The anesthesiologist's expanding role in perioperative liver protection.

摘要

A few decades ago, liver surgery was a highly hazardous undertaking. In the 1960s, the rate of perioperative mortality after liver resection was up to 50%. Substantial progress in surgery and perioperative care has made liver surgery dramatically safer, with a current mortality rate lower than 1 % in patients with normal preoperative liver function. Surgical strategies have evolved considerably, thanks to a better knowledge of liver anatomy and pathophysiology. The use of vascular clamping to minimize blood loss, and more recently the adoption of strategies for manipulating liver volume, such as preoperative embolization and the preservation of remaining liver cells, make it possible to perform extensive resections with low perioperative mortality and morbidity.