Function and volume recovery after partial hepatectomy: influence of preoperative liver function, residual liver volume, and obesity
Function and volume recovery after partial hepatectomy: influence of preoperative liver function, residual liver volume, and obesity
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DOI：
10.1007/s00423-012-0972-2
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发表时间：
2012-12-01
影响因子：
2.3
通讯作者：
Stockmann, Martin
中科院分区：
文献类型：
--
作者：
Lock, Johan Friso;Malinowski, Maciej;Stockmann, Martin
肝脏的再生能力是成功应用部分肝切除术的必要前提。然而，功能恢复的实际动力学仍然不明，没有足够的工具，其临床monitoring.85例接受肝切除术的患者进行了调查，从术前评估，直到术后12周。通过LiMAx试验测定细胞色素P450 1A 2的酶促能力，测定肝功能。通过重复计算机断层扫描的体积分析确定肝脏体积。随访期间比较了功能和容量恢复情况，肝大切除术使肝功能下降至术前的35.7 ± 13.8%。结果表明，功能恢复在10天内已经达到术前值的77.2 +/-33.5%。实际动力学取决于肝切除术的类型和程度。在12周内实现了完全的功能恢复，而肝脏体积仍然保持在术前的73.2 +/-14.8%。在所有的时间点上观察到功能和体积之间的恒定但个体间可变的相关性。部分肝切除导致快速和完全的功能恢复，而体积恢复延迟并且通常不完全。功能恢复主要受术前肝功能、残余肝体积和肥胖的影响。
The regenerative capacity of the liver is an essential pre-condition for the successful application of partial hepatectomy. However, the actual kinetics of functional recovery remains unspecified and no adequate tool for its clinical monitoring has yet been available.Eighty-five patients receiving major hepatectomy were investigated from the preoperative evaluation until 12 weeks after surgery. Liver function was determined by the LiMAx test for the enzymatic capacity of cytochrome P450 1A2. Liver volume was determined by volumetric analysis of repeated computer tomography scans. Functional and volume recovery were compared during follow-up.Major hepatectomy decreased liver function capacity to 35.7 +/- 13.8 % of preoperative function. It was shown that functional recovery already reaches 77.2 +/- 33.5 % of preoperative values within 10 days. The actual kinetics were dependent from the type and extent of hepatectomy. Complete functional restoration was achieved within 12 weeks, while liver volume still remained at 73.2 +/- 14.8 % of preoperative. A constant but interindividually variable correlation between function and volume was observed at all points in time.Partial hepatectomy leads to fast and complete functional recovery, while volume recovery is delayed and remains often incomplete. The functional recovery is mainly influenced by the preoperative liver function, the residual liver volume, and by obesity.