Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-Rmax) is useful for judging the safety of hepatic resection
Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-Rmax) is useful for judging the safety of hepatic resection
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DOI：
10.1016/j.surg.2006.02.011
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发表时间：
2006-09-01
期刊：
影响因子：
3.8
通讯作者：
Ha-Kawa, Sang Kil
中科院分区：
文献类型：
--
作者：
Kwon, A-Hon;Matsui, Yoichi;Ha-Kawa, Sang Kil
背景。对于肝切除术，术前对预测残肝的肝功能储备的估计可能比对整个肝的估计更重要。对残余样品中锝-99m-半乳糖-人血清白蛋白（GSA-Rmax）的最大去除率进行了评价。178例患者接受择期肝切除术。术前检查常规肝功能、吲哚菁绿15分钟留存率（ICGR15）。根据放射药动学模型计算GSA-Rmax；然后根据手术方式，利用单光子发射ct图像计算预测残肝区域GSA-Rmax （GSA-RL）。根据ct图像计算预测残肝体积（LV-RL）。正常肝脏患者术前LV-RL与GSA-RL相关性良好，而慢性肝炎或肝硬化患者无此相关性。术后7例患者均出现高胆红素血症。GSA-RL < 0.15的患者。2例患者术后1 ~ 2个月死于肝功能衰竭。2例患者GSA-RL值均为0。078和0。残肝GSA-Rmax与icgr15存在严重差异。我们得出结论，GSA-RL可能有助于确定肝切除术的程序，该值应保持在大于0.15，以避免术后高胆红素血症或肝功能衰竭。
Background. For hepatic resection, the preoperative estimation of hepatic functional reserve in the predicted remnant liver may be more important than that of the entire liver. We evaluated the maximal removal rate of technetium-99m-galactosyl-human serum albumin (GSA-Rmax) in the remnant.Methods. One hundred and seventy-eight patients were admitted for elective hepatectomy. Conventional liver function, and 15-minute retention rate of indocyanine green (ICGR15) were carried out preoperatively. The GSA-Rmax was calculated according to a radiapharmacokinetic model; then we used the single photon emission computed tomography images to calculate the regional GSA-Rmax in the predicted residual liver (GSA-RL), depending on the operative Procedures. The volume of the predicted residual liver (LV-RL) was calculated on the basis of computed tomography images.Results. The preoperative LV-RL correlated well with the GSA-RL in patients with normal liver,however, there was no such correlation in those with chronic hepatitis or cirrhosis. All of 7 postoperative hyperbilirubinemia occurred. in the patients with GSA-RL < 0.15. Two patients died of postoperative liver failure 1 to 2 months after the operation. These 2 patients had GSA-RL values of 0. 078 and 0. 090, respectively, and severe discrepancies between the GSA-Rmax in the remnant liver and ICGR15.Conclusions. We concluded that GSA-RL may be useful for determining the procedure of hepatectomy and that the value should be maintained at greater than 0.15 to avoid postoperative hyperbilirubinemia or hepatic failure.