Karaciğer Cerrahisi Sonrasında Nutrisyon Desteği
Özet
İlerlemiş karaciğer hastalığı olan bireylerde malnütrisyon, cerrahi süreçlerde morbidite ve mortaliteyi artıran çok faktörlü ciddi bir sağlık sorunudur. Karaciğer cerrahisi sonrasında gelişen iskemi-reperfüzyon hasarı ve rejenerasyon yetersizliği gibi risklerin önüne geçilebilmesi için perioperatif dönemde hastaların beslenme durumunun titizlikle değerlendirilmesi hayati önem taşımaktadır. ESPEN kılavuzları uyarınca, elektif cerrahi veya nakil planlanan hastaların ameliyat öncesinde MUST, SGA, NRS-2002 veya RFHGA gibi nesnel ve subjektif tarama araçlarıyla taranması güçlü bir şekilde önerilmektedir. Bu süreçte gereksiz açlık sürelerinin kısaltılması, katabolik yıkımı engellemek adına geç akşam atıştırmalıklarının verilmesi ve ERAS protokollerinin klinik uygulamaya dahil edilmesi iyileşme sürelerini optimize etmektedir. Ayrıca immünonutrisyon kapsamında dallı zincirli aminoasitler (DZA), omega-3 yağ asitleri, arginin ve probiyotiklerin kullanımı; bakteriyel translokasyonu sınırlayarak inflamatuar yanıtları ve postoperatif enfeksiyon komplikasyonlarını anlamlı düzeyde azaltmaktadır. Sonuç olarak, karaciğer rezeksiyonunun başarısını artırmak ve hastaların yaşam kalitesini optimize etmek, multidisipliner bir yaklaşımla yürütülen kişiselleştirilmiş beslenme desteği ve kısıtlama diyetlerinin erken dönemde başlatılmasına doğrudan bağlıdır.
Malnutrition in patients with advanced liver disease represents a complex challenge that significantly increases morbidity and mortality during surgical interventions. To mitigate risks such as ischemia-reperfusion injury and impaired liver regeneration following major surgeries, a meticulous assessment of the patient's nutritional status during the perioperatieve period is paramount. According to ESPEN guidelines, screening patients scheduled for elective liver resection or transplantation using tools like MUST, SGA, NRS-2002, or RFHGA is strongly recommended. Reducing preoperative fasting intervals, implementing ERAS protocols, and introducing late evening snacks are essential to prevent overnight catabolism and optimize functional recovery. Furthermore, immunonutrition targeting the administration of branched-chain amino acids (BCAAs), omega-3 fatty acids, arginine, and probiotics plays a crucial role in limiting bacterial translocation, tempering inflammatory cascades, and reducing postoperative infectious complications. Ultimately, improving surgical outcomes and upgrading the post-resection quality of life depend heavily on timely, individualized nutritional support and specific dietary strategies managed by multidisciplinary teams.
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