Yano Koichi, Nanashima Atsushi, Fujii Yoshiro, Hiyoshi Masahide, Imamura Naoya, Hamada Takeomi, Tsuchimochi Yuki, Wada Takashi, Mizutani Yoichi, Hirai Toshinori
Departments of aSurgery, Division of Hepato-Biliary-Pancreas Surgery bRadiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Nucl Med Commun. 2017 Aug;38(8):701-707. doi: 10.1097/MNM.0000000000000702.
Recently, posthepatectomy complications have been predicted by advances of new liver functional parameters, and the technetium-99m-galactosyl human serum albumin (GSA) liver scintigraphy has been applied widely for this purpose. We evaluated the clinical significance of the regional maximal removal rate (GSA-Rmax) in patients with various liver diseases as predictors of posthepatectomy complications.
Between 2012 and March 2016, we examined 200 patients who underwent hepatectomy for liver and biliary diseases. The patients' background liver conditions included chronic viral liver diseases in 147 patients, normal liver in 44 patients, and others in nine patients. Hepatectomy-related postoperative complications (i.e. long-term ascites, intra-abdominal infection, and hepatic failure) occurred in 69 (35%) patients. A multivariate logistic analysis was carried out to detect the predictive parameters for complications.
The median and mean preoperative GSA-Rmax was 0.420 and 0.448±0.148 mg/min, respectively. The GSA-Rmax was significantly correlated with liver functional parameters of ICGR15, LHL15, HH15, platelet count, prothrombin activity, and serum hyaluronic acid level (P<0.01), and was significantly correlated with postoperative total bilirubin level and C-reactive protein level (P<0.05). With respect to patient outcomes, GSA-Rmax was significantly lower in patients with long-term ascites (P<0.05). The predictive cutoff value for posthepatectomy long-term ascites for GSA-Rmax was 0.421 mg/min. However, the multivariate logistic regression analysis identified that a higher serum hyaluronic acid level and a lower platelet count were significant, independent factors, but not lower GSA-Rmax.
GSA-Rmax is one of the liver functional parameters and is a complementary parameter to predict postoperative hyperbilirubinemia, inflammatory responses, and ascites when Tc-GSA scintigraphy is performed.
近年来，新的肝功能参数进展已可用于预测肝切除术后并发症，99m锝-半乳糖基人血清白蛋白（GSA）肝脏闪烁扫描术已广泛应用于此目的。我们评估了不同肝脏疾病患者的区域最大清除率（GSA-Rmax）作为肝切除术后并发症预测指标的临床意义。
2012年至2016年3月期间，我们检查了200例行肝脏和胆道疾病肝切除术的患者。患者的基础肝脏状况包括147例慢性病毒性肝病患者、44例正常肝脏患者和9例其他患者。69例（35%）患者发生了与肝切除相关的术后并发症（即长期腹水、腹腔内感染和肝衰竭）。进行多因素逻辑回归分析以检测并发症的预测参数。
术前GSA-Rmax的中位数和平均值分别为0.420和0.448±0.148mg/min。GSA-Rmax与ICGR15、LHL15、HH15、血小板计数、凝血酶原活性和血清透明质酸水平的肝功能参数显著相关（P<0.01），并与术后总胆红素水平和C反应蛋白水平显著相关（P<0.05）。关于患者预后，长期腹水患者的GSA-Rmax显著降低（P<0.05）。GSA-Rmax预测肝切除术后长期腹水的临界值为0.421mg/min。然而，多因素逻辑回归分析确定，较高的血清透明质酸水平和较低的血小板计数是显著的独立因素，而不是较低的GSA-Rmax。
GSA-Rmax是肝功能参数之一，是在进行Tc-GSA闪烁扫描时预测术后高胆红素血症、炎症反应和腹水的补充参数。
