The most common malignant tumor of the liver is hepatocellular carcinoma. Surgical resection is the preferred treatment option. Due to the combination of chronic liver disease and poor basic conditions of patients, there are many postoperative complications.
1.Postoperative bleeding: liver has two sets of blood supply systems, hepatic artery and portal vein. The causes of bleeding are.
(1) Patients mostly have cirrhosis and lack of coagulation factors, resulting in postoperative trauma bleeding. Adequate preoperative preparation is necessary, including preoperative hepatoprotection, vitamin K1, platelet transfusion, cold precipitation or fresh plasma if necessary. If traumatic bleeding is considered, supplemental coagulation factors, fibrinogen and hemostatic drugs can be given and most patients can be successfully treated conservatively.
(2) Vascular ligature line dislodgement, liver texture is soft, ligature line easily cut liver tissue, resulting in ligature line dislodgement, or the patient’s blood pressure fluctuation is too large and other factors roughly large vascular bleeding, the patient bleeding volume, conservative treatment effect is poor, if the patient’s physical condition can be, should actively surgical hemostasis, or interventional treatment.
(3) liver section part of the liver tissue necrosis, secondary infection, or patient subdiaphragmatic infection, mostly occur 3-5 days after surgery, late secondary infection, treatment is difficult, high mortality, so the emphasis on prevention, postoperative reasonable antibiotic application to a full course of treatment.
After surgery, the patient’s vital signs should be closely observed, whether the drainage tube is unobstructed, so that internal bleeding can be detected in a timely manner.
2. Liver failure: most patients with hepatocellular carcinoma are combined with hepatitis B cirrhosis and poor liver function. Some patients have cirrhosis loss of compensation before surgery, and although it can be corrected before surgery, patients are prone to acute liver failure after surgery. The manifestations are.
(1) hepatic encephalopathy, also known as hepatic coma, is the most characteristic manifestation of hepatic failure [1]. Initially, there are behavioral and personality changes, inability to answer questions correctly, decreased discrimination and computational ability, progressive development of excitement or drowsiness, fluttering tremor, EEG abnormalities, and finally coma.
(2) Jaundice starts with deepening of urine color, and soon appears as yellow staining of skin, mucous membranes and sclera, and rapidly deepens. The liver may shrink rapidly due to massive hepatocyte necrosis, and the hepatic turbid circles narrow on percussion, which can be further confirmed by B-type ultrasonography. There is a musty odor in the patient’s exhaled breath, i.e. liver odor, the intensity of which is consistent with the degree of hepatocyte necrosis.
(3) Bleeding may occur due to dysfunction of the liver in producing coagulation factors, activation of the coagulation system by endotoxemia, etc. Skin bleeding spots, petechiae, vomiting blood, blood in stool, epistaxis, etc.
(4) Cerebral edema and pulmonary edema may be related to inappropriate massive fluid replacement and hypoxia, which may easily cause brain herniation and respiratory failure.
(5) Ascites portal hypertension, decreased plasma albumin, and other factors may cause a small to moderate amount of ascites in 30% of patients.
In addition, serious complications such as secondary infection, hepatorenal syndrome, and shock can occur. Chronic liver failure occurs on the basis of chronic active liver disease, usually with various manifestations of the original chronic liver disease, and can occur gradually. Signs of liver failure can also appear suddenly during the course of the disease due to certain liver-damaging factors. The prognosis is poor and the mortality rate is high.
3, ascites: poor postoperative liver function, portal hypertension, hypoproteinemia and other reasons, resulting in the majority of patients postoperative ascites, ascites can lead to poor intestinal motility of patients, patients after eating fullness is not, poor diet aggravate the hypoproteinemia, so vicious circle. If the patient’s liver function is well compensated, more 1-2 weeks ascites disappears, the treatment is given with human albumin to correct the hypoproteinemia, while strengthening the meridian nutrition to break the vicious circle, so it is recommended that the patient can eat and then try to strengthen the diet, more protein-rich food, such as shrimp, fish, etc., economical, the patient recovers quickly.
4, subdiaphragmatic infection or abscess: inadequate postoperative drainage, resulting in exudate secondary infection, manifested by high fever, pain in the right quarter rib, accompanied by sepsis, feasible abdominal ultrasound examination, after confirming the diagnosis requires placement of drainage.
5, biliary fistula: mostly due to small bile duct leakage, or ligature wire detachment, manifested as postoperative drainage bile-like fluid drainage, small biliary fistula can heal on its own, large biliary fistula needs to be fully drained, and can be healed on its own, after 8 weeks of non-healing patients need to perform X-ray examination, and ERCP examination, if necessary, surgical treatment.
6. Pulmonary complications: pleural effusion, pulmonary atelectasis, and pneumonia are common. Encourage patients to cough and give nebulization treatment after surgery. Postoperative right pleural cavity can have reactive pleural effusion which can be absorbed by itself, bilateral pleural effusion is considered to be caused by hypoproteinemia.
7, gastrointestinal bleeding: patients more portal hypertensive gastric disease, postoperative emergence of emergency ulcers caused by preoperative and postoperative acid suppression therapy, but patients are mostly combined with esophagogastric fundic varices, should pay attention to the possibility of rupture bleeding, postoperative patients should avoid hard food, chew slowly.
Postoperative precautions
1, strengthen nutrition, low-fat diet, pay attention to avoid hard food.
2.Regular review, abdominal ultrasound and AFP review can be performed in the first period of 1 month, and if necessary, intensive CT examination of upper abdomen.
3.Recommend postoperative interventional therapy and radiofrequency ablation therapy to consolidate the postoperative treatment effect.
4.If the patient’s hepatitis B virus DNA test is high, give antiviral treatment.
5.Keep a positive and healthy attitude towards life.
6.Avoid liver-damaging drugs and diet, and abstain from drinking alcohol.
7, do not listen to small advertisements, Chinese medicine treatment requires regular hospital consultation, do not believe in prescriptions, etc., so as not to bring irreparable damage to your fragile liver.