The liver is the most important treatment laboratory in the body, performing about 500 functions at a time. She 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 is purified through the parenchyma). Further, the purified blood is sent to the heart and lungs, where O2 is enriched.
And also the body participates 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.
Liver pathologies require special attention, because 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 all liver diseases. The resection is well tolerated, and the rehabilitation period is up to six months.
A bit of anatomy to understand resection
The liver is covered with a capsule and has 2 lobes: large right and small left. The first consists of 2 more shares - tailed and square.
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, since it prevents blood loss and does not violate the formation of bile.
The liver has 2 surfaces: diaphragmatic and visceral. On the first is a bed for the gallbladder, and the gate of the liver, the latter includes the hepatic artery and portal vein, bile vessels and hepatic veins exit.
Indications for resection
A liver resection operation is prescribed if there are:
- any mechanical damage;
- benign formations - adenomas, hemagiomas, etc .;
- abnormalities of the development of the organ;
- malignant tumors of any degree, if the parenchyma is not completely affected;
- for liver transplantation;
- cyst;
- treatment of liver metastases from colon cancer and other distant organs;
- echinococcosis;
- stones in the hepatic bile ducts;
- liver abscesses ;
- Caroli's disease is a congenital pathology in which the bile ducts are cystically dilated.
Of these, the most terrible is liver cancer. About it will be discussed below.
With other pathologies, the cure after surgery is complete. The only problem is that in the early stages, diagnosis is difficult, because the liver does not have nerve pain receptors and does not give 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 the patient's benefit, because hepatic pathologies tend to progress.
Diagnostics
When planning an intervention, a complete examination of the patient with the use of blood and urine tests, blood biochemistry, a standard set for hepatitis, HIV and PB is necessary.
Ultrasound, CT are mandatory - they evaluate the size and condition of the liver. If cancer is suspected, blood is donated to tumor markers.
Varieties of operation
There are two main types of surgical intervention: central and atypical.
A central or typical resection of the liver is the removal of its part, taking into account the lobar structure of the organ, this is a more convenient option for the patient and surgeon. During such an operation, it is possible to remove adjacent segments without touching the others, so liver function does not suffer.
To remove sites allocate:
- Segmentectomy - 1 segment is excised.
- Sectionectomy - excision of several segments.
- Hemihepatectomy - resection of the liver lobe.
- Mesohepatectomy - excision of the central sections.
- Extended hemihepatectomy - the lobe + segment is removed.
Even if only one segment is left, the liver will continue to work and the formation of bile is not disturbed.
Atypical resection
With atypical resection of the liver, it is not the structure of the organ that is taken into account, but the localization of the lesion.
The operation has subspecies:
- Edge resection - excision of a part of an organ from the edge.
- Wedge - resection is performed in a pyramid.
- Flat - excision of an organ site from the upper surface.
- Transverse - resection of the lateral regions.
With atypical resection, there is more profuse bleeding and malfunctioning of individual segments. Recovery of the liver at the same time occurs gradually, if there are healthy areas.
Other types of operations
There are several other types of liver surgery:
- Cavitary excision of the organ site with a scalpel.
- Radiofrequency ablation is laparoscopic removal in which radiofrequency radiation is used instead of a scalpel.
- Chemoembolization - used only for oncological processes in the liver in the early stages of the development of the disease. Cytostatics and chemotherapeutic agents are introduced into the segmental vessel of the affected area, which prevent the tumor from growing and kill its cells. So that the drugs do not come out of the vessel and act for a long time, it is clogged with an embolizing agent.
- Alcoholization - the introduction into the organ segment percutaneously (percutaneously) of 95% alcohol, which destroys the pathological focus. The process is monitored by ultrasound.
There is also a combined resection, when along with the liver, any organ of the abdominal cavity is removed. This is usually done with metastases.
The operation itself is carried out by 2 types of access:
- Laparoscopic resection of the liver - the surgeon makes 3-4 incisions on the front wall of the abdomen 2-3 cm in advance. Sensors and instruments are inserted through them. Most often used to remove liver stones.
- Laparotomy method - a large area of the abdomen is cut.
Narcosis
In abdominal surgery, endotracheal anesthesia with mechanical ventilation. Intravenously, sedatives are additionally administered.
When using a radiofrequency knife, spinal anesthesia, which makes the lower body insensitive and the patient does not feel pain. Anesthetic is injected into the lumbar spine.
With chemoembolization and alcoholization, local anesthesia.
Preparation for the operation
Before the operation, in addition to a thorough and comprehensive examination, for a week you need to refuse to take blood-thinning medications - Aspirin, Cardiomagnyl, and others - to exclude the occurrence of bleeding.
The course of abdominal surgery with a scalpel
After a layer-by-layer incision of the skin and abdominal muscles, an audit of the liver and ultrasound is performed to determine the size of the lesion. Parts affected by the disease are excised, ducts that remove bile and blood vessels are ligated.
Resection of the liver as a whole lasts as long as about 3-7 hours, after which the patient is sent to intensive care for a day. An ultrasonic sensor is used to monitor the removal. The remaining blood is removed from the abdominal cavity by suction (aspiration). The liver is poured with an antiseptic, which is also aspirated and only then the wound is sutured by applying staples.
No seams are placed at the resection site; drainage tubes are installed here. They help remove excess blood and transudate.
Postoperative period
In the intensive care unit, sensors are connected to the patient to monitor the pulse and pressure. Temperature and general condition are controlled.
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 prescribed to support the condition:
- Narcotic painkillers - Omnopon 2% - 2 ml or Morphine 1% - 1 ml. Analgesics are prescribed until the moment when they are no longer needed.
- Antibiotics - often in the form of droppers, less often in / muscle to prevent infection.
- Infusion therapy to relieve intoxication, replenish mineral salts, replenish bcc - ringer Ringer, Reosorbilact, glucose.
- If during the operation there was a noticeable loss of blood, the 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 improves gradually and the topic of diet arises.
Reviews of liver resection indicate severe pain after surgery and the importance of diet. The patient and his relatives should 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 end when food intake is allowed.
There are few patients who can eat on the 2nd – 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, the broth into the stomach, but it will end with vomiting, from which the stitches can scatter.
Postoperative hospital care
The first “golden” rule of this care is to keep the bedding and underwear clean. They must be changed every 3 days.
The second indispensable moment of rehabilitation is the care of the sutures. You can’t touch the bandages even after washing your hands, microbes can die only from treatment with an antiseptic, and not soap.
The clothes of the patient should not be folded, but be slightly stretched - this should be monitored. The room must be ventilated regularly, regardless of the weather.
Some relatives buy modern antiseptics-sprays in pharmacies. Their use in the hospital does not matter. But an independent additional treatment with an antiseptic dries the skin and it is quickly inhabited by microbes.
Possible complications
Their roles may include:
- the 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.
All these are 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 percentage of complications
The latter can be triggered by smoking, diabetes, existing chronic liver diseases (cholestasis, cirrhosis), alcohol consumption before or after surgery.
Innovative Surgery Techniques
Today, in addition to classical methods, the latest technologies are used, such as ultrasound, laser and electroresection.
Popular technology is FUS (focused high-frequency ultrasound). This is the Cavitron apparatus, which aspirates excised tissues and simultaneously destroys them. And also produces “welding” of the cut vessels.
High-energy green laser - removes neoplasms and metastases by evaporation.
Nanodear - removes affected tissue at the cellular level. The plus is that the vessels are not damaged.
The know-how of liver surgery is the 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 displayed on the screen in three-dimensional form the entire course of the operation, the robot is remotely controlled. Complications in such an operation are minimal.
Metastatic resection
In theory, patients with metastases are not operated on. Why? Resection of the liver with metastases is unpromising by all international 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 surgery and oncopathology will be aggravated. And for liver resection with metastases, there are already other contraindications: cachexia, myocardial infarction, etc.
Patient after surgery with liver cancer
Liver cancer is irreversible regardless of stage, since all the most important functions of the body are reduced. Such patients come out of anesthesia longer and harder.
Often after surgery, the patient begs for help, complaining of severe pain, although analgesics for all operations are administered in advance. But this does not mean deterioration, it is the so-called residual effects of the operation. Relatives should not panic and seek a nurse, demanding the addition of analgesics. This is a necessary fact - in a few hours a person will forget about unbearable pain.
Moreover, you do not need to buy painkillers and give them to the patient. This is no comment.
Today, to relieve postoperative pain, a catheter (in the lumbar region) is inserted into the spinal cord, followed by dosed administration of analgesics.
It is much more useful if relatives monitor the patient’s breathing, which may stop if they fall asleep after surgery. And you also need to control the color of the skin: if it starts to get dark, you need to urgently call a doctor.
With the onset of wound healing, the doctor prescribes chemo- or radiation therapy.
Home care
After discharge, he remains special:
- according to the doctor’s recommendations, dressings are regularly performed;
- washing is possible only after wound healing;
- analgesics are also dosed by a doctor;
- A scheduled examination by a doctor is required.
Improvement after resection of the liver, a person begins to feel only after a month.
When hospitalization is needed
After discharge, urgent medical attention is necessary if:
- swelling and hyperemia of the wound, protrusion in the incision, temperature;
- vomiting and nausea for more than 2 days;
- severe abdominal pain;
- shortness of breath and chest pain;
- swelling on the legs;
- blood in the urine and frequent painful urination;
- weakness and dizziness.
Rehabilitation
Rehabilitation after resection of the liver consists of several points:
- diet;
- moderate sports activities;
- lifestyle changes and hepatoprotectors.
Diet food
Diet and liver resection largely determine their relationship. Fractional food, at least 6 times a day. This does not overload the gastrointestinal tract. It is forbidden to eat fatty foods, spicy foods, pastries and sweets, alcohol.
Nutrition should be balanced in terms of BZHU, diet after liver resection is prescribed and discussed with the doctor.
Physical activity
Heavy sports, running and jumping are contraindicated, because they increase intra-abdominal pressure. Showing breathing exercises and walks that will saturate the body with oxygen.
The main thing is to raise and strengthen the immune system. For this, doctors recommend taking vitamin-mineral complexes. They contain antioxidants and resveratrol. And also plant immunostimulants are beneficial.
Any treatment is controlled by a doctor, independent actions are unacceptable.
Usually such measures are enough. But sometimes this, it turns out, is not enough in elderly patients after chemotherapy.
Then plant hepatoprotectors come to the rescue: Heptral, LIV-52, Essential, Karsil, folic acid, Galstena. They will help restore the liver faster.