Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection
Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection
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DOI：
10.1016/s1091-255x(02)00370-0
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发表时间：
2003-03-01
影响因子：
3.2
通讯作者：
Fong, YM
中科院分区：
文献类型：
--
作者：
Shoup, M;Gonen, M;Fong, YM
肝增强的方式，如门静脉栓塞，越来越多地采用前主要肝切除术，以防止术后肝功能障碍。这些技术的选择标准没有得到很好的描述。本研究使用基于CT的体积分析作为工具，以识别术后肝功能障碍风险最高的患者。在1999年7月至2000年12月期间，共有126例因结直肠转移而接受肝切除术并在我们机构进行CT扫描的患者被纳入分析。通过术前体积（螺旋）采集的CT扫描半自动勾画肝脏轮廓来确定切除体积。肝功能障碍定义为凝血酶原时间大于18秒或血清胆红素水平大于3 mg/dl。边缘回归用于比较体积分析和切除范围的预测能力。肝残留率与凝血酶原时间和胆红素水平的升高密切相关（P < 0.001）。肝切除术后残肝≤ 25%者90%发生肝功能障碍，而肝切除术后残肝> 25%者无一例发生肝功能障碍（P < 0.0001）。肝脏剩余百分比在预测肝功能障碍方面比切除的解剖范围更特异（P = 0.003）。男性发生肝功能不全的风险几乎是男性的两倍（比值比= 1.89，P = 0.027），而肝脏剩余小于或等于25%的风险是男性的三倍多（比值比= 3.09，P < 0.0001）。肝功能不全和肝脏残留小于或等于25%与并发症和住院时间增加相关（分别为P < 0.0001和P = 0.0003）。术前评估未来剩余肝脏体积可区分哪些接受肝脏切除术的患者最有可能从术前肝脏增强技术（如门静脉栓塞）中获益。(C)2003年消化道外科学会，Inc.
Liver-enhancing modalities, such as portal vein embolization, are increasingly employed prior to major liver resection to prevent postoperative liver dysfunction. Selection criteria for such techniques are not well described. This study uses CT-based volumetric analysis as a tool to identify patients at highest risk for postoperative hepatic dysfunction. Between July 1999 and December 2 000, a total of 12 6 consecutive patients who were undergoing liver resection for colorectal metastasis and had CT scans at our institution were included in the analysis. Volume of resection was determined by semiautomated contouring of the liver on preoperative volumetrically (helical) acquired CT scans. Hepatic dysfunction was defined as prothrombin time greater than 18 seconds or serum bilirubin level greater than 3 mg/dl. Marginal regression was used to compare the predictive ability of volumetric analysis and the extent of resection. The percentage of liver remaining was closely correlated with increasing prothrombin time and bilirubin level (P < 0.001). After trisegmentectomy, 90% of patients with less than or equal to25% of liver remaining developed hepatic dysfunction, compared with none of the patients with more than 2 5 % of liver remaining after trisegmentectomy (P < 0.0001). The percentage of liver remaining was more specific in predicting hepatic dysfunction than was the anatomic extent of resection (P = 0.003). Male sex nearly doubled the risk of hepatic dysfunction (odds ratio = 1.89, P = 0.027), and having less than or equal to25% of liver remaining more than tripled the risk (odds ratio = 3.09, P < 0.0001). Hepatic dysfunction and less than or equal to25% of liver remaining were associated with increased complications and length of hospital stay (P < 0.0001 and P = 0.0003, respectively). Preoperative assessment of future liver volume remaining distinguishes which patients undergoing liver resection will most likely benefit from preoperative liver enhancement techniques such as portal vein embolization. (C) 2003 The Society for Surgery of the Alimentary Tract, Inc.