Stockmann Martin, Bednarsch Jan, Malinowski Maciej, Blüthner Elisabeth, Pratschke Johann, Seehofer Daniel, Jara Maximilian
Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
Department of Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
HPB (Oxford). 2017 Nov;19(11):1016-1025. doi: 10.1016/j.hpb.2017.07.010. Epub 2017 Aug 23.
Since perioperative morbidity and mortality in ALPPS are extraordinarily high, a deeper understanding of actual liver function during the procedure is essential to make the approach safer.
Data from 17 patients who underwent ALLPS were analyzed regarding their course of liver function capacity assessed with the LiMAx test and compared to an equal-sized matched cohort of patients that underwent PVE.
A comparison of LiMAx prior to and following ALPPS Step I (330 [258-385] vs. 197 [144-224] μg/kg/h, p = 0.003) and prior to and following PVE (386 [330-519] vs. 378 [336-455] μg/kg/h, p = 0.534) demonstrated a significant drop in function after ALLPS. A volume/function analysis predicting FLR function regarding step II revealed an excellent correlation of predicted versus assessed postoperative liver function with a mean relative difference of 9 (-6 to 18)% and an ICC of 0.905 (123 [74-138] vs. 107 [77-175] μg/kg/h, p = 0.310).
We provide evidence that liver function capacity is significantly impaired due to ALPPS step I. This is particularly notable when compared to PVE. Our data also shows that the portal ligated liver lobe still continues to contribute significantly to overall liver function. Therefore, FLR function after step II is still predictable by volume/function analysis.
由于联合肝脏分隔和门静脉结扎的二步肝切除术（ALPPS）围手术期的发病率和死亡率极高，深入了解手术过程中的实际肝功能对于使该手术方法更安全至关重要。
分析了17例行ALPPS患者的肝功能数据，这些数据通过LiMAx试验评估其肝功能变化过程，并与同等规模的接受门静脉栓塞术（PVE）的匹配患者队列进行比较。
比较ALPPS第一步前后的LiMAx（330[258 - 385]与197[144 - 224]μg/kg/h，p = 0.003）以及PVE前后（386[330 - 519]与378[336 - 455]μg/kg/h，p = 0.534），结果显示ALPPS后肝功能显著下降。关于第二步预测未来肝残余量（FLR）功能的体积/功能分析表明，预测的术后肝功能与评估的术后肝功能具有良好的相关性，平均相对差异为9（-6至18）%，组内相关系数（ICC）为0.905（123[74 - 138]与107[77 - 175]μg/kg/h，p = 0.310）。
我们提供的证据表明，ALPPS第一步会显著损害肝功能。与PVE相比，这一点尤为明显。我们的数据还表明，门静脉结扎的肝叶仍对整体肝功能有显著贡献。因此，第二步后的FLR功能仍可通过体积/功能分析进行预测。
