Okabe Hirohisa, Beppu Toru, Hayashi Hiromitsu, Mima Kosuke, Nakagawa Shigeki, Kuroki Hideyuki, Imai Katsunori, Nitta Hidetoshi, Masuda Toshiro, Hashimoto Daisuke, Chikamoto Akira, Watanabe Masayuki, Ishiko Takatoshi, Yoshida Morikatsu, Yamashita Yasuyuki, Baba Hideo
Departments of aGastroenterological Surgery bDiagnostic Radiology, Graduate School of Life Sciences, Kumamoto University cDepartment of Multidisciplinary Treatment for Gastroenterological Cancer, Kumamoto University Hospital, Kumamoto, Japan.
Nucl Med Commun. 2014 May;35(5):478-83. doi: 10.1097/MNM.0000000000000075.
(99m)Tc-galactosyl human serum albumin (GSA) scintigraphy is helpful in estimating liver function and the extent of liver fibrosis. Estimation of the liver function necessary for evaluating hepatic resection damage may be difficult in patients with chronic liver damage because of the discrepancy between liver functional parameters. The aim of this study was to develop a classification system for liver function using indocyanine green retention rate at 15 min (ICG R15) and the ratio of uptake by the liver to that by the liver and the heart at 15 min (LHL15) in GSA scintigraphy for hepatic resection.
A total of 548 consecutive patients who underwent hepatectomy were enrolled in this study. On the basis of ICG R15 cutoff values, the corresponding LHL15 values were determined for rank classification. Postoperative outcomes were compared between patients who met the classification and those who did not.
Ranks were classified into four categories (rank, ICG R15 range, LHL15 range, minimum percentage of future liver remnant volume) - rank 1: ≤10%, ≥0.935, >35%; rank 2: ≤20%, ≥0.90, >60%; rank 3: ≤30%, ≥0.87, >80%; and rank 4: >30%, <0.87, >90%. Patients meeting each classification showed significantly better morbidity, mortality, postoperative prothrombin time (PT) activity, and total bilirubin value on day 5 compared with those who did not. In the ICG rank 2 group (n=249), patients with LHL rank 4 had significantly worse platelet count, PT activity, and histological fibrosis than those with LHL rank 1 despite similar ICG R15 values.
Rank classification can predict the safety of hepatic resection. LHL15 contributes to the classification by predicting histological liver fibrosis.
锝-99m半乳糖基人血清白蛋白（GSA）闪烁扫描有助于评估肝功能及肝纤维化程度。由于肝功能参数存在差异，对于慢性肝损伤患者，评估肝切除损伤所需的肝功能可能较为困难。本研究旨在利用吲哚菁绿15分钟滞留率（ICG R15）和GSA闪烁扫描中肝脏在15分钟时的摄取量与肝脏和心脏摄取量之比（LHL15），为肝切除建立一种肝功能分类系统。
本研究共纳入548例连续接受肝切除术的患者。根据ICG R15的截断值，确定相应的LHL15值进行等级分类。比较符合分类的患者与不符合分类的患者的术后结局。
等级分为四类（等级、ICG R15范围、LHL15范围、未来肝残余体积的最小百分比）——1级：≤10%，≥0.935，>35%；2级：≤20%，≥0.90，>60%；3级：≤30%，≥0.87，>80%；4级：>30%，<0.87，>90%。与不符合分类的患者相比，符合各分类的患者在术后第5天的发病率、死亡率、术后凝血酶原时间（PT）活性和总胆红素值均显著更好。在ICG 2级组（n = 249）中，尽管ICG R15值相似，但LHL 4级患者的血小板计数、PT活性和组织学纤维化程度明显比LHL 1级患者差。
等级分类可预测肝切除的安全性。LHL15通过预测肝脏组织学纤维化有助于进行分类。
