Study on the prediction of the safety of hemihepatectomy by the standard remnant liver volume combined with transient elastography

doi:10.3877/cma.j.issn.1674-3946.2020.06.015

Abstract

Abstract:

Objective

To explore the feasibility and safety of standard remnant liver volume (SRLV) and the transient elastography(TE) in the evaluation of liver reserve function of patients undergoing hemihepatectomy for hepatocellular carcinoma (HCC).

Methods

The clinical data of 27 patients undergoing hepatectomy with a pathological diagnosis of HCC from January 2016 to January 2020 were analyzed retrospectively; the total liver volume, tumor volume and remnant liver volume were detected by CT before operation; the volume of resected half liver was measured by using drainage method and SRLV was calculated during operation. IBM SPSS 25.0 was used for data analysis. Measurement data were expressed as (±s) and were analyzed by using t test or one-way analysis of variance. The comparison of count data between groups were performed by using χ² analysis; ROC curve was used for analyzing the areas under the ROC curves of different factors. A P value <0.05 was considered as statistically significant difference.

Results

The threshold value of SRLV in all S2~S4 liver fibrosis patients undergoing hepatectomy was 0.329L/m^2; hepatic insufficiency occurred in 13 patients after hemihepatectomy, of whom the safety threshold value of SRLV in S2~S4 liver fibrosis patients was 0.329L/m2 too; the accuracy rate of Child-Pugh score in predicting good postoperative liver function compensation was 52.2%, while the accuracy rate of the new evaluation model in predicting good postoperative liver function compensation was 100% (P<0.05); the accuracy rate of Child-Pugh score in predicting mildly poor postoperative liver function compensation was 25%, while the accuracy rate of the new evaluation model in predicting mildly poor postoperative liver function compensation was 88.24% (P<0.05).

Conclusion

SRLV combined with transient elastography is a safe index to evaluate the safety of hemihepatectomy for HCC, and the new liver reserve evaluation model of Child-Pugh score combined with instantaneous hepatic elasticity could achieve a better clinical guiding significance for the evaluation of the reserve liver function of patients undergoing hemihepatectomy.

Key words: Carcinoma, hepatocellular, Liver cirrhosis, Hepatectomy, Elasticity imaging techniques

Jinzhu Wu, Weihua Cai, Lei Xu, Lin Chen, Feng Xiao, Tian Xu, Jianxin Wang, Renfei Zhu, Hanzhen Ji, Peng Zhang. Study on the prediction of the safety of hemihepatectomy by the standard remnant liver volume combined with transient elastography[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(06): 585-589.

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Figures/Tables 8

References 17

[1]	中华医学会外科学分会肝脏外科学组．肝切除术围手术期管理专家共识[J]．中国实用外科杂志，2017, 37(5): 525-530.
[2]	Shen S, Qiu YW, Yang XW, et al. Remnant Liver-to-Standard Liver Volume Ratio Below 40% is Safe in Ex Vivo Liver Resection and Autotransplantation[J]．J Gastrointest Surg，2019, 23(10) : 1964-1972.
[3]	中国研究型医院学会肝胆胰外科专业委员会．肝硬化患者肝切除术后肝功能不全的预防与治疗专家共识(2019版) [J]．中华消化外科杂志，2019, 18(4): 297-302.
[4]	Feng LM, Wang PQ, Yu H, et al. New formula for predicting standard liver volume in Chinese adults[J]. World J Gastroenterol, 2017, 23(27): 4968-4977.
[5]	Hussain A, Gul MA, Khalid MU. Validation of Novel Fibrosis Index (NFI) for assessment of liver fibrosis: comparison with transient elastography (FibroScan)[J]. BMJ open gastroenterol, 2019, 6(1): e000316.
[6]	Taneja S, Tohra S, Duseja A, et al. Noninvasive Assessment of Liver Fibrosis By Transient Elastography and FIB4/APRI for Prediction of Treatment Response in Chronic Hepatitis C-An Experience from a Tertiary Care Hospital[J]．J Clin Exp Hepatol，2016, 6(4): 282-290.
[7]	Maruyama M, Yoshizako T, Araki H, et al. Future Liver Remnant Indocyanine Green Plasma Clearance Rate as a Predictor of Post-hepatectomy Liver Failure After Portal Vein Embolization[J]. Cardiovasc Intervent Radiol，2018, 41(12): 1877-1884.
[8]	Endo Y, Ohta M, Tada K, et al. Improvement of non-alcoholic fatty liver disease after laparoscopic sleeve gastrectomy in Japanese obese patients[J]. Ann Gastroenterol Surg，2019, 3(3): 285-290.
[9]	Bozkurt B, Emek E, Arikan T, et al. Liver Graft Volume Estimation by Manual Volumetry and Software-Aided Interactive Volumetry: Which is Better？[J]. Transplant Proc，2019, 51(7): 2387-2390.
[10]	欧阳高雄，刘剑勇，张志明，等．标准残肝体积联合肝纤维化评分指标对HCC肝切除术安全性评估[J]．中华肿瘤防治杂志，2018, 25(7): 499-505.
[11]	Gong WF, Zhong JH, Lu Z, et al. Evaluation of liver regeneration and post-hepatectomy liver failure after hemihepatectomy in patients with hepatocellular carcinoma[J]. Biosci Rep，2019, 39(8): BSR20190088.
[12]	陈孝平，张万广．肝癌切除技术创新与发展[J/CD]．中华普外科手术学杂志(电子版)，2017, 11(5): 361-363.
[13]	Yang XP, Yang JD, Lee S, et al. Estimation of Standard Liver Volume Using CT Volume, Body Composition, and Abdominal Geometry Measurements[J]. Yonsei Med J, 2018, 59(4): 546-553.
[14]	Furlan A, Tublin ME, Yu L, et al. Comparison of 2D Shear Wave Elastography, Transient Elastography, and MR Elastography for the Diagnosis of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease[J]. AJR Am J Roentgenol，2020, 214(1): 1-7.
[15]	Zhang YH, Wang CF, Li H, et al. Decreased liver stiffness by transient elastography indicates lower incidence of hepatocellular carcinoma in patients with chronic hepatitis B[J]. Medicine，2019, 98(3): e13929.
[16]	雷洁雯. 瞬时弹性技术(Fibro-Touch)预测乙肝相关性肝癌患者肝切除术后发生肝衰竭价值的初步研究[D]．上海：第二军医大学，2017：1-53.
[17]	Hwang JY, Yoon HM, Kim JR, et al. Diagnostic Performance of Transient Elastography for Liver Fibrosis in Children: A Systematic Review and Meta-Analysis[J]. AJR Am J Roentgenol，2018, 211(5): W1-W10.

临床资料		数值	临床资料		数值
年龄(岁)		57.4±9.1	INR(s)		1.1±0.1
性别		?	肝脏硬度( kPa)		13.6±5.6
?	男	24(88.9)	Child-Pugh分级		?
?	女	3(11.1)	?	A	23(85.2)
身高(cm)		168.0±7.3	?	B	4(14.8)
BSA(m²)		1.7±0.2	CT测肿瘤大小(cm)		7.4±4.9
WBC(×10⁹/L)		5.2±1.6	CT测肿瘤体积(cm³)		785.7±323.2
RBC(×10¹²/L)		4.5±0.5	肝门阻断时间(min)		15.6±19.5
PLT(×10⁹/L)		134.9±62.4	手术时间(min)		137.6±69.9
ALT(U/L)		61.3±82.3	术中出血量(ml)		1237.0±1276.2
AST(U/L )		51.4±48.4	手术方式		?
TBIL(μmol/L)		16.8±8.4	?	左半肝	9(33.3)
ALB(g/L)		40.5±4.2	?	右半肝	18(66.7)
GGT(U/L)		126.6±133.5	病理肝纤维化		?
Scr(μmol/L)		67.3±11.6	?	S0～S1	6(22.2)
PIVKA-II(μg/L)		2848.5±6244.7	?	S2～S3	11(40.8)
PT(s)		12.6±1.2	?	S4	10(37.0)

临床资料		数值	临床资料		数值
年龄(岁)		57.4±9.1	INR(s)		1.1±0.1
性别		?	肝脏硬度( kPa)		13.6±5.6
?	男	24(88.9)	Child-Pugh分级		?
?	女	3(11.1)	?	A	23(85.2)
身高(cm)		168.0±7.3	?	B	4(14.8)
BSA(m²)		1.7±0.2	CT测肿瘤大小(cm)		7.4±4.9
WBC(×10⁹/L)		5.2±1.6	CT测肿瘤体积(cm³)		785.7±323.2
RBC(×10¹²/L)		4.5±0.5	肝门阻断时间(min)		15.6±19.5
PLT(×10⁹/L)		134.9±62.4	手术时间(min)		137.6±69.9
ALT(U/L)		61.3±82.3	术中出血量(ml)		1237.0±1276.2
AST(U/L )		51.4±48.4	手术方式		?
TBIL(μmol/L)		16.8±8.4	?	左半肝	9(33.3)
ALB(g/L)		40.5±4.2	?	右半肝	18(66.7)
GGT(U/L)		126.6±133.5	病理肝纤维化		?
Scr(μmol/L)		67.3±11.6	?	S0～S1	6(22.2)
PIVKA-II(μg/L)		2848.5±6244.7	?	S2～S3	11(40.8)
PT(s)		12.6±1.2	?	S4	10(37.0)

指标	1分	2分	3分
HE	无	1～2	3～4
ABD	无	轻度	中、重度
TIBL(μmol/L)	<34	34～51	>51
ALB(g/L)	>35	28～35	<28
PT(s)	<4	4～6	>6
LSM(kPa)	<15	5～25	>25

指标	1分	2分	3分
HE	无	1～2	3～4
ABD	无	轻度	中、重度
TIBL(μmol/L)	<34	34～51	>51
ALB(g/L)	>35	28～35	<28
PT(s)	<4	4～6	>6
LSM(kPa)	<15	5～25	>25

肝纤维化分期	术后病理不同的SRLV
肝纤维化分期	例数	SRLV (L/m²)	F	P
S1	6	279.0±31.1	12.799	0.000
S2～S3	11	287.3±49.1
S4	10	419.9±94.2
肝纤维化分期	术后肝功能不全时的SRLV
肝纤维化分期	例数	SRLV (L/m²)	F	P
S1	1	234.2	4.270	0.046
S2～S3	3	299.1±37.3			?	?
S4	9	429.9±94.2

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