Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany; Semmelweis University of Medicine, Asklepios Campus Hamburg, Germany.
Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany; Semmelweis University of Medicine, Asklepios Campus Hamburg, Germany.
Surgery. 2022 Sep;172(3):926-932. doi: 10.1016/j.surg.2022.04.022. Epub 2022 May 21.
Associating liver partition and portal vein ligation for staged hepatectomy induces rapid and effective hypertrophy of the future liver remnant to prevent postoperative liver failure. The aim of this study was to determine cofactors, including sarcopenia, influencing the kinetic growth rate, and subsequently future liver remnant, in terms of safety, complications, and posthepatectomy liver failure.
Patients undergoing associating liver partition and portal vein ligation for staged hepatectomy between 2010 and 2020 were included in this study. Kinetic growth rate was defined as the quotient of the degree of hypertrophy and the time interval between the 2 steps. The sarcopenia muscle index was defined as the skeletal muscle area of both psoas major muscles normalized to the patient's height.
During the study period, 90 patients underwent associating liver partition and portal vein ligation for staged hepatectomy. The association between kinetic growth rate and posthepatectomy liver failure indicates a significant nonlinear effect (P = .02). The incidence of posthepatectomy liver failure significantly increased at a kinetic growth rate below 7% per week (31%) compared to patients with a kinetic growth rate >7%/wk (7%, P = .02). In patients with a low kinetic growth rate (<7%/wk), the sarcopenia muscle index was significantly lower compared to patients with a high kinetic growth rate (>7%/wk). Furthermore, a low sarcopenia muscle index and a high body mass index turned out to be independent risk factors for a low kinetic growth rate.
After the first step of the associating liver partition and portal vein ligation for staged hepatectomy procedure, a low kinetic growth rate (<7%/wk) increases the risk of posthepatectomy liver failure. The presence of a low sarcopenia muscle index and a high body mass index are profoundly correlated with clinically substantial impaired liver regeneration, which can result in increased liver dysfunction after associating liver partition and portal vein ligation for staged hepatectomy.
联合肝脏离断和门静脉结扎的分阶段肝切除术可使未来肝残存量迅速而有效地增大，从而防止术后肝衰竭。本研究的目的是确定包括肌肉减少症在内的多种因素对动力学生长速率的影响，以及对安全性、并发症和术后肝衰竭的影响。
本研究纳入了 2010 年至 2020 年间接受联合肝脏离断和门静脉结扎的分阶段肝切除术的患者。动力学生长速率定义为两次手术之间的肝残存量与时间间隔的商。肌肉减少症肌肉指数定义为双侧腰大肌的骨骼肌面积与患者身高的比值。
在研究期间，90 例患者接受了联合肝脏离断和门静脉结扎的分阶段肝切除术。动力学生长速率与术后肝衰竭之间存在显著的非线性关系（P=0.02）。动力学生长速率低于 7%/周（31%）的患者与动力学生长速率高于 7%/周（7%）的患者相比，术后肝衰竭的发生率显著增加（P=0.02）。在动力学生长速率较低（<7%/周）的患者中，肌肉减少症肌肉指数明显低于动力学生长速率较高的患者（>7%/周）。此外，低肌肉减少症肌肉指数和高身体质量指数是动力学生长速率较低的独立危险因素。
在联合肝脏离断和门静脉结扎的分阶段肝切除术的第一阶段之后，低动力学生长速率（<7%/周）增加了术后肝衰竭的风险。低肌肉减少症肌肉指数和高身体质量指数的存在与明显的临床肝再生受损密切相关，这可能导致联合肝脏离断和门静脉结扎的分阶段肝切除术后肝功能障碍增加。
