Objective evaluation of liver consistency to estimate hepatic fibrosis and functional reserve for hepatectomy
Objective evaluation of liver consistency to estimate hepatic fibrosis and functional reserve for hepatectomy
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DOI：
10.1016/s1072-7515(00)00309-4
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发表时间：
2000-07-01
影响因子：
5.2
通讯作者：
Omata, S
中科院分区：
文献类型：
--
作者：
Kusaka, K;Harihara, Y;Omata, S
背景：目前使用肝脏一致性的经验评估来规划手术策略。本研究的目的是验证肝脏一致性客观测量的可行性，并检查其与肝纤维化和肝功能储备的相关性。研究设计：连续纳入52例在我科接受肝切除术的患者。肝切除适应症为肝细胞癌36例，转移性肝肿瘤12例，其他情况4例。使用新的触觉传感器测量肝脏的稠度。纤维化指数计算为纤维化组织百分比的表达。将肝脏一致性与组织学标本中观察到的肝纤维化程度（纤维化指数）以及肝功能参数进行比较。结果：肝脏硬度与纤维化指数呈显着正相关（r = 0.887，p < 0.0001）。通过单变量分析，肝脏硬度也与吲哚菁绿测试呈显着正相关（r = 0.631，p < 0.0001）。通过多元回归分析，吲哚菁绿测试和血小板计数与肝脏硬度独立且显着相关。在五名患者中，术中测量的肝脏硬度值与吲哚菁绿测试值的预期值明显不同。在这些患者中，最终根据触觉传感器测量的肝脏硬度来选择手术方案，并获得了良好的临床效果。结论：这些结果首次表明临床上可以通过触觉传感器对肝脏硬度进行定量评估。触觉传感器充分估计肝脏硬度，并且该估计与肝纤维化和功能储备密切相关。以这种方式客观确定的肝脏一致性可能有助于优化手术决策。 （J Am Cell Surg 2000；191：47-53。(C) 2000 年美国外科医生学会）。
Background: The empiric evaluation of liver consistency is currently used to plan the surgical strategy. The aim of this study was to verify the feasibility of the objective measurement of liver consistency and to check its correlation with liver fibrosis and liver functional reserve.Study Design: Fifty-two consecutive patients who underwent hepatic resections in our department were enrolled. The indications for liver resection were hepatocellular carcinoma in 36 patients, metastatic liver tumors in 12 patients, and other conditions in 4 patients. Liver consistency was measured with a new tactile sensor. A fibrosis index was calculated as an expression of the percentage of fibrotic tissue. Liver consistency was compared with the degree of liver fibrosis observed in histologic specimens (fibrosis index) and with liver function parameters.Results: Liver stiffness showed a significant positive correlation with fibrosis index (r = 0.887, p < 0.0001). Liver stiffness also showed significant positive correlation with the indocyanine green test (r= 0.631, p < 0.0001) by a univariate analysis. The indocyanine green test and platelet count were independently and significantly associated with liver stiffness by a multiple regression analysis. In five patients, the liver stiffness values measured intraoperatively differed markedly from those expected from the indocyanine green test values. In these patients, the operative procedures were finally selected based on the liver stiffness measured with the tactile sensor and good clinical outcomes were obtained.Conclusions: These results show for the first time that liver stiffness can be clinically assessed quantitatively by means of the tactile sensor. The tactile sensor adequately estimates liver stiffness and this estimation is well correlated with liver fibrosis and functional reserve. Liver consistency determined objectively in this manner may be useful for optimizing surgical decision making. (J Am Cell Surg 2000;191:47-53. (C) 2000 by the American College of Surgeons).