title: [Hepatic failure after liver resection in patients with cirrhosis].
abstract: Despite improvements in the preoperative assessment of liver function and advances in surgical techniques, liver resection for hepatocellular carcinoma still holds a risk for postoperative hepatic failure, especially in patients with cirrhosis. Physiologic characteristics in patients with cirrhosis include hyperdynamic state of the systemic circulation, decrease in hepatic blood flow, portal hypertension, metabolic disorders, dysfunction of the reticuloendothelial system, and thrombocytopenia. Surgical stress including massive bleeding, disturbance of hepatic circulation, and infection are risk factors for postoperative hepatic failure. The risk of hepatic failure also correlates with the severity of active hepatitis and the degree of hepatic fibrosis. To prevent postoperative hepatic failure, dopamine, prostaglandin, and hydrocortisone have been used. Although various treatments including plasma exchange have been tried in hepatic failure, the results have often been unsatisfactory. Careful preoperative evaluation of the hepatic functional reserve and the severity of active hepatitis, and adequate selection of surgical method are important to prevent postoperative hepatic failure.
authors.affiliation: Department of Gastroenterological and Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Taichi
authors.initials: T
authors.lastname: Shuto
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uenishi
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hirohashi
mesh_terms: D000527:Alprostadil / Q000008:administration & dosage; D004298:Dopamine / Q000008:administration & dosage; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology* / Q000517:prevention & control*; D008111:Liver Function Tests; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D012307:Risk Factors
chemical_list: D000527:Alprostadil; D004298:Dopamine; D006854:Hydrocortisone