Kokudo Norihiro, Vera David R, Tada Keiichiro, Koizumi Mitsuru, Seki Makoto, Matsubara Toshiki, Ohta Hirotoshi, Yamaguchi Toshiharu, Takahashi Takashi, Nakajima Toshifusa, Muto Tetsuichiro
Department of Surgery, Cancer Institute Hospital, 1-37-1 Kami-Ikebukuro, Toshima-ku, Tokyo, Japan 170-8455.
World J Surg. 2002 Nov;26(11):1342-7. doi: 10.1007/s00268-002-6262-3. Epub 2002 Sep 26.
To test the clinical usefulness of hepatic asialogycoprotein receptor analysis in liver surgery, we have conducted univariate and multivariate analysis for the detection of cirrhotic patients and prediction of morbidity after hepatic resection. Liver scintigraphy using technetium 99m-labeled asialoglycoprotein analog (TcGSA), ICG test, and CT hepatic volumetry were undertaken in 158 surgical patients including 111 who underwent hepatic resection. Hepatic functional parameters including Child-Pugh score, indocyanine green retention at 15 minutes (ICG-R15), clearance index (HH15), receptor index (LHL15), receptor concentration ([R]0), total hepatic receptor amount (R0) and hepatic parenchymal volume (HPV) were compared among patients with normal, cirrhotic, and non-cirrhotic damaged liver. Preoperative hepatic functional parameters, resected parenchymal fraction (RPf), operative blood loss, and total receptor amount of the remnant liver (R0-remnant) were compared between patients with and without signs of postoperative liver failure. All parameters but HPV were significantly different among patients with normal, cirrhotic, and noncirrhotic damaged liver. The multivariate analysis selected two significant (p <0.05) parameters, [R]0 and Child-Pugh score for the detection of liver cirrhosis. Of the 111 patients who underwent resection, 14 developed transient signs of postoperative liver failure. Of the parameters tested, presence of liver cirrhosis, LHL15, R0, intraoperative blood loss, and R0-remnant were significantly different between patients with and without signs of postoperative liver failure (p <0.05). The multivariate logistic regression analysis selected only R0-remnant as a significant (p = 0.022) parameter for the prediction of liver failure. The morbidity rate in patients with R0-remnant under 0.05 mmoles was 100%, and the rate decreased in inverse proportion to R0-remnant. In conclusion, combining the ASGP-R concentration ([R]0) and the Child-Pugh score best detected liver cirrhosis in surgical candidates. Cirrhotic patients and patients with a low R0-remnant are at higher risk for postoperative liver failure. The present study confirms the usefulness of hepatic asialogycoprotein receptor analysis in liver surgery.
为了测试肝脏去唾液酸糖蛋白受体分析在肝脏手术中的临床实用性，我们对肝硬化患者的检测以及肝切除术后发病率的预测进行了单因素和多因素分析。对158例外科手术患者进行了使用锝99m标记的去唾液酸糖蛋白类似物（TcGSA）的肝脏闪烁扫描、吲哚菁绿试验（ICG试验）和CT肝脏容积测量，其中111例患者接受了肝切除术。比较了正常肝脏、肝硬化肝脏和非肝硬化受损肝脏患者的肝功能参数，包括Child-Pugh评分、15分钟吲哚菁绿潴留率（ICG-R15）、清除指数（HH15）、受体指数（LHL15）、受体浓度（[R]0）、肝脏总受体量（R0）和肝实质体积（HPV）。比较了有和没有术后肝衰竭迹象患者的术前肝功能参数、切除的实质部分比例（RPf）、术中失血量和残余肝脏的总受体量（R0-残余）。除HPV外，正常肝脏、肝硬化肝脏和非肝硬化受损肝脏患者的所有参数均有显著差异。多因素分析选择了两个显著（p<0.05）参数，即[R]0和Child-Pugh评分用于肝硬化的检测。在111例接受切除术的患者中，14例出现了术后肝衰竭的短暂迹象。在所测试的参数中，有和没有术后肝衰竭迹象的患者之间，肝硬化的存在、LHL15、R0、术中失血量和R0-残余有显著差异（p<0.05）。多因素逻辑回归分析仅选择R0-残余作为预测肝衰竭的显著（p = 0.022）参数。R0-残余低于0.05毫摩尔的患者发病率为100%，发病率与R0-残余成反比下降。总之，联合去唾液酸糖蛋白受体浓度（[R]0）和Child-Pugh评分能最好地检测手术候选者中的肝硬化。肝硬化患者和R0-残余低的患者术后肝衰竭风险更高。本研究证实了肝脏去唾液酸糖蛋白受体分析在肝脏手术中的实用性。
