评估肝脏储备以指导肝切除术：我的做法。

Assessment of hepatic reserve for indication of hepatic resection: how I do it.

作者信息

Lee Wei-Chen, Chen Miin-Fu

机构信息

Department of General Surgery, Chang-Gung Memorial Hospital and Chang-Gung Medical School, 5 Fu-Hsing Street, Kwei-Shan Hsiang, Taoyuan, Taiwan, China.

出版信息

J Hepatobiliary Pancreat Surg. 2005;12(1):23-6. doi: 10.1007/s00534-004-0947-y.

DOI:10.1007/s00534-004-0947-y

PMID:15754095

Abstract

BACKGROUND/PURPOSE: Hepatic resection may result in liver failure in patients with cirrhotic livers. Preoperative evaluation of liver function in cirrhotic patients, to prevent postoperative liver failure, is very important.

METHODS

Sixteen patients with hepatocellular carcinoma in cirrhotic livers were enrolled in this study. Liver function was determined quantitatively by monoethylglycinexylidide (MEGX) formation from the metabolism of lidocaine. The whole liver volume and tumor volume were measured by computed tomographic volumetry. The volume of resected liver was recorded by water displacement. The relationship between liver function and remnant liver volume was determined.

RESULTS

A relationship between the percentage remnant liver volume and ratio of MEGX formation after hepatectomy was found. The regression equation was: (postoperative MEGX formation/preoperative MEGX formation) x 100% = (0.688 x percentage remnant liver volume + 0.179) x 100% (r (2) = 0.49). A relationship between MEGX formation after hepatectomy and the international ratio (INR) of prothrombin time was also found. The regression equation was INR = 1.99 - 0.01 x MEGX (r (2) = 0.30).

CONCLUSIONS

Post-hepatectomy liver function can be estimated for an individual patient by the appropriate regression equations. Prevention of post-hepatectomy liver failure for patients with cirrhotic livers is feasible.

摘要

背景/目的：肝切除可能导致肝硬化患者出现肝衰竭。术前评估肝硬化患者的肝功能以预防术后肝衰竭非常重要。

方法

本研究纳入了16例肝硬化肝脏合并肝细胞癌的患者。通过利多卡因代谢产生单乙基甘氨酰二甲苯胺（MEGX）来定量测定肝功能。采用计算机断层扫描容积法测量全肝体积和肿瘤体积。通过水置换法记录切除肝脏的体积。确定肝功能与残余肝体积之间的关系。

结果

发现肝切除术后残余肝体积百分比与MEGX生成率之间存在关系。回归方程为：（术后MEGX生成量/术前MEGX生成量）×100% =（0.688×残余肝体积百分比 + 0.179）×100%（r² = 0.49）。还发现肝切除术后MEGX生成与凝血酶原时间的国际标准化比值（INR）之间存在关系。回归方程为INR = 1.99 - 0.01×MEGX（r² = 0.30）。