基于肝储备正常患者的体重，评估未来肝残余体积以预测大肝切除术后肝衰竭的合适方法。

Appropriate methods of evaluating future liver remnant volume to predict postoperative liver failure after major hepatectomy based on the body mass of patients with normal hepatic reserve.

作者信息

Ikehara Tomohiko, Shimizu Akira, Kubota Koji, Notake Tsuyoshi, Kitagawa Noriyuki, Masuo Hitoshi, Yoshizawa Takahiro, Hosoda Kiyotaka, Sakai Hiroki, Soejima Yuji

机构信息

Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan.

出版信息

Surg Today. 2025 Mar 27. doi: 10.1007/s00595-025-03030-0.

DOI:10.1007/s00595-025-03030-0

PMID:40146336

Abstract

PURPOSE

Several parameters are used to assess future liver remnant (FLR) size before major hepatectomy. This study aimed to clarify which is the most appropriate method to use for the prediction of post-hepatectomy liver failure (PHLF).

METHODS

The subjects of this study were 307 patients with Child-Pugh class A only, who underwent major hepatectomy, to focus on FLR size. The parameters we evaluated for their accuracy in predicting Grade B/C PHLF (PHLF B/C) using receiver operating characteristic curve analysis were FLR volume (FLRV), the FLRV to total liver volume ratio (FLRV/TLV), standard liver volume (FLRV/SLV), and body weight (FLRV/BW) according to body mass.

RESULTS

The predictive value accuracy of these four parameters for PHLF was similar for the entire cohort. However, in the subgroup analysis based on body mass index, FLRV/BW accuracy was highest in the obese group, whereas that of FLRV/TLV was highest in the lean group. Multivariate analysis identified that FLRV/BW (< 0.7%) and blood loss (≥ 1000 ml) were independent risk factors for PHLF B/C in the obese group. In the lean group, FLRV/TLV (< 40%) and biliary reconstruction were risk factors for PHLF B/C.

CONCLUSIONS

The FLR size evaluation method for predicting PHLF should be appropriately selected based on the patient's body mass.

摘要

目的

在进行大型肝切除术前，有多个参数可用于评估未来肝脏残余量（FLR）的大小。本研究旨在明确哪种方法最适合用于预测肝切除术后肝功能衰竭（PHLF）。

方法

本研究的对象为仅Child-Pugh A级的307例接受大型肝切除术的患者，重点关注FLR大小。我们使用受试者工作特征曲线分析评估其预测B/C级PHLF（PHLF B/C）准确性的参数包括FLR体积（FLRV）、FLR体积与全肝体积之比（FLRV/TLV）、标准肝体积（FLRV/SLV）以及根据体重计算的FLR体积与体重之比（FLRV/BW）。

结果

对于整个队列，这四个参数对PHLF的预测价值准确性相似。然而，在基于体重指数的亚组分析中，FLRV/BW在肥胖组中的准确性最高，而FLRV/TLV在消瘦组中的准确性最高。多因素分析确定，FLRV/BW（<0.7%）和失血量（≥1000 ml）是肥胖组中PHLF B/C的独立危险因素。在消瘦组中，FLRV/TLV（<40%）和胆肠吻合是PHLF B/C的危险因素。