Shah Amit, Goffette Pierre, Hubert Catherine, Lerut Jan, Van Beers Bernard Be, Annet Laurence, Sempoux Christine, Gigot Jean-François
Department of Abdominal Surgery and Transplantation, Saint-Luc University Hospital, Université Catholique de Louvain, Hippocrate Avenue, 10, 1200 Brussels, Belgium.
Hepatogastroenterology. 2011 Jan-Feb;58(105):109-14.
BACKGROUND/AIMS: Even though preoperative portal vein embolization (PVE) can lead to hypertrophy of the future liver remnant (FLR) in candidates with small remnant liver prior to anticipated major hepatic resection, quantification of FLR after PVE is important to ensure adequate hepatic reserve in order to avoid postoperative hepatic failure. This study aims to determine the accuracy and reliability of three commonly used FLR quantification methods by correlating their ability to detect postoperative hepatic failure. The role of the degree of liver hypertrophy (DLH) in this context was also explored.
The records of 98 consecutive patients considered for PVE prior to major hepatic resections were reviewed retrospectively. Out of these 98 patients, 66 patients who underwent major liver resection after PVE were included in the present study. Pre- and post-PVE FLR volume and volumes of other liver segments were studied using MRI scans. The three FLR quantification methods employed were: (A) the estimation of the Total Liver Volume (TLV) directly by MRI; (B) by indirect estimation of TLV from patients' body surface area; and (C) by indirect estimation of TLV by patients' body weight. The difference of pre- and post-FLR% determined the DLH by all three methods. Receiver-operator characteristic (ROC) curve analysis was used to demonstrate the efficacy of the three methods in predicting postoperative hepatic failure (HF).
The assessment of FLR% by method B was significantly better (p < 0.005) than by method A. However, there was no significant difference among these two methods in determining the DLH. Ten out of 66 patients developed postoperative HF and 8 patients recovered. From the ROC curves plotted to demonstrate efficacy in predicting postoperative HF, it was evident that all three methods were comparable due to small FLR%, all methods having a significant predictability. The DLH also had significant predictability for postoperative HF but there was significant inverse correlation between the DLH and the pre-FLR%.
All 3 methods were equally efficient in predicting postoperative hepatic failure. The DLH assay alone should not be used to predict postoperative hepatic failure but should be used in conjunction with FLR%.
背景/目的：尽管术前门静脉栓塞术（PVE）可使预期进行大型肝切除手术且残余肝脏较小的患者的未来肝脏残余量（FLR）增大，但对PVE术后的FLR进行量化对于确保足够的肝储备以避免术后肝衰竭至关重要。本研究旨在通过关联三种常用的FLR量化方法检测术后肝衰竭的能力，来确定其准确性和可靠性。同时还探讨了肝肥大程度（DLH）在此背景下的作用。
回顾性分析98例拟行大型肝切除术前接受PVE的连续患者的病历。在这98例患者中，66例在PVE后接受大型肝切除的患者被纳入本研究。使用MRI扫描研究PVE前后的FLR体积以及其他肝段的体积。采用的三种FLR量化方法为：（A）通过MRI直接估计全肝体积（TLV）；（B）根据患者体表面积间接估计TLV；（C）根据患者体重间接估计TLV。三种方法通过术前和术后FLR%的差值来确定DLH。采用受试者操作特征（ROC）曲线分析来证明这三种方法预测术后肝衰竭（HF）的效能。
方法B对FLR%的评估显著优于方法A（p < 0.005）。然而，在确定DLH方面，这两种方法之间没有显著差异。66例患者中有10例发生术后HF，8例康复。从绘制的用于证明预测术后HF效能的ROC曲线来看，由于FLR%较小，很明显所有三种方法具有可比性，所有方法都具有显著的预测性。DLH对术后HF也具有显著的预测性，但DLH与术前FLR%之间存在显著的负相关。
所有三种方法在预测术后肝衰竭方面同样有效。单独的DLH测定不应被用于预测术后肝衰竭，而应与FLR%结合使用。
