Gao Jun-Ping, Lu Zhan, Zhang Jie, Qin Shang-Dong, Zhao Jing-Fei, Huang Jun-Tao, Gong Wen-Feng, Xiang Bang-De
Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China.
Surg Laparosc Endosc Percutan Tech. 2025 Aug 1;35(4):e1387. doi: 10.1097/SLE.0000000000001387.
Many patients with cirrhosis develop posthepatectomy liver failure (PHLF). Factors associated with clinically relevant PHLF (CRPHLF) in cirrhosis with different remnant liver volume (RLV)-to-standard liver volume (SLV) ratios are unclear.
The study aimed to determine whether an RLV/SLV value of <40% is safe for hepatectomy in patients with cirrhosis.
Patients with cirrhosis were divided into an RLV/SLV <40% group (28 cases) and an RLV/SLV ≥40% group (39 cases) based on their RLV/SLV ratio. The incidence of CRPHLF and surgical complications in the 2 groups were analysed, and CRPHLF was determined according to the criteria of the International Study Group of Liver Surgery. Factors associated with CRPHLF were identified using multivariate logistic regression for all patients. We further performed the Hosmer-Lemeshow test and calculated the area under the receiver operating characteristic curve (AUC) to assess the overall model fit. All analyses were performed using SPSS 19.0 software.
Patients who developed CRPHLF had a higher rate of severe complications (17.1%) than those who did not. Body mass index (BMI), prothrombin time (PT), RLV/SLV value, and blood transfusion were associated with CRPHLF in all patients with cirrhosis ( P <0.05). Clinically relevant PHLF was associated with PT in patients with RLV/SLV ≥40% and with BMI in patients with RLV/SLV <40% ( P <0.05). Model diagnostics suggested satisfactory calibration (Hosmer-Lemeshow P =0.436) and moderate discrimination (AUC=0.78) in the overall cohort. Patients with cirrhosis with an RLV/SLV value of <40% (and ≥30%) had the same complications or CRPHLF as patients with an RLV/SLV value of ≥40% ( P >0.05).
We found that a high PT was a risk factor in patients with RLV/SLV ≥40%, while a low BMI was a risk factor in those with RLV/SLV <40%. Increased surgical complications may not be associated with low RLV/SLV ratios, and hepatectomy may be safe in some patients with cirrhosis with RLV/SLV values <40% (and ≥30%).
许多肝硬化患者会发生肝切除术后肝衰竭（PHLF）。不同残余肝体积（RLV）与标准肝体积（SLV）比值的肝硬化患者中，与临床相关的PHLF（CRPHLF）相关的因素尚不清楚。
本研究旨在确定RLV/SLV值<40%对肝硬化患者肝切除术是否安全。
根据RLV/SLV比值，将肝硬化患者分为RLV/SLV<40%组（28例）和RLV/SLV≥40%组（39例）。分析两组患者CRPHLF的发生率和手术并发症，并根据国际肝脏手术研究组的标准确定CRPHLF。对所有患者使用多因素logistic回归分析确定与CRPHLF相关的因素。我们进一步进行了Hosmer-Lemeshow检验并计算了受试者工作特征曲线下面积（AUC），以评估整体模型拟合情况。所有分析均使用SPSS 19.0软件进行。
发生CRPHLF的患者严重并发症发生率（17.1%）高于未发生者。在所有肝硬化患者中，体重指数（BMI）、凝血酶原时间（PT）、RLV/SLV值和输血与CRPHLF相关（P<0.05）。在RLV/SLV≥40%的患者中，临床相关的PHLF与PT相关，而在RLV/SLV<40%的患者中与BMI相关（P<0.05）。模型诊断表明，总体队列中的校准效果令人满意（Hosmer-Lemeshow P=0.436），区分度中等（AUC=0.78）。RLV/SLV值<40%（且≥30%）的肝硬化患者与RLV/SLV值≥40%的患者并发症或CRPHLF相同（P>0.05）。
我们发现，PT升高是RLV/SLV≥40%患者的危险因素，而BMI降低是RLV/SLV<40%患者的危险因素。手术并发症增加可能与RLV/SLV比值低无关，对于一些RLV/SLV值<40%（且≥30%）的肝硬化患者，肝切除术可能是安全的。
