Truant Stéphanie, Baillet Clio, Deshorgue Anne Claire, El Amrani Mehdi, Huglo Damien, Pruvot François-René
Department of Digestive Surgery and Transplantation, Hôpital HURIEZ, Rue M. Polonovski, CHU, Univ Nord de France, 59000, Lille, France.
Department of Nuclear Medicine, Hôpital HURIEZ, Lille, France.
Updates Surg. 2017 Sep;69(3):411-419. doi: 10.1007/s13304-017-0481-5. Epub 2017 Aug 9.
To reduce post-hepatectomy liver failure (PHLF), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients with a limited future remnant liver (FRL). Nevertheless, high morbi-mortality rates have been reported . The current study aimed to analyze the kinetics of FRL function in patients who were offered ALPPS. Serial SPECT (99 m)Tc-mebrofenin hepatobiliary scintigraphy (HBS) was performed in all patients before and after surgery as well as at inter-stage to quantitatively assess hepatic function [total liver (TL) and FRL]. Patients were offered ALPPS for colorectal liver metastases (CLMs) (n = 6) and gallbladder carcinoma (n = 1). The data of delta of function or volume, expressed as (postoperative FRL - preoperative FRL/preoperative FRL) were compared to those derived from HBS of patients referred to the university hospital of Lille for one-stage major hepatectomy (n = 93). Additionally, the intrinsic liver function (i.e. function per unit of volume) was used to assess the regeneration rate. All but one patient had an anticipated FRL to body weight ratio (FRLBWR) ≤0.5%. Inter-stages HBS showed a progressive attenuation of the functional value of the excluded hepatic segments in favour of the FRL for all patients. Overall, there was a drop of total liver function contrasting with subnormal passive biochemical tests. Notably, the increase in FRL function between ALPPS stages [+12.5% (4.2-28.6%)] was lower than the volumetric gain [+42.6% (18.3-110.2%)] and inferior to that observed after one-stage major hepatectomy [+41.7% (-38.6 to +158.33%)]. This resulted in a drop of the FRL intrinsic liver function in ALPPS patients, of whom one died from PHLF. Our study enhances the importance of assessing liver function along with volume during ALPPS procedure and supports HBS as a suitable and reliable method, including a valuable contribution to determine most appropriate stage 2 surgical timing.
为降低肝切除术后肝衰竭（PHLF）的发生率，最近针对未来残余肝（FRL）有限的患者开发了联合肝脏分割和门静脉结扎分期肝切除术（ALPPS）。然而，已有报道称其具有较高的病死亡率。本研究旨在分析接受ALPPS治疗的患者FRL功能的动力学变化。在所有患者手术前后以及分期手术期间均进行了连续的SPECT（99m）Tc-美布芬宁肝胆闪烁显像（HBS），以定量评估肝功能[全肝（TL）和FRL]。患者接受ALPPS治疗的原因包括结直肠癌肝转移（CLMs）（n = 6）和胆囊癌（n = 1）。将功能或体积变化量的数据[表示为（术后FRL - 术前FRL）/术前FRL]与转诊至里尔大学医院接受一期大肝切除术的患者（n = 93）的HBS数据进行比较。此外，使用肝脏固有功能（即单位体积的功能）来评估再生率。除1例患者外，所有患者的预期FRL与体重比（FRLBWR）≤0.5%。分期手术期间的HBS显示，所有患者被切除肝段的功能值逐渐衰减，而FRL的功能值则逐渐增加。总体而言，全肝功能下降，与被动生化检查结果低于正常水平形成对比。值得注意的是，ALPPS分期之间FRL功能的增加[+12.5%（4.2 - 28.6%）]低于体积增加[+42.6%（18.3 - 110.2%）]，且低于一期大肝切除术后观察到的增加幅度[+41.7%（-38.6至+158.3%）]。这导致ALPPS患者FRL的肝脏固有功能下降，其中1例患者死于PHLF。我们的研究强调了在ALPPS手术过程中评估肝功能和体积的重要性，并支持HBS作为一种合适且可靠的方法，包括对确定最合适的二期手术时机具有重要贡献。
