Care after liver surgery
Post-operative care and liver cancer, liver resection is a major surgery, after surgery there are many potentially serious complication of the disease must be closely observed, monitoring vital signs of problems in time, if necessary, will be placed in intensive care patients ward.
Liver cancer in the postoperative treatment includes general supportive care first: nutritional support: adequate oxygen, adequate heat, add enough protein, glucose, vitamin K, etc.; Drug Support: hemostatic agents, antimicrobial agents, hepatoprotective drug, acid-suppressing drugs; attention to water and electrolyte balance, acid-base balance; blood transfusion: the lower of complement proteins in plasma, and anemia are advised to add new blood and so on. Second, to support the treatment of complications based on symptomatic treatment given:
(1) hemorrhage: early postoperative bleeding wounds to stop bleeding because the liver is not thorough enough. Active bleeding from a small branch of hepatic artery, bleeding may be difficult to stop on their own; from the hepatic vein, portal vein, sinusoidal hemorrhage, and more will be gradually reduced itself to stop. In addition to careful intraoperative bleeding, the postoperative drainage fluid should be on the color, amount and composition of close observation. Active bleeding bright red color of arterial bleeding should be thought of, such as through blood transfusion, hemostasis bleeding still no less, should be early surgery to stop bleeding. Coagulopathy bleeding, can occur in a wide range of liver cirrhosis and liver resection and massive blood transfusion, they often showed diffuse oozing wound, there is no active bleeding point for sure, it is difficult to achieve complete hemostasis two blood transfusion may be given at this time and correct the coagulopathy.
(2) ascites: liver resection Another prominent issue is the hypoproteinemia after the operation and the rapid increase in ascites, low sodium and low dilution bait hyperlipidemia. The most occurred in patients with cirrhosis after 2 weeks, this is due to the albumin synthesis in liver tissue remaining obstacles, on the other hand is leaving tour due to water dilution of the plasma proteins. Timely treatment of albumin or plasma infusion, appropriate diuretic, an appropriate complement bait, to enhance the maintenance of plasma colloid osmotic pressure and electrolyte balance.
Care after liver surgery (3) Preserved or pleural effusion under: As the great wound of liver resection, more exudate, such as poor drainage, fluid can be formed, such as secondary infection, can form a version of swelling. Treatment is to maintain unobstructed drainage. If necessary, in the B-, CT guided catheter drainage. And should be broad-spectrum antibiotics and metronidazole application of lag and other infections. Because many pathogens were opportunistic pathogen is not sensitive to some antibiotics, or resistance, for the effective control of infection, bacterial culture and sensitivity should test for bacteria sensitive to antibiotics given. Long-term antibiotics are advised to test the proportion of fecal bacteria in the ball and find fungi, to avoid the flora disturbance, increase the patient's condition.
(4), bile leakage: shortly after liver resection may be a small amount of bile leakage from the wound, such as adequate drainage to reduce and stop quickly. Such as the continuing reduction of 1 week to consider a larger drain bile duct ligature tie or off, or part of liver tissue necrosis. The most important treatment is to maintain unobstructed drainage, adequate drainage of bile to leak into the body, to avoid the formation of bile peritonitis.
(5) Yellow Fever: surgery is a lot of blood can enter the stock early postoperative bilirubin due to liver overload before the emergence of the yellow mild disease, usually subsided within 5 days after the operation. Extensive liver resection, can occur after surgery yellow disease, such as Yuan complications, can be dissipated in the l0_14 days. If complications such as intra-abdominal infections, liver failure, the yellow plague increased again and continued, often as a symbol of poor prognosis. Note yellow with extrahepatic obstructive blast phase identification, which usually requires surgery. On intra-abdominal infections caused by the yellow disease, must be adequate drainage, while application of broad-spectrum antibiotics.
(6) gastrointestinal bleeding: gastrointestinal bleeding after hepatectomy in cirrhotic portal hypertension can be derived from esophageal varices or gastric stress ulcer. The liver after liver resection of more than smaller, portal vein obstruction, portal hypertension can cause temporary, such as patients with esophageal varices before, the more susceptible to bleeding. More effective approach is three-cavity tube to stop bleeding or injection sclerotherapy. Stress, War, to give acid-fast stain preparations, in order to reduce gastric acid secretion, can be effective in reducing bleeding.
(7), liver failure and hepatic encephalopathy: the most found in chronic active hepatitis and cirrhosis patients significantly. Huang disease after rebate, continuing to deepen a sign of liver failure, and disturbance of consciousness, liver smelly, bleeding, and concurrent failure of other organ systems. In addition to treatment, liver treatment, use of glucose and branched-chain amino acids, not fat emulsion, amino acid mixture normally restricted. Available oral lactulose or enema. Application of antibiotics for the intestinal flora. Application of glutamic acid reduced blood ammonia. Intravenous infusion of L-dopa, may be beneficial to restore brain function. At the same time to control MODS. In fact, the prevention of the occurrence of liver failure is more important than treatment. Also need to pay attention to the incentives induced hepatic coma: Low Kam alkalosis, upper gastrointestinal bleeding, urination, ascites, high-protein diet, surgery and infections, sedative narcotic drugs and constipation.
Care after liver surgery (8) Other: such as low blood sugar, infection, wound dehiscence, renal failure, thrombosis treatment. Meanwhile, the physician for the patient's emotions to give the necessary psychological treatment, the patients in the normal attitude to face the disease, treatment with a doctor to complete the system. In short, liver cancer patients after recovery is a complex and dangerous process that requires health care workers and patients work together to overcome difficulties, be possible to overcome the disease.
- pleural effusion after liver resection