Surgical Critical Unit, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
PLoS One. 2018 Sep 17;13(9):e0204163. doi: 10.1371/journal.pone.0204163. eCollection 2018.
We investigated whether chronological changes in portal flow and clinical factors play a role in the liver regeneration (LR) process after right donor-hepatectomy.
Participants in this prospective study comprised 58 donors who underwent right donor-hepatectomy during the period February 2014 to February 2015 at a single medical institution. LR was estimated using two equations: remnant left liver (RLL) growth (%) and liver volumetric recovery (LVR) (%). Donors were classified into an excellent regeneration (ER) group or a moderate regeneration (MR) group based on how their LR on postoperative day 7 compared to the median value.
Multivariate analysis revealed that low residual liver volume (OR = .569, 95% CI: .367- .882) and high portal venous velocity in the immediate postoperative period (OR = 1.220, 95% CI: 1.001-1.488) were significant predictors of LR using the RLL growth equation; high portal venous velocity in the immediate postoperative period (OR = 1.325, 95% CI: 1.081-1.622) was a significant predictor of LR using the LVR equation. Based on the two equations, long-term LR was significantly greater in the ER group than in the MR group (p < .001).
Portal venous velocity in the immediate postoperative period was an important factor in LR. The critical time for short-term LR is postoperative day 7; it is associated with long-term LR in donor-hepatectomy.
本研究旨在探讨术后门静脉流量的时间变化和临床因素是否在右半肝供肝者肝切除术后肝再生(LR)过程中起作用。
本前瞻性研究纳入了 2014 年 2 月至 2015 年 2 月期间在一家医疗机构接受右半肝供肝者肝切除术的 58 名供者。使用两种方程估计 LR:残余左肝(RLL)生长(%)和肝体积恢复(LVR)(%)。根据术后第 7 天的 LR 与中位数的比较,将供者分为优秀再生(ER)组或中等再生(MR)组。
多变量分析显示,低残余肝体积(OR=0.569,95%CI:0.367-0.882)和术后即刻高门静脉流速(OR=1.220,95%CI:1.001-1.488)是使用 RLL 生长方程预测 LR 的显著因素;术后即刻高门静脉流速(OR=1.325,95%CI:1.081-1.622)是使用 LVR 方程预测 LR 的显著因素。基于这两种方程,ER 组的长期 LR 明显大于 MR 组(p<0.001)。
术后即刻门静脉流速是 LR 的一个重要因素。短期 LR 的关键时间是术后第 7 天,它与供肝者肝切除术后的长期 LR 有关。