Department of Surgery, Jichi Medical University, Shimotsuke 329-0498, Tochigi, Japan.
World J Gastroenterol. 2022 Oct 14;28(38):5614-5625. doi: 10.3748/wjg.v28.i38.5614.
Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.
To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma (HCC).
We reviewed the medical records of 199 patients who underwent resection of HCC. Hepatic clearance of the remnant liver was calculated using fusion images of Tc-labelled galactosyl-human serum albumin liver scintigraphy and computed tomography. Posthepatectomy liver failure (PHLF) was classified according to the International Study Group of Liver Surgery. Complications was classified according to Clavien-Dindo classification. We analyzed by the risk factors for PHLF, morbidity and mortality with multivariate analysis.
Twenty-seven (30%) patients had major complications and 23 (12%) developed PHLF. The incidence of major complications increased with increasing albumin-bilirubin (ALBI) grade. The area under the curve values for hepatic clearance of the remnant liver, liver to heart-plus-liver radioactivity at 15 min (LHL15), and ALBI score predicting PHLF were 0.868, 0.629, and 0.655, respectively. The area under the curve for hepatic clearance of the remnant liver, LHL15, and ALBI score predicting major complications were 0.758, 0.594, and 0.647, respectively. The risk factors for PHLF and major complications were hepatic clearance of the remnant liver and intraoperative bleeding.
The measurement of hepatic clearance may predict PHLF and major complications for patients undergoing resection of HCC.
评估残余肝脏的功能储备对于降低发病率和死亡率非常重要。
评估肝细胞癌（HCC）患者残余肝脏的功能储备。
我们回顾了 199 例接受 HCC 切除术患者的病历。使用 Tc 标记半乳糖基人血清白蛋白肝脏闪烁扫描和计算机断层扫描的融合图像来计算残余肝脏的肝清除率。根据国际肝脏外科研究小组的标准对术后肝功能衰竭（PHLF）进行分类。并发症根据 Clavien-Dindo 分类进行分类。我们通过多变量分析来分析 PHLF、发病率和死亡率的危险因素。
27 例（30%）患者出现严重并发症，23 例（12%）发生 PHLF。白蛋白-胆红素（ALBI）分级越高，严重并发症的发生率越高。残余肝脏肝清除率、肝脏至心脏加肝脏放射性活度在 15 分钟时（LHL15）和 ALBI 评分预测 PHLF 的曲线下面积值分别为 0.868、0.629 和 0.655。残余肝脏肝清除率、LHL15 和 ALBI 评分预测严重并发症的曲线下面积值分别为 0.758、0.594 和 0.647。预测 PHLF 和严重并发症的危险因素是残余肝脏的肝清除率和术中出血。
残余肝脏肝清除率的测定可能预测 HCC 切除术患者的 PHLF 和严重并发症。
