Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
J Hepatobiliary Pancreat Sci. 2010 Nov;17(6):871-8. doi: 10.1007/s00534-010-0281-5. Epub 2010 Apr 9.
BACKGROUND/PURPOSE: To prevent or reduce hepatic complications after hepatectomy, it is important to employ preoperative predictive parameters and to determine the indications for hepatectomy. In the present study, we evaluated risk parameters in patients who underwent hepatectomy between 1994 and 2003, and selected three parameters to modify the surgical indications. Using these indications before surgery in patients who underwent hepatectomy between 2004 and 2008, we compared the prevalences of postoperative complications in the the two groups of patients.
We examined 250 consecutive patients who underwent hepatectomy for liver disease [149 in 1994-2003 (termed the early period) and 101 in 2004 to 2008 (termed the later period)].
In the early period, uncontrolled ascites was observed in 55 patients and hepatic failure was observed in 15 of the 149 patients. Multivariate analysis identified volume of the resected liver (> or =50%), intraoperative blood loss (> or =1500 ml), prothrombin activity (<70%), hyaluronic acid level (> or =200 ng/ml), and LHL15 (hepatic uptake ratio of technetium-99m galactosyl human serum albumin ((99m)Tc-GSA) (<0.85) as risk factors; the latter three parameters were evaluated as predictors of outcome. From 2004, we used these three parameters, in addition to the indocyanine green retention rate at 15 min (ICGR15), as criteria for indications for hepatectomy. Despite the lower prevalence of normal liver in the later period, comparisons showed decreases in the rates of uncontrolled ascites (23 vs. 37%, P = 0.03), hepatic failure (4 vs. 10%, P = 0.12), and hepatic complications (25 vs. 44%, P = 0.003) in patients in the later period compared with these rates in the previous period.
The use of prothrombin activity, and levels of hyaluronic acid and LHL15, as parameters of functional liver reserve in the selection of candidates for surgery reduced the incidence of hepatic complications after hepatectomy.
背景/目的：为了预防或减少肝切除术后的肝脏并发症，使用术前预测参数并确定肝切除术的适应证非常重要。在本研究中，我们评估了 1994 年至 2003 年间接受肝切除术的患者的风险参数，并选择了三个参数来修改手术适应证。在 2004 年至 2008 年间接受肝切除术的患者中，我们在术前使用这些适应证，并比较了两组患者术后并发症的发生率。
我们检查了 250 例连续接受肝切除术治疗肝脏疾病的患者[1994-2003 年（早期）的 149 例，2004 年至 2008 年（晚期）的 101 例]。
在早期，55 例患者存在无法控制的腹水，149 例患者中有 15 例出现肝功能衰竭。多变量分析确定了切除肝脏的体积（≥50%）、术中出血量（≥1500ml）、凝血酶原活动度（<70%）、透明质酸水平（≥200ng/ml）和 LHL15（锝-99m 半乳糖白蛋白（99m）Tc-GSA）的肝脏摄取率（<0.85）作为危险因素；后三个参数被评估为预后的预测因素。从 2004 年开始，我们将这三个参数以及 15 分钟时的吲哚菁绿滞留率（ICGR15）作为肝切除术适应证的标准。尽管晚期患者正常肝脏的患病率较低，但与早期相比，晚期患者无法控制的腹水（23%对 37%，P=0.03）、肝功能衰竭（4%对 10%，P=0.12）和肝并发症（25%对 44%，P=0.003）的发生率均降低。
在选择手术候选人时，使用凝血酶原活性以及透明质酸和 LHL15 水平作为功能性肝储备的参数，降低了肝切除术后肝并发症的发生率。
