BACKGROUND:Whether a major liver resection is safe has been judged mainly from the patient’s hepatic reserve.However,a safe limit for liver resection does not exist yet.This study aimed to construct a new scoring sys...BACKGROUND:Whether a major liver resection is safe has been judged mainly from the patient’s hepatic reserve.However,a safe limit for liver resection does not exist yet.This study aimed to construct a new scoring system as a guide to determine a safe limit for liver resection and avoid liver dysfunction after hepatectomy.METHODS:Eighty-six patients with hepatocellular carcinoma who had undergone hepatectomy in West China Hospital from March 2007 to June 2010 were reviewed.The patients were classified according to the levels of total bilirubin after hepatectomy and the parameters in the perioperative period were compared.Receiver operating characteristic (ROC) analysis was made to assess the liver function compensatory (LFC) value to predict liver dysfunction of the patients after hepatectomy.LFC value is defined as the preoperative KICG value×22.487+standard remnant liver volume (SRLV)×0.020.RESULTS:Patients were classified into group Ⅰ (normal group,n=69) and group Ⅱ (with total bilirubin >85.5 μmol/L for 7 days after hepatectomy,n=17) based on the levels of total bilirubin after hepatectomy.Group II was further divided into two subgroups:recovered subgroup (n=14) and fatal subgroup (n=3).There were no significant differences in preoperative data or intraoperative findings except the indocyanine green test parameters (KICG and ICG R15) and SRLV.ROC analysis showed that the sensitivity and specificity of an LFC value ≤13.01 were 94.1% and 82.6% respectively for predicting liver dysfunction of the patients after hepatectomy.CONCLUSIONS:The LFC value appears to be a good predictor of postoperative liver dysfunction in patients who undergo hepatectomy for HCC.An expected LFC value of 13.01 seems to be a safe limit for liver resection.展开更多
目的目前对于肝细胞癌(hepatocellular carcinoma,HCC)患者肝切除术后的安全性评估,绝大多数研究都是通过测定残余肝体积(remnant liver volume,RLV)或标准残肝体积(standard remnant liver volume,SRLV)实现,这些研究并没有结合HCC患...目的目前对于肝细胞癌(hepatocellular carcinoma,HCC)患者肝切除术后的安全性评估,绝大多数研究都是通过测定残余肝体积(remnant liver volume,RLV)或标准残肝体积(standard remnant liver volume,SRLV)实现,这些研究并没有结合HCC患者肝纤维化严重程度。本研究通过肝纤维化评分指标联合SRLV测定探讨预防不同肝纤维化分期HCC患者术后发生肝功能代偿不全时SRLV的安全临界值。方法收集2014-06-20-2016-08-20广西医科大学附属肿瘤医院行HCC肝切除术的163例患者临床资料,采用ROC曲线分别计算术后病理不同肝纤维化分期和术后肝功能不全者不同肝纤维化分期SRLV的临界值,并进行比较分析;计算4种肝纤维化评分指标天门冬氨酸氨基转移酶与血小板比值指数(aspartate aminotransferase to platelet ratio index,APRI)、Frons指数、FIB4指数(index based on the four factors,FIB4)和S指数对术后病理不同肝纤维化分期进行评分,并比较其评价肝纤维化分期的效能;以评价肝纤维化分期最优指标ROC曲线的Cutoff值进行分组,分别计算不同肝纤维化分期SRLV的临界值。结果术后病理肝纤维化S2~S3和S4期SRLV临界值分别为0.392和0.447L/m2,术后肝功能不全者肝纤维化S2~S3和S4期SRLV临界值分别为0.408和0.451L/m2。FIB4以1.585为临界值,诊断肝纤维化S2~S3期曲线下面积为0.830,优于APRI(z=2.468,P<0.05),与Frons和S指数相比,差异无统计学意义,z值分别为1.120和1.083,均P>0.05;FIB4以2.183为临界值,诊断肝纤维化S4期曲线下面积为0.853,分别优于APRI、Frons和S指数,z值分别为4.612、2.740和2.765,均P<0.05。FIB4以临界值1.585和2.183分别进行分组,评估肝纤维化(S2~S3和S4期)HCC患者术后SRLV临界值,分别为0.421和0.474L/m2。结论 FIB4联合SRLV是评估HCC切除术安全性的最优指标;FIB4≥1.585和SRLV≥0.421L/m2、FIB4≥2.183及SRLV≥0.474L/m2 HCC患者术后发生肝功能不全的概率较小,相对安全。展开更多
[目的]探讨标准残肝体积(SRLV)大小及肝纤维化程度与原发性肝癌切除术后发生肝功能代偿不全间的关系。[方法]对因肝癌行肝切除术的104例病例进行研究。残肝体积=全肝体积-切除肝脏体积;SRLV=残肝体积/体表面积;根据声脉冲辐射力成像(aco...[目的]探讨标准残肝体积(SRLV)大小及肝纤维化程度与原发性肝癌切除术后发生肝功能代偿不全间的关系。[方法]对因肝癌行肝切除术的104例病例进行研究。残肝体积=全肝体积-切除肝脏体积;SRLV=残肝体积/体表面积;根据声脉冲辐射力成像(acoustic radiation force impulse,ARFI)评分将所有病例分为A组(中、重度肝纤维化组)和B组(正常或轻度肝纤维化组)。通过受试者工作特征曲线(ROC)分析预防发生肝功能代偿不全的SRLV安全临界值。并将术后发生肝功能中度代偿不全患者的术前ARFI评分与术后SRLV进行直线回归分析。[结果]A组病例术后发生肝功能轻度代偿不全、中度代偿不全及重度代偿不全分别为53例、22例、4例。在A组病例中,肝功能中、重度代偿不全发生率为32.9%,(26/79),肝功能轻度代偿不全患者和中、重度代偿不全患者的SRLV[(605.69±118.98)ml/m^2vs(470.81±62.59)ml/m^2]比较具有显著差异(P<0.05)。ROC曲线分析提示发生肝功能中、重度代偿不全的SRLV的临界值为503ml/m^2。B组病例数少,不作统计学分析。将术后发生肝功能中度代偿不全患者的术前ARFI评分及术后SRLV进行直线回归分析,显示呈正相关(R=0.719,P<0.01),其回归方程为:SRLV(ml/m^2)=149.6×ARFI评分(m/s)+194.1。[结论 ]联合SRLV及肝纤维化程度测定对原发性肝癌术前安全切肝量评估有重要指导价值,对伴中、重度肝纤维化患者安全SRLV临界值为503ml/m^2。展开更多
目的:探讨肝硬化肝细胞癌术后标准残肝体积与肝功能代偿不全的相关性.方法:回顾性分析我院2009-08/2012-08收治的80例肝硬化肝细胞癌患者的资料,根据术后残肝比率的大小分为少量切除组(SR组)与大量切除组(LR组),分析比较两组患者手术前...目的:探讨肝硬化肝细胞癌术后标准残肝体积与肝功能代偿不全的相关性.方法:回顾性分析我院2009-08/2012-08收治的80例肝硬化肝细胞癌患者的资料,根据术后残肝比率的大小分为少量切除组(SR组)与大量切除组(LR组),分析比较两组患者手术前后肝功能指标、肿瘤标志物及术后转归情况.结果:两组患者术后总胆红素(total bilirubin,T B)、国际标准化比值(i n t e r n a t i o n a l normalized ratio,INR)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)均较术前大幅升高,并随时间推移而降低,差异具有统计学意义(P<0.05);LR组TB、INR、AST于术后均高于SR组,且ALT在术后第5、7天显著高于SR组,差异具有统计学意义(P<0.05);两组患者术后甲胎蛋白(α-fetoprotein,AFP)、CA19-9较术前均显著下降,差异具有统计学意义(P<0.05);LR组AFP于术后均高于SR组,差异具有统计学意义(P<0.05);LR组术后肝功能失代偿发生率及肝功能衰竭发生率高于SR组,差异具有统计学意义(25.0%vs 3.3%,12.0%vs 0%,均P<0.05),LR组患者的切口感染、门脉血栓、腹腔内出血的发生率虽与SR组并没有统计学差异,但仍可见其较SR组高.结论:标准残肝体积是反映肝硬化肝细胞癌患者术后肝贮备功能的一项良好的指标,标准残肝体积高的患者肝功能代偿不全及肝功能衰竭发生率较低.展开更多
文摘BACKGROUND:Whether a major liver resection is safe has been judged mainly from the patient’s hepatic reserve.However,a safe limit for liver resection does not exist yet.This study aimed to construct a new scoring system as a guide to determine a safe limit for liver resection and avoid liver dysfunction after hepatectomy.METHODS:Eighty-six patients with hepatocellular carcinoma who had undergone hepatectomy in West China Hospital from March 2007 to June 2010 were reviewed.The patients were classified according to the levels of total bilirubin after hepatectomy and the parameters in the perioperative period were compared.Receiver operating characteristic (ROC) analysis was made to assess the liver function compensatory (LFC) value to predict liver dysfunction of the patients after hepatectomy.LFC value is defined as the preoperative KICG value×22.487+standard remnant liver volume (SRLV)×0.020.RESULTS:Patients were classified into group Ⅰ (normal group,n=69) and group Ⅱ (with total bilirubin >85.5 μmol/L for 7 days after hepatectomy,n=17) based on the levels of total bilirubin after hepatectomy.Group II was further divided into two subgroups:recovered subgroup (n=14) and fatal subgroup (n=3).There were no significant differences in preoperative data or intraoperative findings except the indocyanine green test parameters (KICG and ICG R15) and SRLV.ROC analysis showed that the sensitivity and specificity of an LFC value ≤13.01 were 94.1% and 82.6% respectively for predicting liver dysfunction of the patients after hepatectomy.CONCLUSIONS:The LFC value appears to be a good predictor of postoperative liver dysfunction in patients who undergo hepatectomy for HCC.An expected LFC value of 13.01 seems to be a safe limit for liver resection.
文摘目的目前对于肝细胞癌(hepatocellular carcinoma,HCC)患者肝切除术后的安全性评估,绝大多数研究都是通过测定残余肝体积(remnant liver volume,RLV)或标准残肝体积(standard remnant liver volume,SRLV)实现,这些研究并没有结合HCC患者肝纤维化严重程度。本研究通过肝纤维化评分指标联合SRLV测定探讨预防不同肝纤维化分期HCC患者术后发生肝功能代偿不全时SRLV的安全临界值。方法收集2014-06-20-2016-08-20广西医科大学附属肿瘤医院行HCC肝切除术的163例患者临床资料,采用ROC曲线分别计算术后病理不同肝纤维化分期和术后肝功能不全者不同肝纤维化分期SRLV的临界值,并进行比较分析;计算4种肝纤维化评分指标天门冬氨酸氨基转移酶与血小板比值指数(aspartate aminotransferase to platelet ratio index,APRI)、Frons指数、FIB4指数(index based on the four factors,FIB4)和S指数对术后病理不同肝纤维化分期进行评分,并比较其评价肝纤维化分期的效能;以评价肝纤维化分期最优指标ROC曲线的Cutoff值进行分组,分别计算不同肝纤维化分期SRLV的临界值。结果术后病理肝纤维化S2~S3和S4期SRLV临界值分别为0.392和0.447L/m2,术后肝功能不全者肝纤维化S2~S3和S4期SRLV临界值分别为0.408和0.451L/m2。FIB4以1.585为临界值,诊断肝纤维化S2~S3期曲线下面积为0.830,优于APRI(z=2.468,P<0.05),与Frons和S指数相比,差异无统计学意义,z值分别为1.120和1.083,均P>0.05;FIB4以2.183为临界值,诊断肝纤维化S4期曲线下面积为0.853,分别优于APRI、Frons和S指数,z值分别为4.612、2.740和2.765,均P<0.05。FIB4以临界值1.585和2.183分别进行分组,评估肝纤维化(S2~S3和S4期)HCC患者术后SRLV临界值,分别为0.421和0.474L/m2。结论 FIB4联合SRLV是评估HCC切除术安全性的最优指标;FIB4≥1.585和SRLV≥0.421L/m2、FIB4≥2.183及SRLV≥0.474L/m2 HCC患者术后发生肝功能不全的概率较小,相对安全。
文摘[目的]探讨标准残肝体积(SRLV)大小及肝纤维化程度与原发性肝癌切除术后发生肝功能代偿不全间的关系。[方法]对因肝癌行肝切除术的104例病例进行研究。残肝体积=全肝体积-切除肝脏体积;SRLV=残肝体积/体表面积;根据声脉冲辐射力成像(acoustic radiation force impulse,ARFI)评分将所有病例分为A组(中、重度肝纤维化组)和B组(正常或轻度肝纤维化组)。通过受试者工作特征曲线(ROC)分析预防发生肝功能代偿不全的SRLV安全临界值。并将术后发生肝功能中度代偿不全患者的术前ARFI评分与术后SRLV进行直线回归分析。[结果]A组病例术后发生肝功能轻度代偿不全、中度代偿不全及重度代偿不全分别为53例、22例、4例。在A组病例中,肝功能中、重度代偿不全发生率为32.9%,(26/79),肝功能轻度代偿不全患者和中、重度代偿不全患者的SRLV[(605.69±118.98)ml/m^2vs(470.81±62.59)ml/m^2]比较具有显著差异(P<0.05)。ROC曲线分析提示发生肝功能中、重度代偿不全的SRLV的临界值为503ml/m^2。B组病例数少,不作统计学分析。将术后发生肝功能中度代偿不全患者的术前ARFI评分及术后SRLV进行直线回归分析,显示呈正相关(R=0.719,P<0.01),其回归方程为:SRLV(ml/m^2)=149.6×ARFI评分(m/s)+194.1。[结论 ]联合SRLV及肝纤维化程度测定对原发性肝癌术前安全切肝量评估有重要指导价值,对伴中、重度肝纤维化患者安全SRLV临界值为503ml/m^2。
文摘目的:探讨肝硬化肝细胞癌术后标准残肝体积与肝功能代偿不全的相关性.方法:回顾性分析我院2009-08/2012-08收治的80例肝硬化肝细胞癌患者的资料,根据术后残肝比率的大小分为少量切除组(SR组)与大量切除组(LR组),分析比较两组患者手术前后肝功能指标、肿瘤标志物及术后转归情况.结果:两组患者术后总胆红素(total bilirubin,T B)、国际标准化比值(i n t e r n a t i o n a l normalized ratio,INR)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)均较术前大幅升高,并随时间推移而降低,差异具有统计学意义(P<0.05);LR组TB、INR、AST于术后均高于SR组,且ALT在术后第5、7天显著高于SR组,差异具有统计学意义(P<0.05);两组患者术后甲胎蛋白(α-fetoprotein,AFP)、CA19-9较术前均显著下降,差异具有统计学意义(P<0.05);LR组AFP于术后均高于SR组,差异具有统计学意义(P<0.05);LR组术后肝功能失代偿发生率及肝功能衰竭发生率高于SR组,差异具有统计学意义(25.0%vs 3.3%,12.0%vs 0%,均P<0.05),LR组患者的切口感染、门脉血栓、腹腔内出血的发生率虽与SR组并没有统计学差异,但仍可见其较SR组高.结论:标准残肝体积是反映肝硬化肝细胞癌患者术后肝贮备功能的一项良好的指标,标准残肝体积高的患者肝功能代偿不全及肝功能衰竭发生率较低.
