Karaciğer Cerrahisinde Preoperatif Değerlendirme
Özet
Karaciğer cerrahisi, gerek anestezi gerekse cerrahi açıdan yüksek morbiditeye sahip olduğundan, hastaların preoperatif değerlendirmesi titizlikle yapılmalıdır. Bu süreçte hastanın mevcut özelliklerinin yanı sıra, planlanan cerrahi ve uygulanacak teknikler kapsamlıca değerlendirilir. Karaciğer disfonksiyonunun ciddiyetini ve cerrahi riskleri belirlemede yaygın olarak ASA skorlaması, Child-Turcotte-Pugh (CTP), MELD-Na ve ALFED modeli gibi sistemler kullanılır. Cerrahi öncesinde pulmoner, kardiyovasküler, nörolojik, renal, gastrointestinal ve hematolojik sistemlerin fonksiyonları ayrıntılı şekilde incelenir. Ayrıca ameliyat esnasında koagülopati ve peroperatif kanama riskini azaltmak amacıyla, hedef sıfır dengede sıvı replasmanı yapılması ve santral venöz basıncın düşük tutulması önerilir. Karaciğer fonksiyon testleri, radyolojik görüntüleme teknikleri ve anestezik ilaçların karaciğer üzerindeki etkileri de bu değerlendirmenin önemli bileşenleridir. Son dönem karaciğer yetmezliğinde tek tedavi seçeneği olan transplantasyon işlemlerinde ise hem alıcının hem de vericinin (donör) güvenliğini sağlamak için kalan karaciğer hacminin doğru hesaplanması ve intraoperatif süreçte PiCCO, TÖE ve TEG gibi ileri monitörizasyon yöntemlerinin kullanılması kritik bir öneme sahiptir.
Liver surgery carries high morbidity from both anesthetic and surgical perspectives, requiring a meticulous preoperative evaluation of patients. In this process, the patient's current characteristics, planned surgery, and specific techniques are comprehensively assessed. Systems such as ASA scoring, Child-Turcotte-Pugh (CTP), MELD-Na, and the ALFED model are widely used to determine the severity of liver dysfunction and surgical risks. Prior to surgery, pulmonary, cardiovascular, neurological, renal, gastrointestinal, and hematological systems are examined in detail. Additionally, to reduce the risk of coagulopathy and perioperative bleeding during surgery, a target of zero-balance fluid replacement and maintaining low central venous pressure are recommended. Liver function tests, radiological imaging, and the effects of anesthetic drugs on the liver are also critical components of this assessment. For liver transplantation, which is the sole treatment option in end-stage liver failure, accurate calculation of the remnant liver volume to ensure both recipient and donor safety, alongside the utilization of advanced intraoperative monitoring methods like PiCCO, TEE, and TEG, is of paramount importance.
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