Neethirajan Saravanan Manickam, Rachapoodivenkata Raghavendra Rao
Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
National Institute of Gastroenterology and Liver Diseases, Hyderabad, India.
Ann Hepatobiliary Pancreat Surg. 2017 Feb;21(1):1-10. doi: 10.14701/ahbps.2017.21.1.1. Epub 2017 Feb 28.
BACKGROUNDS/AIMS: We intended to determine the role of the Oral glucose tolerance test (OGTT), in addition to volumetry, in preoperative assessment of patients undergoing liver resection.
This was a prospective study conducted at a tertiary care hospital, between February 2009 and February 2011. OGTT curve (parabolic/linear), linearity index (LI) and Parenchymal Hepatic Resection Rate (PHRR) were correlated with postoperative outcomes in terms of postoperative liver failure (PLF), by 50-50 criteria, morbidity, mortality and hospital stay.
Of the 33 patients included in the study, 23 (69.7%) patients underwent major liver resections. Hepatocellular carcinoma (30.3%) was the leading indication. The overall postoperative morbidity rate was 72.7%, but major complications occurred in 3 (9.1%) patients only. There was no 90-day mortality. The 50-50 criteria were met by 3 patients undergoing major resection. Significant correlation was noted between the linear OGTT curve and the overall hospital stay (12.1 days vs. 9.6 days in parabolic; =0.04). Patients with linear OGTT met the 50-50 criteria more often (18%) than those having a parabolic curve (4.5%; =0.25). Although the OGTT was more often linear with occurrence of morbidity (41.7% vs 11.1%), major morbidity (66.7% vs 30%) and PLF by 50-50 criteria (66.7% vs 30%), it was not statistically significant. The linearity index was marginally lower (0.9 vs 1.2) in the presence of major morbidity and PLF by 50-50 criteria.
Linear OGTT affects the PLF and major morbidity, therein impacting the hospital stay. OGTT LI and PHRR can help predict postoperative outcome for a given extent of liver resection.
背景/目的：我们旨在确定口服葡萄糖耐量试验（OGTT）除容积测量外，在肝切除患者术前评估中的作用。
这是一项于2009年2月至2011年2月在一家三级护理医院进行的前瞻性研究。OGTT曲线（抛物线形/线性）、线性指数（LI）和实质肝切除率（PHRR）与术后肝功能衰竭（PLF）、50-50标准下的发病率、死亡率和住院时间等术后结局相关。
在纳入研究的33例患者中，23例（69.7%）接受了大肝切除术。肝细胞癌（30.3%）是主要指征。总体术后发病率为72.7%，但仅3例（9.1%）患者发生了严重并发症。无90天死亡率。3例接受大切除的患者符合50-50标准。线性OGTT曲线与总体住院时间之间存在显著相关性（抛物线形为9.6天，线性为12.1天；P=0.04）。OGTT呈线性的患者比呈抛物线形的患者更常符合50-50标准（18%对4.5%；P=0.25）。尽管OGTT在发生发病率（41.7%对11.1%）、严重发病率（66.7%对30%）和50-50标准下的PLF（66.7%对30%）时更常呈线性，但差异无统计学意义。在存在严重发病率和50-50标准下的PLF时，线性指数略低（0.9对1.2）。
线性OGTT影响PLF和严重发病率，进而影响住院时间。OGTT LI和PHRR有助于预测给定肝切除范围的术后结局。
