Prediction of the safe limits of hepatectomy by combined volumetric and functional measurements in patients with impaired hepatic function.
Prediction of the safe limits of hepatectomy by combined volumetric and functional measurements in patients with impaired hepatic function.
复制标题
通过合并肝功能受损患者的体积和功能测量来预测肝切除术的安全限度。
作者：
E. Okamoto;A. Kyo;N. Yamanaka;N. Tanaka;K. Kuwata
通过使用计算机断层扫描测量，对 38 名接受不同程度肝切除术的原发性肝细胞癌患者进行了术前肝切除安全限度的评估。这 38 名患者中有 28 名（73.7%）患有肝硬化。将术前计算机断层扫描对肝脏和肝细胞癌体积的估计与切除标本的测量体积进行了比较。切除的肝脏和肝细胞癌的估计体积与实际体积之间的平均差异分别在 10% 和 7% 以内。为了量化肝切除的范围，提供了“肝实质切除率”（公式：见正文）。作为肝功能损伤的指标，使用静脉注射吲哚菁绿染料(ICG)0.5mg/kg(ICG R15)后15分钟的保留率。观察到肝实质切除率和 ICG R15 与患者预后之间存在密切相关性，表明它们在预测肝切除术的安全限度和肝切除术后肝功能衰竭的可能发展方面具有潜在用途。
By use of computed tomography measurements, preoperative estimations of the safe limits of hepatic resection have been attempted in 38 patients with primary hepatocellular carcinoma who underwent hepatectomies of varying degrees. Twenty eight (73.7%) of these 38 patients had cirrhosis. Preoperative computed tomography estimations of volume of liver and hepatocellular carcinoma have been compared with measured volume of the resected specimens. The average differences between the estimated and actual volumes of resected liver and hepatocellular carcinoma were within 10% and 7%, respectively. To quantify the extent of hepatectomy, the "parenchymal hepatic resection rate" (formula: see text) was provided. As an indicator of functional impairment of the liver, the retention rate 15 minutes after an intravenous injection of indocyanine green dye (ICG) at 0.5 mg/kg (ICG R15) was used. A close correlation was observed between the parenchymal hepatic resection rate and ICG R15 relative to the patients' outcome, indicating their potential use in the prediction of the safe limits of hepatectomy and the probable development of posthepatectomy liver failure.