Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure.
Remnant growth rate after portal vein embolization is a good early predictor of post-hepatectomy liver failure.
复制标题
门静脉栓塞后的残留生长速率是肝后肝衰竭后的良好早期预测指标。
DOI：
10.1016/j.jamcollsurg.2014.04.022
复制
发表时间：
2014-10
影响因子：
5.2
通讯作者：
Jarnagin, William R.
中科院分区：
文献类型：
--
作者：
Leung, Universe;Simpson, Amber L.;Araujo, Raphael L. C.;Goenen, Mithat;McAuliffe, Conor;Miga, Michael I.;Parada, E. Patricia;Allen, Peter J.;D'Angelica, Michael I.;Kingham, T. Peter;DeMatteo, Ronald P.;Fong, Yuman;Jarnagin, William R.
门静脉栓塞（PVE）后，未来肝脏残留（FLR）在几周内肥大。一个早期标志物，预测肝切除术后肝衰竭的低风险可能会减少手术的延迟。1999年9月至2012年11月期间，对153例因原发性或继发性肝脏恶性肿瘤接受PVE后进行大肝切除术（>3个肝段）的患者的肝脏体积进行了回顾性评估。测量PVE前后的FLR体积和功能性肝脏体积（FLV）。计算肥大程度（DH = postFLR/postFLV - preFLR/preFLV）和生长速率（GR =自PVE以来的DH /周数）。术后并发症和肝功能衰竭与DH、测量的GR和根据体表面积公式得出的估计GR（eGR）相关。符合条件的患者接受了93例右肝切除术，51例扩大右肝切除术，4例左肝切除术和5例扩大左肝切除术。发生严重并发症44例（28.7%），肝功能衰竭6例（3.9%）。非参数回归显示，栓塞后FLR%与肝衰竭相关性较差。ROC曲线显示，DH和GR是肝衰竭的良好预测因子（AUC=0.80，p=0.011和AUC=0.79，p=0.015）和严重并发症的适度预测因子（AUC=0.66，p=0.002和AUC=0.61，p=0.032）。GR >2.66%/wk者无一例发生肝功能衰竭。对于肝功能衰竭，测量的GR的预测值上级优于eGR（AUC 0.79 vs 0.58，p=0.046）。PVE后的DH和GR都是肝切除术后肝功能衰竭的强预测因子。GR可能比静态体积测量更好地指导肝切除的最佳时机。测量的容量与结果的相关性优于估计的容量。
After portal vein embolization (PVE), the future liver remnant (FLR) hypertrophies over several weeks. An early marker that predicts a low risk of post-hepatectomy liver failure may reduce the delay to surgery. Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional liver volume (FLV) were measured. Degree of hypertrophy (DH = postFLR/postFLV - preFLR/preFLV) and growth rate (GR = DH / weeks since PVE) were calculated. Postoperative complications and liver failure were correlated with DH, measured GR, and estimated GR (eGR) derived from a formula based on body surface area. Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and liver failure in 6 patients (3.9%). Non-parametric regression showed that post-embolization FLR% correlated poorly with liver failure. ROC curves showed that DH and GR were good predictors of liver failure (AUC=0.80, p=0.011, and AUC=0.79, p=0.015) and modest predictors of major complications (AUC=0.66, p=0.002, and AUC=0.61, p=0.032). No patient with GR >2.66%/wk developed liver failure. The predictive value of measured GR was superior to eGR for liver failure (AUC 0.79 vs 0.58, p=0.046). Both DH and GR after PVE are strong predictors of post-hepatectomy liver failure. GR may be a better guide for the optimum timing of liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.
登录
查看更多内容
影响因子：
3.8
作者：
ALYASSIN, AM;LANCASTER, JL;FOX, PT
通讯作者：
FOX, PT
影响因子：
9
作者：
Covey, Anne M.;Brown, Karen T.;Fong, Yuman
通讯作者：
Fong, Yuman
影响因子：
2.6
作者：
Beal, I. K.;Anthony, S.;Davidson, B.
通讯作者：
Davidson, B.
影响因子：
2.9
作者：
Nafidi, Otmane;Desy, Delphine;Lapointe, Real W.
通讯作者：
Lapointe, Real W.
影响因子：
9
作者：
Balzan, S;Belghiti, J;Durand, F
通讯作者：
Durand, F