99mTc-GSA 闪烁显像和改良的白蛋白-胆红素评分可与 ICG 互补，预测肝切除术后肝功能衰竭。
99mTc-GSA scintigraphy and modified albumin-bilirubin score can be complementary to ICG for predicting posthepatectomy liver failure.
机构信息
Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, 501-1194, Japan.
出版信息
BMC Surg. 2024 Nov 1;24(1):342. doi: 10.1186/s12893-024-02624-8.
BACKGROUND
Posthepatectomy liver failure (PHLF) remains a severe complication after liver resection. This retrospective study investigated the correlation of three hepatic functional tests and whether 99mTc-galactosyl human serum albumin (99mTc-GSA) scintigraphy and modified albumin-bilirubin (ALBI) score are useful for predicting PHLF.
METHODS
This retrospective cohort study included 413 consecutive patients undergoing hepatectomies between January 2017 and December 2020. To evaluate preoperative hepatic functional reserve, modified ALBI grade, indocyanine green clearance (ICG-R15), and 99mTc-GSA scintigraphy (LHL15) were examined before scheduled hepatectomy. Based on a retrospective chart review, multivariable logistic regression analysis adjusted for confounding factors was performed to confirm that mALBI, ICG-R15, and LHL15 are independent risk factors for PHLF.
RESULTS
ICG-R15 and LHL15 were moderately correlated (r = - 0.61) but this correlation weakened when ICG-R15 was about ≥ 20. Weak correlations were observed between LHL15 and ALBI score (r = - 0.269) and ALBI score and ICG-R15 (r = 0.339). Of 413 patients, 66 (19%) developed PHLF (20 grade A, 44 grade B, 2 grade C). Multivariable logistic regression analyses, major hepatectomy (P < 0.001), mALBI grade (P = 0.01), ICG-R15 (P < 0.001), and Esophagogastric varices (P = 0.007) were significant independent risk factors for PHLF. Subgroup analysis showed that ICG-R15 < 19, major hepatectomy, and mALBI grade and ICG-R15 ≥ 19, major hepatectomy, LHL15, and Esophagogastric varices were significant independent risk factors for PHLF (P = 0.033, 0.017, 0.02, 0.02, and 0.001, respectively).
CONCLUSION
LHL15, the assessment of Esophagogastric varices, and mALBI grade are complementary to ICG-R15 for predicting PHLF risk.
背景
肝切除术后肝功能衰竭（PHLF）仍然是肝脏切除术后的严重并发症。本回顾性研究调查了三种肝功能试验的相关性，以及 99mTc-半乳糖白蛋白（99mTc-GSA）闪烁显像和改良白蛋白-胆红素（ALBI）评分是否有助于预测 PHLF。
方法
本回顾性队列研究纳入了 2017 年 1 月至 2020 年 12 月期间接受肝切除术的 413 例连续患者。为了评估术前肝储备功能，在预定肝切除术前检查了改良 ALBI 分级、吲哚氰绿清除率（ICG-R15）和 99mTc-GSA 闪烁显像（LHL15）。基于回顾性病历回顾，对混杂因素进行多变量逻辑回归分析，以确认 mALBI、ICG-R15 和 LHL15 是 PHLF 的独立危险因素。
结果
ICG-R15 和 LHL15 中度相关（r=−0.61），但当 ICG-R15 约≥20 时，这种相关性减弱。LHL15 与 ALBI 评分（r=−0.269）和 ALBI 评分与 ICG-R15（r=0.339）之间存在弱相关性。在 413 例患者中，有 66 例（19%）发生了 PHLF（20 级 A，44 级 B，2 级 C）。多变量逻辑回归分析显示，主要肝切除术（P<0.001）、mALBI 分级（P=0.01）、ICG-R15（P<0.001）和胃食管静脉曲张（P=0.007）是 PHLF 的显著独立危险因素。亚组分析显示，ICG-R15<19、主要肝切除术、mALBI 分级和 ICG-R15≥19、主要肝切除术、LHL15 和胃食管静脉曲张是 PHLF 的显著独立危险因素（P=0.033、0.017、0.02、0.02 和 0.001）。
结论
LHL15、胃食管静脉曲张的评估和 mALBI 分级与 ICG-R15 一起可用于预测 PHLF 风险。
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