Brunetti Maxim Neganov Alessandro Giacomoni Paolo Aseni Elena Guffanti 

机构地区：[1]Former Head,Anesthesia and Critical Care Service 2,Grande Ospedale Metropolitano Niguarda ASST GOM Niguarda,Milan 20163,Italy [2]AR1,Ospedale Papa Giovanni 23,Bergamo 24100,Italy [3]Anesthesia and Critical Care Service 2,Grande Ospedale Metropolitano Niguarda AR2,ASST GOM Niguarda,Milan 20163,Italy [4]Anestesia e Terapia Intensiva Generale,Istituto Clinico Humanitas,Rozzano 20089,Italy [5]Chirurgia Oncologica Miniinvasiva,Grande Ospedale Metropolitano Niguarda ASST GOM Niguarda,Milan 20163,Italy [6]Dipartimento di Medicina d’Urgenza ed Emergenza,Grande Ospedale Metropolitano Niguarda ASST GOM Niguarda,Milano 20163,MI,Italy

出　　处：《World Journal of Critical Care Medicine》2024年第2期49-71,共23页世界重症医学杂志

摘　　要：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 anesthesiologistsmust respond to or prevent,to positively impact PHLF(a proactive approach);and(2)the maximal intensivetreatment of PHLF,including artificial options,mainly based,so far,on Acute Liver Failure treatment(s),to buytime waiting for the recovery of the native liver or,when appropriate and in very selected cases,toward livertransplant.Such a clinical context requires a strong commitment to surgeons,anesthesiologists,and intensivists towork together,for a fruitful collaboration in a mandatory clinical continuum.

关 键 词：Liver resection Chronic liver disease Preoperative assessment Vascular clamping Intraoperative hemodynamic monitoring Postoperative intensive care unit Posthepatectomy liver failure Artificial liver support 

分 类 号：R641[医药卫生—外科学]