The liver is the most important purification laboratory in the body, performing about 500 functions simultaneously. It takes part in the detoxification of the body (the vena cava collects all the blood containing decay products from the organs of the lower half of the body and, passing through the parenchyma, is cleared). Further, the purified blood is sent to the heart and lungs, where it is enriched with O2.
And also the body is involved in lipid and carbohydrate metabolism, converting fats and carbohydrates into energy for the body to work, the synthesis of bile and vitamins, enzymes and cells of the immune system, hematopoiesis.
Pathologies of the liver require special attention, since the organ is vital. Some of her diseases can only be cured by surgery. Partial removal of the liver is called resection. The operation is quite common and is used in 55% of cases of all liver diseases. The resection is well tolerated, and the rehabilitation period is up to six months.
A bit of anatomy to understand the essence of resection
The liver is covered with a capsule and has 2 lobes: large right and small left. The first consists of 2 more lobes - caudate and square.
The lobes of the liver form 8 segments (lobules), which are separated by connective tissue septa and have their own autonomous blood supply and bile ducts. This structure, by the way, during the operation gives great advantages, because it prevents blood loss and does not interfere with the formation of bile.
The liver has 2 surfaces: diaphragmatic and visceral. The first is the bed for the gallbladder, and the gate of the liver, the latter enter the hepatic artery and portal vein, the biliary vessels and hepatic veins exit.
Indications for resection
Liver resection surgery scheduled if available:
- any mechanical damage;
- benign formations - adenomas, hemagiomas, etc.;
- anomalies in the development of the organ;
- malignant tumors of any grade, if the parenchyma is not completely affected;
- for liver transplant;
- cyst;
- treatment of liver metastases from colon cancer and other distant organs;
- echinococcosis;
- hepatic bile duct stones;
- liver abscesses;
- Caroli disease is a congenital pathology in which the bile ducts are cystically dilated.
Of these, the worst is liver cancer. It will be discussed below.
In case of other pathologies, the recovery after the operation is complete. The only problem is that in the early stages, diagnosis is difficult, since the liver does not have nerve pain receptors and does not produce symptoms. The clinic appears already with an increase in the liver and pressure on the capsule.
If a doctor recommends a liver resection, there is no need to think for a long time, this is not in favor of the patient, because liver pathologies tend to progress.
Diagnosis
When planning an intervention, a complete examination of the patient is required using blood and urine tests, blood biochemistry, a standard set for hepatitis, HIV and RV.
Ultrasound, CT scan is mandatory - they assess the size and condition of the liver. If oncology is suspected, blood is donated for tumor markers.
Varieties of operation
There are two main types of surgery: central and atypical.
Central or typical resection of the liver - removal of its part, taking into account the lobar structure of the organ, this is a more convenient option for the patient and the surgeon. During such an operation, it is possible to remove adjacent segments without touching others, so liver function does not suffer.
To remove sections, allocate:
- Segmentectomy - 1 segment is excised.
- Sectionectomy - excision of several segments.
- Hemihepatectomy - resection of a lobe of the liver.
- Mesohepatectomy - excision of the central sections.
- Extended hemihepatectomy - lobe+segment is removed.
Even if there is one segment left, the liver will continue to work andbile formation is not disturbed.
Atypical resection
In atypical liver resection, it is not the structure of the organ that is taken into account, but the localization of the lesion.
The operation has subtypes:
- Marginal resection - excision of part of the organ from the edge.
- Wedge-shaped - resection is performed in pyramids.
- Planar - excision of a portion of the organ from the upper surface.
- Transverse - resection of the lateral areas.
With atypical resection, more abundant bleeding and disruption of individual segments occur. Recovery of the liver in this case occurs gradually, if there are he althy areas.
Other types of transactions
There are several other types of liver surgery:
- Cavity excision of a part of an organ with a scalpel.
- Radiofrequency ablation is a laparoscopic removal that uses radiofrequency radiation instead of a scalpel.
- Chemoembolization - is used only for oncological processes in the liver in the early stages of the development of the disease. Cytostatics and chemotherapy drugs are injected into the segmental vessel of the affected area, which prevent the tumor from growing and kill its cells. So that the drugs do not leave the vessel and act for a long time, it is clogged with an embolizing agent.
- Alcoholization is the introduction of 95% alcohol percutaneously (percutaneously) into the segment of the organ, which destroys the pathological focus. The process is controlled by ultrasound.
There is also a combined resection, when, along with the liver, someabdominal organ. This is usually done for metastases.
The operation itself is carried out by 2 types of access:
- Laparoscopic liver resection - the surgeon makes preliminary 3-4 incisions on the anterior wall of the abdomen, 2-3 cm each. Sensors and instruments are inserted through them. More often used when removing liver stones.
- Laparotomy method - a large area of the abdomen is cut.
Anesthesia
In abdominal surgery, endotracheal anesthesia with mechanical ventilation. Sedatives are additionally administered intravenously.
When using a radiofrequency knife, anesthesia is spinal, which makes the lower body insensible and the patient does not feel pain. An anesthetic is injected into the lumbar spine.
In case of chemoembolization and alcoholization local anesthesia.
Preparation for the operation
Before the operation, in addition to a thorough and comprehensive examination, one should stop taking blood-thinning drugs - Aspirin, Cardiomagnyl, etc. - for a week in order to exclude bleeding.
The course of abdominal surgery with a scalpel
After a layer-by-layer incision of the skin and abdominal muscles, a liver revision and ultrasound are performed to determine the size of the lesion. Parts affected by the disease are excised, bile ducts and blood vessels are tied up.
Resection of the liver as a whole lasts about 3-7 hours, after which the patient is sent to intensive care for a day. An ultrasonic sensor is used to control the removal. Residual blood is removed fromabdominal cavity by means of suction (aspiration). The liver is filled with an antiseptic, which is also aspirated, and only then the wound is sutured with staples.
No sutures are placed at the resection site, drainage tubes are installed here. They help to remove excess blood and transudate.
Post-op period
In intensive care, sensors are connected to the patient to monitor the pulse and pressure. Temperature and general condition are monitored.
A catheter must be inserted into the bladder to collect the resulting urine. The next day the patient is transferred to the general ward. In total, discharge occurs after a week in the absence of complications.
Immediately after liver resection treatment is given to support the condition:
- Narcotic painkillers - Omnopon 2% - 2 ml or Morphine 1% - 1 ml. Analgesics are prescribed until they are no longer needed.
- Antibiotics - more often in the form of droppers, less often intramuscularly to prevent infection.
- Infusion therapy for removing intoxication, replenishing mineral s alts, replenishing BCC - Ringer's solution, Rheosorbilact, glucose.
- If there was a noticeable blood loss during the operation, thrombo-erythrocyte mass and plasma with albumin are infused.
- For the prevention of thrombosis, anticoagulants are administered - Heparin, Fraxiparin.
Late postoperative period
At this time, the patient has already come to his senses and received the necessary analgesics, the condition is improvinggradually and the topic of diet arises.
Reviews of liver resection talk about severe pain after surgery and the importance of diet. The patient and his relatives must be prepared for the fact that any food and even water will cause vomiting within a week. Therefore, the emphasis is on parenteral nutrition in the form of droppers, which ends when food is allowed.
There are few patients who can eat on the 2nd or 3rd day after surgery. The patient should gradually begin to eat with pleasure, and not through force, as many relatives try to impose.
There will be no harm from getting, for example, broth into the stomach, but it will end with vomiting, from which the seams may open.
Post-operative care in the hospital
The first "golden" rule of such care is keeping bed and underwear clean. They need to be changed every 3 days.
The second indispensable moment of rehabilitation is the care of the stitches. Bandages should not be touched even after washing hands, germs can only die from antiseptic treatment, not soap.
The patient's clothes should not be folded, but slightly stretched - this must be monitored. The room must be ventilated regularly, regardless of the weather.
Some relatives buy modern antiseptic sprays in pharmacies. Their use in the hospital does not matter. But self-treatment with an antiseptic dries the skin and it is more quickly populated by microbes.
Possible Complications
They can be played by:
- occurrence of internal bleeding;
- air entering the hepatic veins and their rupture;
- reaction to anesthesia in the form of cardiac arrest;
- wound infection;
- vomiting and nausea;
- hypoglycemia;
- liver failure.
These are all quick complications, and long-term complications are rare as the liver regenerates. It is worth noting that old age slows down the recovery process.
Factors that increase the rate of complications
The latter can be triggered by smoking, diabetes, existing chronic liver diseases (cholestasis, cirrhosis), alcohol consumption before or after surgery.
Innovative surgical techniques
Today, in addition to classical methods, the latest technologies such as ultrasound, laser and electroresection are used.
FUS (High Frequency Focused Ultrasound) technology is popular. This is the Cavitron apparatus, which aspirates excised tissues and destroys them at the same time. It also simultaneously “welds” the cut vessels.
High-energy green laser - removes neoplasms and metastases by evaporation method.
Nanoknife - removes the affected tissue at the cellular level. The advantage is that the vessels are not damaged.
Know-how of hepatic surgery – Da Vinci operating robot. The operation is non-traumatic, performed by the manipulators of a robotic surgeon, under the control of a tomograph. The specialist is shown on the screen in a three-dimensional form the entire course of the operation, the robot is controlled remotely. Complications insuch operations are minimal.
Resection for metastases
In theory, patients with metastases are not operated on. Why? Liver resection for metastases is futile by all world standards.
What can she give? The difficulty is that it is impossible to remove metastases, a person dies from them, and the tumor continues to grow in the body for a long time. In other words, life will not last.
Moreover, the body weakens after the operation and oncopathology will be aggravated. And for liver resection with metastases, there are already other contraindications: cachexia, myocardial infarction, etc.
Patient after surgery for liver cancer
Liver cancer is irreversible, regardless of the stage, since all the most important functions of the body are reduced. Such patients come out of anesthesia longer and harder.
Often after the operation, the patient begs for help, complaining of severe pain, although analgesics are administered in advance for all operations. But this does not mean a deterioration in the condition, these are the so-called residual effects of the operation. Relatives should not panic and look for a nurse, demanding to add analgesics. This is a due fact - in a few hours a person will forget about unbearable pain.
Moreover, you do not need to buy painkillers and give the patient yourself. This is without comment.
Today, to relieve postoperative pain, a catheter is inserted into the spinal cord (in the lumbar region), followed by a dosed injection of analgesics.
It is much more useful if relatives monitor the patient's breathing, which can stop if he falls asleepafter operation. You also need to control the color of the skin: if it starts to darken, you need to urgently call a doctor.
As the wound heals, the doctor prescribes chemotherapy or radiation therapy.
Homecare
After discharge, it remains special:
- Regular dressings as recommended by the doctor;
- washing is possible only after the wound has healed;
- analgesics are also dosed by the doctor;
- Scheduled medical check-ups are required.
Improvement after liver resection a person begins to feel only after a month.
When hospitalization is needed
After discharge, urgent medical attention is necessary if:
- edema and hyperemia of the wound, protrusion in the incision area, temperature;
- vomiting and nausea for more than 2 days;
- severe abdominal pain;
- shortness of breath and chest pain;
- swelling on the legs;
- blood in urine and frequent painful urination;
- weakness and dizziness.
Rehab
Rehabilitation after liver resection consists of several points:
- diet;
- moderate exercise;
- reviewing lifestyle and taking hepatoprotectors.
Diet food
Diet and liver resection largely determine their relationship. Fractional food, at least 6 times a day. This does not allow too much load on the gastrointestinal tract. It is forbidden to eat fatty foods, spicy, muffins and sweets, alcohol.
Nutrition should be balanced in terms of BJU, a diet after liver resection is prescribed anddiscussed with the doctor.
Physical activity
Heavy sports, running and jumping are contraindicated, because they increase intra-abdominal pressure. Breathing exercises and walks are shown, which will saturate the body with oxygen.
The main thing is to raise and strengthen the immune system. For this, doctors recommend taking vitamin and mineral complexes. They contain antioxidants and resveratrol. Herbal immunostimulants are also beneficial.
Any treatment is controlled by a doctor, independent actions are unacceptable.
Usually such measures are sufficient. But sometimes this is not enough in elderly patients after chemotherapy.
Then vegetable hepatoprotectors come to the rescue: Heptral, LIV-52, Essentiale, Karsil, folic acid, Galstena. They will help restore the liver faster.
