Departments of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.
HPB (Oxford). 2010 Mar;12(2):139-46. doi: 10.1111/j.1477-2574.2009.00151.x.
Liver failure has remained a major cause of mortality after hepatectomy, but it is difficult to predict preoperatively. This study describes the introduction into clinical practice of the new LiMAx test and provides an algorithm for its use in the clinical management of hepatic tumours.
Patients with hepatic tumours and indications for hepatectomy were investigated perioperatively with the LiMAx test. In one patient, analysis of liver volume was carried out with preoperative three-dimensional virtual resection.
A total of 329 patients with hepatic tumours were evaluated for hepatectomy. Blinded preoperative LiMAx values were significantly higher before resection (n= 139; mean 351 microg/kg/h, range 285-451 microg/kg/h) than before refusal (n= 29; mean 299 microg/kg/h, range 223-376 microg/kg/h; P= 0.009). In-hospital mortality rates were 38.1% (8/21 patients), 10.5% (2/19 patients) and 1.0% (1/99 patients) for postoperative LiMAx of <80 microg/kg/h, 80-100 microg/kg/h and >100 microg/kg/h, respectively (P < 0.0001). A decision tree was developed to avoid critical values and its prospective preoperative application revealed a reduction in mortality from 9.4% to 3.4% (P= 0.019).
The LiMAx test can validly determine liver function capacity and is feasible in every clinical situation. Combination with virtual resection could enable the calculation of residual liver function. The LiMAx decision tree algorithm for hepatectomy might significantly improve preoperative evaluation and postoperative outcome in liver surgery.
肝衰竭仍然是肝切除术后死亡的主要原因，但很难在术前预测。本研究描述了新的 LiMAx 试验在临床实践中的引入，并提供了一种用于肝肿瘤临床管理的算法。
对有肝肿瘤并需要肝切除术的患者进行 LiMAx 试验的围手术期检查。在一位患者中，术前进行了三维虚拟切除的肝脏体积分析。
对 329 例肝肿瘤患者进行了肝切除术评估。术前 LiMAx 值（n=139；平均值 351μg/kg/h，范围 285-451μg/kg/h）明显高于术前拒绝手术者（n=29；平均值 299μg/kg/h，范围 223-376μg/kg/h；P=0.009）。术后 LiMAx 值<80μg/kg/h、80-100μg/kg/h 和>100μg/kg/h 的患者住院死亡率分别为 38.1%（21 例中的 8 例）、10.5%（19 例中的 2 例）和 1.0%（99 例中的 1 例）（P<0.0001）。开发了一个决策树来避免临界值，前瞻性术前应用表明死亡率从 9.4%降至 3.4%（P=0.019）。
LiMAx 试验可以有效地确定肝功能能力，并且在每种临床情况下都是可行的。与虚拟切除相结合，可以计算剩余肝功能。LiMAx 决策树算法用于肝切除术可能会显著改善肝外科的术前评估和术后结果。
