Fard-Aghaie M H, Stern L, Ghadban T, Apostolova I, Lehnert W, Klutmann S, Hackert T, Izbicki J R, Li J, von Kroge P H, Heumann A
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Langenbecks Arch Surg. 2024 Mar 11;409(1):92. doi: 10.1007/s00423-024-03280-5.
Posthepatectomy liver failure (PHLF) remains a life-threatening complication after hepatectomy. To reduce PHLF, a preoperative assessment of liver function is indispensable. For this purpose, Tc-mebrofenin hepatobiliary scintigraphy with SPECT (MSPECT) can be used. The aim of the current study was to evaluate the predictive value of MSPECT for PHLF in patients with non-colorectal liver tumors (NCRLT) compared to patients with colorectal liver metastasis (CRLM) undergoing extended liver resection.
We included all patients undergoing extended liver resections via two-stage procedures between January 2019 and December 2021 at the University Medical Center Hamburg-Eppendorf, Germany. All patients received a preoperative MSPECT.
Twenty patients were included. In every fourth patient, PHLF was observed. Four patients had PHLF grade C. There were no differences between patients with CRLM and NCRLT regarding PHLF rate and future liver remnant (FLR) volume. Patients with CRLM had higher mebrofenin uptake in the FLR compared to those with NCRLT (2.49%/min/m vs. 1.51%/min/m; p = 0.004).
Mebrofenin uptake in patients with NCRLT was lower compared to those patients with CRLM. However, there was no difference in the PHLF rate and FLR volume. Cut-off values for the mebrofenin uptake might need adjustments for different surgical indications, surgical procedures, and underlying diseases.
肝切除术后肝衰竭（PHLF）仍然是肝切除术后危及生命的并发症。为降低PHLF的发生率，术前肝功能评估必不可少。为此，可采用锝-美罗芬宁肝胆动态显像联合单光子发射计算机断层扫描（MSPECT）。本研究的目的是评估与接受扩大肝切除的结直肠癌肝转移（CRLM）患者相比，MSPECT对非结直肠癌肝肿瘤（NCRLT）患者PHLF的预测价值。
我们纳入了2019年1月至2021年12月期间在德国汉堡-埃彭多夫大学医学中心接受两阶段扩大肝切除术的所有患者。所有患者均接受了术前MSPECT检查。
共纳入20例患者。每4例患者中就有1例发生PHLF。4例患者为C级PHLF。CRLM患者和NCRLT患者在PHLF发生率和未来肝残余量（FLR）方面无差异。与NCRLT患者相比，CRLM患者的FLR中美罗芬宁摄取率更高（2.49%/min/m对1.51%/min/m；p = 0.004）。
与CRLM患者相比，NCRLT患者的美罗芬宁摄取率较低。然而，PHLF发生率和FLR体积并无差异。美罗芬宁摄取率的临界值可能需要根据不同的手术适应证、手术方式和基础疾病进行调整。
