Mediterranean Institute for Transplantation and Advanced Specialized Therapies, University of Pittsburgh Medical Center, Palermo, Italy.
Liver Transpl. 2012 Aug;18(8):907-13. doi: 10.1002/lt.23450.
Early liver regeneration was studied in a series of 70 patients who underwent right hepatectomy for living donation between November 2004 and January 2010. Liver regeneration was evaluated with multidetector computed tomography (MDCT) at a mean of 61.07 days after surgery. Presurgical variables [eg, age, weight, height, body mass index (BMI), liver function tests, creatinine levels, platelet counts, international normalized ratio, and glucose levels] and variables detected with preoperative MDCT imaging [eg, main portal vein diameter, steatosis, original liver volume, and spleen volume (SV)] were investigated as potential predictors of liver regeneration. The future remnant liver volume (FRLV) was preoperatively calculated with a virtual surgical cut. Liver function tests and creatinine levels were recorded on the 30th postoperative day. In addition, the onset of postoperative complications occurring within 90 days of surgery was analyzed, and the complications were codified according to the 5 tiers of the Clavien-Dindo classification. In 26 of the 70 patients (37.14%), 100% or greater hepatic regeneration had occurred at 2 months. There was no association between the clinical outcome and the liver regeneration rate. A stepwise multiple regression analysis showed that a higher BMI (coefficient = 0.035, P < 0.0001) and preoperative parameters such as a smaller FRLV (coefficient = -0.002, P < 0.0001) and a greater SV/FRLV ratio (coefficient = 1.196, P < 0.0001) were predictors of greater liver regeneration.
我们对 2004 年 11 月至 2010 年 1 月期间接受活体右半肝切除术的 70 例患者进行了一系列早期肝再生研究。术后平均 61.07 天，采用多排螺旋 CT（MDCT）评估肝再生情况。术前变量（如年龄、体重、身高、体重指数（BMI）、肝功能检查、肌酐水平、血小板计数、国际标准化比值和血糖水平）和术前 MDCT 成像检测到的变量（如主门静脉直径、脂肪变性、原始肝体积和脾体积（SV））被认为是肝再生的潜在预测因子。通过虚拟手术切面对未来残肝体积（FRLV）进行术前计算。术后第 30 天记录肝功能检查和肌酐水平。此外，还分析了术后 90 天内发生的术后并发症的发病情况，并根据 Clavien-Dindo 分类的 5 个等级对并发症进行编码。在 70 例患者中的 26 例（37.14%）中，2 个月时肝再生达到 100%或更高。临床结果与肝再生率之间无相关性。逐步多元回归分析显示，较高的 BMI（系数=0.035，P<0.0001）和术前参数，如较小的 FRLV（系数=-0.002，P<0.0001）和较大的 SV/FRLV 比值（系数=1.196，P<0.0001）是肝再生较多的预测因子。
