tailieunhanh - An Internist’s Illustrated Guide to Gastrointestinal Surgery - part 7

đáp ứng các biến chứng đã nói ở trên. Điều quan trọng là nhận ra rằng các mô hoại tử không cần phải bị nhiễm bệnh để gây hội chứng này. Một quét CT thu được trong 10 d đầu tiên sau khi cryoablation có thể được gây hiểu lầm trong vấn đề này bởi vì nó có thể hiển thị không khí | 202 Taggert and Whalen response in addition to the complications noted above. It is important to realize that the necrotic tissue need not be infected to provoke this syndrome. A CT scan obtained in the first 10 d after a cryoablation may be misleading in this regard because it can show air even in a normally resorbing cryolesion 12 . Another particular complication of cryoablation and RFA is the accidental unrecognized ablation of a structure abutting the liver while the ablation lesion within the liver is being carefully and safely monitored with ultrasound. The structures at risk for this complication are the diaphragm and lung the gallbladder the hepatic flexure of the colon duodenum and any adherent small intestine. After a significant hepatic resection the liver begins to regenerate within 12-36 h 2 4 13-15 . This blessed event is often heralded by a precipitous drop in serum phosphorus and an exacerbation of the mild hepatic insufficiency which accompanies removal of a large amount of functional liver. The reason is that hepatocytes use large amounts of ATP as their task changes from differentiated hepatic synthetic and excretory function to cell division 13 16 . It is important to keep the patient hydrated during this period to replete phosphorus and not let the prothrombin time get too prolonged 16 sec because that may lead to a delayed bleed in the operative field. The hepatic insufficiency is usually mild and transitory clearing by postoperative day 5. The most feared liver-specific complication following hepatectomy is liver failure. This can be provoked straightforwardly by removing or devascularizing too much functional tissue. It can also develop more insidiously in the postoperative period when the liver fails to regenerate. The reasons why this happens are varied. Infection is certainly one culprit and occult infections should be sought and aggressively treated if the problem develops. Hepatotoxic drugs are another cause. Therefore the patient s .