Tanoue Yukinori, Nanashima Atsushi, Yano Koichi, Fujii Yoshirou, Hiyoshi Masahide, Imamura Naoya, Hamada Takeomi, Ikenoue Makoto, Wada Takashi, Mizutani Yoichi, Hirai Toshinori
Departments of Surgery, Division of Hepato-Biliary-Pancreas Surgery.
Department of Surgical Oncology, Nagasaki University School of Biomedical Sciences, Nagasaki, Japan.
Nucl Med Commun. 2019 Feb;40(2):145-152. doi: 10.1097/MNM.0000000000000950.
The relationship between posthepatectomy complications and liver functional parameters was preliminary reported in a pilot study. The present study sequentially evaluated the clinical significance of maximal removal rate of technetium-99m-galactosyl human serum albumin (GSARmax) in the future remnant liver (rGSARmax) in patients to predict posthepatectomy complications.
Between 2010 and August 2017, GSARmax, rGSARmax, their difference (Dif), and the rGSARmax to GSARmax ratio were examined in 247 additional patients who underwent hepatectomy for liver and biliary diseases. Hepatectomy-related postoperative complications (i.e. long-term ascites, intra-abdominal infection, and hepatic failure) occurred in 73 (29.6%) patients.
The median and mean preoperative GSARmax values were 0.477 and 0.498±0.166 mg/min, respectively; rGSARmax values were 0.341 and 0.366±0.145 mg/min, respectively; Dif values were 0.105 and 0.132±0.111 mg/min, respectively; and the rGSARmax to GSARmax ratio values were 0.774 and 0.746±0.177, respectively. Among these, the GSARmax and rGSARmax values were significantly correlated with the liver functional parameters ICGR15, LHL15, HH15, prothrombin activity, serum hyaluronic acid level, and platelet count (all P<0.01). The rGSARmax values were significantly lower in patients with long-term ascites (P<0.05), and the predictive cutoff values of rGSARmax were 0.290 mg/min; however, the multivariate logistic regression analysis showed that rGSARmax was not independently related to long-term ascites.
When accompanied by other functional liver reserve parameters, rGSARmax seemed to be an alternative liver functional parameter related to ascites.
在一项初步研究中初步报道了肝切除术后并发症与肝功能参数之间的关系。本研究连续评估了未来残余肝中锝-99m-半乳糖基人血清白蛋白最大清除率（GSARmax）（rGSARmax）对预测肝切除术后并发症的临床意义。
2010年至2017年8月期间，对另外247例因肝脏和胆道疾病接受肝切除术的患者进行了GSARmax、rGSARmax、它们的差值（Dif）以及rGSARmax与GSARmax的比值检查。73例（29.6%）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）。
术前GSARmax的中位数和平均值分别为0.477和0.498±0.166mg/min；rGSARmax值分别为0.341和0.366±0.145mg/min；Dif值分别为0.105和0.132±0.111mg/min；rGSARmax与GSARmax的比值分别为0.774和0.746±0.177。其中，GSARmax和rGSARmax值与肝功能参数ICGR15、LHL15、HH15、凝血酶原活性血清透明质酸水平和血小板计数显著相关（均P<0.01）。长期腹水患者的rGSARmax值显著较低（P<0.05），rGSARmax的预测临界值为0.290mg/min；然而，多因素逻辑回归分析显示rGSARmax与长期腹水无独立相关性。
当与其他肝功能储备参数同时存在时，rGSARmax似乎是一个与腹水相关的替代肝功能参数。
