肝切除术后 99mTc-半乳糖白蛋白闪烁扫描测定残肝功能性储备的自然病程。

Natural course of the remnant hepatic functional reserve as estimated by technetium-99m-galactosyl human serum albumin scintigraphy after a hepatectomy.

机构信息

Division of Gastroenterological and General Surgery, Department of Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.

出版信息

J Gastroenterol. 2010 Mar;45(3):308-16. doi: 10.1007/s00535-009-0144-5. Epub 2009 Nov 7.

DOI:10.1007/s00535-009-0144-5

PMID:19894018

Abstract

BACKGROUND

Technetium-99m-galactosyl human serum albumin (GSA) scintigraphy provides an accurate estimation of the hepatic functional reserve but is not applied after a hepatectomy. The aim of this study was to elucidate the natural course of the remnant hepatic functional reserve (RHFR) after hepatectomy by GSA scintigraphy.

METHODS

Eighty-six patients (partial hepatic resection, Hr0 = 46; sectionectomy, Hr1 = 21; bisectionectomy, Hr2 = 19) classified as Child-Pugh class A before the hepatectomy were enrolled, and GSA scintigraphy to detect HH15 (uptake ratio of the heart at 15 min to that at 3 min) and LHL15 (uptake ratio of the liver at 15 min to the liver plus the heart at 15 min) was performed periodically before and after the hepatectomy. HH15, LHL15, and the percentages of patients that recovered to the preoperative levels of these entities were estimated. In addition, hematobiochemical tests and the remnant liver volume were also periodically monitored.

RESULTS

HH15 and LHL15 levels deteriorated until 2 months postoperatively (PO) after the procedure and subsequently recovered to the preoperative levels at 6 months PO in Hr0 patients. In Hr1 patients, but not in Hr2 patients, these levels also deteriorated until 3 months PO and had improved by 6 months after the surgery. Only 40% of the patients showed recovery to the preoperative levels by 6 months PO in the Hr0 group; furthermore, the percentage of patients who showed recovery to the preoperative levels by 6 months PO was under 40% in the Hr1 group and around 10% in the Hr2 group. However, the results of hematobiochemical tests and the remnant liver volume in all types of hepatectomies were rapidly normalized after the hepatectomy.

CONCLUSIONS

Remnant hepatic functional reserve estimated by GSA scintigraphy revealed that a larger resected liver volume induced both more serious and continued remnant hepatic dysfunction in comparison to results shown by hematobiochemical tests, while the functional regeneration was also appreciably slower and more gradual in comparison to the volume regeneration.

摘要

背景

锝-99m 半乳糖白蛋白（GSA）闪烁扫描术可准确估计肝储备功能，但不适用于肝切除术后。本研究旨在通过 GSA 闪烁扫描术阐明肝切除术后残余肝储备功能（RHFR）的自然病程。

方法

共纳入 86 例患者（部分肝切除术，Hr0=46 例；节段切除术，Hr1=21 例；半肝切除术，Hr2=19 例），这些患者在肝切除术前均被归类为 Child-Pugh 分级 A 级。所有患者在肝切除术前和术后均行 GSA 闪烁扫描术以检测 HH15（15 分钟时心脏与 3 分钟时的摄取比）和 LHL15（15 分钟时肝脏与肝脏加心脏的摄取比）。估计 HH15、LHL15 和恢复至术前水平的患者百分比。此外，还定期监测血液生化学检查和残余肝体积。

结果

HH15 和 LHL15 水平在术后 2 个月（PO）内恶化，随后在 6 个月 PO 时恢复至术前水平。在 Hr0 患者中，这些水平在 3 个月 PO 时再次恶化，而在 Hr1 患者中，这些水平在 6 个月 PO 时恢复至术前水平。在 Hr0 组中，仅 40%的患者在 6 个月 PO 时恢复至术前水平；此外，在 Hr1 组中，40%的患者在 6 个月 PO 时恢复至术前水平，而在 Hr2 组中，这一比例约为 10%。然而，所有类型肝切除术后的血液生化学检查和残余肝体积结果均在术后迅速恢复正常。