国际肝脏外科研究组提出的肝切除术后肝功能衰竭预测：99mTc-半乳糖基人血清白蛋白闪烁显像测定剩余肝功能。

Prediction of Posthepatectomy Liver Failure Proposed by the International Study Group of Liver Surgery: Residual Liver Function Estimation With 99mTc-Galactosyl Human Serum Albumin Scintigraphy.

出版信息

Clin Nucl Med. 2018 Feb;43(2):77-81. doi: 10.1097/RLU.0000000000001913.

DOI:10.1097/RLU.0000000000001913

Abstract

PURPOSE

The International Study Group of Liver Surgery (ISGLS) proposed a definition and grading system for posthepatectomy liver failure (PHLF). We evaluated the usefulness of residual liver function estimation using Tc-galactosyl human serum albumin (Tc-GSA) for the prediction of PHLF.

METHODS

Patients with liver tumors (n = 136) and scheduled for hepatectomy underwent Tc-GSA scintigraphy. Based on their imaging data, the maximal GSA removal rate (GSA-Rmax)was calculated using multicompartment analysis. We also calculated GSA-Rmax in the predicted residual liver (GSA-RL) whose volume was determined on computed tomography (CT) scans. We compared the age, sex, 15-minute indocyanine green retention rate; albumin, bilirubin, hyaluronic acid, and type 4 collagen levels; the Child-Pugh classification; residual liver volume; residual liver percentage; GSA-Rmax; and GSA-RL in patients with and without PHLF. Univariate and multivariate logistic analyses were used for statistical assessments.

RESULTS

Of 136 patients, 17 (12.5%) met the ISGLS criteria for PHLF (ISGLS-PHLF). There was a statistically significant difference in the age, albumin level, Child-Pugh classification, residual liver volume, residual liver percentage, GSA-Rmax, and GSA-RL between patients with and without PHLF. Based on multivariate analysis, GSA-RL and the residual liver volume were significant independent predictors of ISGLS-PHLF (P = 0.004 and P = 0.038, respectively). The odds ratio was 149423 for GSA-RL and 1.003 for the residual liver volume.

CONCLUSIONS

GSA-RL calculated using Tc-GSA scintigraphy was the most useful independent predictor for ISGLS-PHLF.

摘要

目的

国际肝脏外科学研究组（ISGLS）提出了一种用于肝切除术后肝功能衰竭（PHLF）的定义和分级系统。我们评估了使用 Tc-半乳糖基人血清白蛋白（Tc-GSA）评估残肝功能对 PHLF 的预测价值。

方法

136 例肝脏肿瘤患者行 Tc-GSA 闪烁显像。根据其影像数据，使用多室分析计算最大 GSA 清除率（GSA-Rmax）。我们还计算了基于计算机断层扫描（CT）确定的预测残余肝脏体积（GSA-RL）的 GSA-Rmax。我们比较了有和无 PHLF 患者的年龄、性别、15 分钟吲哚菁绿滞留率；白蛋白、胆红素、透明质酸和 4 型胶原水平；Child-Pugh 分级；残余肝体积；残余肝百分比；GSA-Rmax；和 GSA-RL。采用单因素和多因素逻辑回归分析进行统计学评估。

结果

136 例患者中，17 例（12.5%）符合 ISGLS 定义的 PHLF（ISGLS-PHLF）标准。有和无 PHLF 患者的年龄、白蛋白水平、Child-Pugh 分级、残余肝体积、残余肝百分比、GSA-Rmax 和 GSA-RL 存在统计学差异。多因素分析显示，GSA-RL 和残余肝体积是 ISGLS-PHLF 的独立显著预测因素（P = 0.004 和 P = 0.038）。GSA-RL 的比值比为 149423，残余肝体积的比值比为 1.003。