一种预测肝切除术后肝功能储备的简易指标。

A Simple Index to Predict Liver Functional Reserve after Hepatectomy.

作者信息

Kudo Atsushi, Igari Toru, Kumagai Jiro, Ban Daisuke, Tanaka Shinji, Irie Takumi, Noguchi Norio, Nakamura Noriaki

出版信息

Hepatogastroenterology. 2014 May;61(131):712-6.

Abstract

BACKGROUND/AIMS: It is difficult to estimate the functional reserve of the liver required for safe hepatectomy in patients with severe chronic liver disease The aim of this study was to retrospectively construct simple model based on routine laboratory data to predict both early liver failure (ELF) and mortality from recurrence-free liver failure (MLF) as an index for late liver failure after hepatectomy.

METHODOLOGY

Between 2000 and 2004, 196 consecutive patients underwent curative hepatectomy, and data from 127 minor hepatectomies were included in this study.

RESULTS

Mean survival time was [mean (SD)] 1252 (670) days after hepatectomy. ELF and MLF were observed in 29 and 13 patients, respectively. PT%, TB, and direct bilirubin (DB) were the best predictors in patients with both ELF and MLF. PT% alone was the best predictor of ELF and MLF with area under ROC curves of 0.70 and 0.81, respectively. By using a preoperative PT% of ≤ 70, we could accurately predict ELF and MLF in 77% and 87% of patients, respectively. ICG-R15 could not accurately predict both ELF and MLF for any cut-off values.

CONCLUSIONS

Unlike ICG-R15, PT% is a simple noninvasive index for estimating liver functional reserve to predict both ELF and MLF.

摘要

背景/目的：对于严重慢性肝病患者，很难估计安全肝切除所需的肝脏功能储备。本研究的目的是基于常规实验室数据回顾性构建一个简单模型，以预测早期肝衰竭（ELF）和无复发生存期肝衰竭（MLF）导致的死亡率，将其作为肝切除术后晚期肝衰竭的指标。

方法

2000年至2004年期间，196例连续患者接受了根治性肝切除术，本研究纳入了127例小范围肝切除术的数据。

结果

肝切除术后平均生存时间为[均值（标准差）]1252（670）天。分别有29例和13例患者发生ELF和MLF。PT%、总胆红素（TB）和直接胆红素（DB）是ELF和MLF患者的最佳预测指标。单独PT%是ELF和MLF的最佳预测指标，ROC曲线下面积分别为0.70和0.81。术前PT%≤70时，我们分别能准确预测77%和87%患者的ELF和MLF。对于任何临界值，吲哚菁绿滞留率（ICG-R15）都不能准确预测ELF和MLF。