Cai Hao, Zhu Xiao-Dong, Li Xiao-Long, Shen Ying-Hao, Huang Cheng, Shi Guo-Ming, Tang Min, Wu Dong, Deng Min, Sun Hui-Chuan
Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, 200032, China; Department of Transplantation, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, 200032, China.
Surgeon. 2022 Dec;20(6):e416-e422. doi: 10.1016/j.surge.2022.02.004. Epub 2022 Mar 10.
Major hepatectomy is associated with high incidence of post-hepatectomy liver failure (PHLF). This study aimed to evaluate the effect of future remnant liver volume combined with liver function tests on predicting PHLF.
Patients who underwent major hepatectomy from April 2009 to May 2017 were enrolled in the training cohort. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors of PHLF and generate a logistic regression model for the prediction of PHLF. A conditional inference tree was generated based on the optimal cutoff value of independent predictive factors of PHLF. The precedent results were validated in an independent cohort from June 2017 to March 2018.
One hundred and eighteen patients were included in the training cohort, while another 34 in the validation cohort. Future remnant liver volume/estimated standard total liver volume (FLV/eTV) and preoperative platelet count were independent predictive factors of PHLF (P = 0.0021 and P = 0.012, respectively). The conditional inference tree showed that patients with FLV/eTV ≤0.56 and PLT count ≤145 × 10/L were at high risk of developing PHLF.
FLV/eTV combined with preoperative PLT count is effective in predicting PHLF after major hepatectomy.
肝大部切除术与肝切除术后肝功能衰竭（PHLF）的高发生率相关。本研究旨在评估未来残余肝体积联合肝功能检查对预测PHLF的作用。
将2009年4月至2017年5月接受肝大部切除术的患者纳入训练队列。进行单因素和多因素逻辑回归分析以确定PHLF的独立危险因素，并生成用于预测PHLF的逻辑回归模型。基于PHLF独立预测因素的最佳截断值生成条件推断树。先前的结果在2017年6月至2018年3月的独立队列中得到验证。
训练队列纳入118例患者，验证队列纳入34例患者。未来残余肝体积/估计标准全肝体积（FLV/eTV）和术前血小板计数是PHLF的独立预测因素（分别为P = 0.0021和P = 0.012）。条件推断树显示，FLV/eTV≤0.56且血小板计数≤145×10/L的患者发生PHLF的风险较高。
FLV/eTV联合术前血小板计数可有效预测肝大部切除术后的PHLF。
Zotero 插件