• 摘要: 肝切除术是治疗肝脏外科疾病的重要手段。然而,肝细胞癌等疾病常合并肝实质损害,导致肝脏储备功能不同程度下降。肝切除术造成肝实质细胞损失、肝脏缺血再灌注损伤、剩余肝脏血流异常、手术创伤反应等,引发术后肝功能不全,成为患者围手术期死亡的重要原因。因此,术前准确评估肝脏储备功能,对于选择肝切除手术方式、制订围手术期处理方案、降低术后肝功能衰竭风险及促进患者术后康复至关重要。《肝切除术前肝脏储备功能评估的专家共识(2011版)》为肝切除术患者临床评估提供了重要参考,在临床上得到广泛应用。随着精准肝脏外科理念与范式的深入发展和精准肝切除技术的不断进步,该共识亟需更新,以进一步规范肝脏外科临床实践。中国研究型医院学会肝胆胰外科专业委员会和《中华消化外科杂志》编辑委员会组织相关专家,充分讨论,制订《围手术期肝脏储备功能评估专家共识(2025版)》,主要内容包括整合肝脏血液生化检测指标、肝脏综合评分系统、肝功能定量试验、影像技术及三维体积测量,形成多模态肝脏储备功能评估系统,并在此基础上修订肝切除安全限量决策系统。

     

    Abstract: Hepatectomy is an important treatment for hepatobiliary surgical diseases. However, diseases such as hepatocellular carcinoma are often complicated by parenchymal liver injury, resulting in varied degrees of impairment of liver reserve function. Factors such as hepatocyte loss caused by hepatectomy, hepatic ischemia‑reperfusion injury, abnormal blood flow in the residual liver, and surgical trauma response can induce postoperative liver dysfunction, which has become an important cause of perioperative death in patients. Therefore, accurate preoperative assessment of hepatic reserve function is crucial for selecting the surgical method of hepatectomy, formulating perioperative management plans, reducing the risk of postoperative liver failure, and promoting patients′ postoperative rehabilitation. The Expert consensus on preoperative assessment of liver reserve function for hepatectomy (2011 edition) has provided important references for the clinical evaluation of patients undergoing hepatectomy and been widely used in clinical practice. With the ongoing refinement of precision hepatobiliary surgical paradigms and the rapid evolution of precision hepatectomy techniques, an updated consensus is urgently warranted to further guide and stan-dardize clinical practice in hepatic surgery. Society for Hepato‑pancreato‑biliary Surgery of Chinese Research Hospital Association, Editorial Board of Chinese Journal of Digestive Surgery have organized relevant experts to conduct in‑depth discussions and formulate Expert consensus on perioperative assessment of liver reserve function (2025 edition). Its main contents include integrating liver functional test indicators, comprehensive liver scoring systems, quantitative liver function tests, imaging tech-nologies, and three‑dimensional volumetry to establish a multi-modal assessment system for evalua-ting liver reserve function. Based on this system, the decision‑making algorithm for determining the safe resection limits in hepatectomy is further refined and updated.

     

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