肝切除术【英文讲义】

Hepatectomy

                               
登录/注册后可看大图

Hepatectomy

Definition

A hepactectomy might be the surgery of the liver where one or more lobe of lever is resected.

Demographics

It's the most typical cancer in Africa and Asia for which it is done, using more than tens of thousands of new cases diagnosed every year. In the USA, liver cancer and cancer from the bile ducts only take into account about 1.5% of cancer cases. Liver cancer can also be related to cirrhosis in 50%-80% of patients.

Purpose

Hepatectomies are carried out to surgically take out tumors in the liver. Most liver cancers begin in liver cells called "hepatocytes." The resulting cancer is known as hepatocellular carcinoma or malignant hepatoma. The kind of cancer that may be removed by hepatectomy is known as localized removable liver cancer. It's diagnosed as such if find no evidence it has spread towards the nearby lymph nodes or to every other areas of the body. Laboratory tests also show how the liver is working well. Included in a multidisciplinary approach, the process will offer an opportunity of long-term remission to patients otherwise guaranteed of getting an undesirable outcome.

Description

The extent from the hepatectomy is determined by the dimensions, number, and placement from the cancer. Additionally, it depends upon whether liver function continues to be adequate. The doctor may remove part of the liver which has the tumor, a whole lobe, or a level larger part of the liver. Inside a partial hepatectomy, the doctor leaves a margin of healthy liver tissue to keep the functions of the liver. For many patients, liver transplantation might be indicated. In this instance, the transplant doctor performs an overall total hepatectomy, and therefore the patient's complete liver is taken away, which is substituted for a proper liver from the donor. A liver transplant is definitely an option only when cancer hasn't spread away from liver in support of if suitable donor liver are available that suits the individual. While awaiting a sufficient donor, the care team monitors the patient's health while giving other therapy.

The surgical treatment is conducted under general anesthesia and it is quite lengthy, needing 3 to 4 hours. The anesthetized patient is face-up and both of the arms are drawn from the body. Doctors often make use of a heating pad and wrappings round the legs and arms to lessen losses in body's temperature throughout the surgery. The patient's abdomen is opened by an incision over the upper abdomen along with a midline-extension incision as much as the xiphoid. The primary steps of the partial hepatectomy start the following:

• Freeing the liver. The very first task from the surgeon would be to free the liver by cutting the long fibers that wrap it.
• Removal of segments. When the surgeon has freed the liver, removing segments can begin. The surgeon must avoid rupturing important arteries to prevent a hemorrage. Two different techniques may be used. The very first has got the surgeon create a superficial burn by having an electric lancet at first glance from the liver to mark the junction between sections marked for removal and also the remaining liver. He/she reduces the section, after which tears for the hepatic parenchyma. It's the difference in resistance between patient’s parenchyma and also the vessels which allows the surgeon to recognize the existence of a vessel. At this time, he/she isolates the vessel by taking out the surrounding ligament, after which clamps it. The surgeon may then cut the vessel, with no danger towards the patient. The second technique requires identifying the big vessels feeding the segments to become removed. The surgeon operates first in the degree of the veins to free after which clamp the vessels needed. Finally, the doctor could make incisions without worrying about cutting little vessels
  

Who performs the process and where could it be carried out?

A hepactectomy is conducted inside a hospital setting with a surgeon assisted with a full abdominal surgery team, and perhaps an oncologist.

Diagnosis/Preparation

An analysis of liver cancer needing a hepatectomy is obtained using the following procedures:

• physical evaluation
• blood tests
• computed tomagraphy (CT) scan
• ultrasound test
• magnetic resonance imaging (MRI)
• angiograms
• biopsy
  

To organize someone for any hepactectomy, clean towels are laid over the patient's face, alongside, and over the knees. The anterior part of the chest area, the abdomen, and also the lower extremities right down to the knees are scrubbed with betadine for Ten minutes. In case of someone being allergic to iodine, hibiscrub can be utilized as a substitute. On completing the scrub, two sterile towels are utilized to pat the region dry. The region will be painted with iodine in alcohol, and draping continues with side drapes, arm board drapes, bottom and top drapes, along with a large steridrape. Three suctions equipment, one diathermy pencil and a forceps are put conveniently round the field.

Important questions a patient should ask a doctor:

• How long will a patient have to stay in a healthcare facility?
• What would be the risks involved?
• What tests will a patient have to know?
• How will the hepatectomy affect my ordinary activities?
• What kind of hepatectomy is needed?
• How many hepatectomies would doctor performs each year?
  

Risks

Patients with chronic hepatitis and cirrhosis are in high-risk whenever a hepatectomy is conducted. You will find always risks with any surgery, but a hepatectomy that eliminates 25%-60% from the liver carries a lot more than the typical risk. Pain, bleeding, infection, and/or problems for the areas within the abdomen, in addition to death, are potential risks. Other risks consist of postoperative fevers, pneumonia, and urinary tract infection. Patients who undergo any kind of abdominal surgery will also be in danger to create thrombus within their legs. This thrombus can liberate and undertake one's heart towards the lungs. Within the lungs, the blood clot could cause a significant problem called pulmonary embolism, an ailment usually given blood-thinning medicine. However in certain cases, embolisms may cause death. You will find special equipment accustomed to keep blood flowing with the legs during surgery to try and prevent clot formation.

There's also risks which are specific and then liver surgery. Throughout the preoperative evaluation, the therapy team attempts to assess the patient's liver to enable them to decide what piece can be removed without danger. Elimination of some from the liver could cause the residual liver to operate poorly for a while of time. The residual the main liver will start to grow back inside a couple weeks and can improve. However, someone may grow liver failure.

Normal results

The outcomes of the hepactetomy are thought normal when liver function resumes carrying out a partial hepatectomy, or once the transplant liver begins functioning regarding an overall total hepatectomy.

Morbidity and mortality rates

Liver cancer might be cured by hepatectomy, although surgery may be the treating choice for less than a part of patients with localized disease. Prognosis depends upon the extent from the cancer as well as liver function impairment. Non-Hispanic white women and men possess the lowest occurrence of and mortality rates for primary liver cancer. Rates within the black and Hispanic populations are about two times as high since the rates in whites. The greatest incidence minute rates are in Vietnamese men (41.8 per 100,000); probably reflecting risks linked to the high prevalence of viral hepatitis infections within their homeland. Other Asian-American groups also provide liver cancer occurrence and mortality rates many times greater than the white population.

Aftercare

After a hepatectomy, the recovery process needs time to work; how long necessary to recover differs from person to person. Patients in many cases are uncomfortable for that first couple of days following surgery plus they are usually prescribed pain medication. The treating physician or nurse can be obtained to go over pain management. Patients generally feel totally tired or weak for some time. Also, patients might have diarrhea along with a feeling of fullness within the abdomen. The care team closely monitors the individual for bleeding, infection, liver failure, or another problems needing immediate medical assistance.

Following a total hepatectomy then a liver transplant, the individual generally stays within the hospital for many weeks. In that time, the care team constantly monitors how well the individual is accepting the donated liver. The individual is prescribed drugs to avoid against rejecting the transplant, which might cause puffiness hard, hypertension, or a rise in body hair.

Alternatives

There aren't any alternatives because hepatectomies are carried out when liver cancer doesn't react to anything else.