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首页> 外文期刊>Annals of Medicine and Surgery >Impact of liver volume and liver function on posthepatectomy liver failure after portal vein embolization– A multivariable cohort analysis
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Impact of liver volume and liver function on posthepatectomy liver failure after portal vein embolization– A multivariable cohort analysis

机译：门静脉栓塞术后肝体积和肝功能对肝切除术后肝功能衰竭的影响–多变量队列分析

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Background Liver failure remains a life-threatening complication after liver resection, and is difficult to predict preoperatively. This retrospective cohort study evaluated different preoperative factors in regard to their impact on posthepatectomy liver failure (PHLF) after extended liver resection and previous portal vein embolization (PVE). Methods Patient characteristics, liver function and liver volumes of patients undergoing PVE and subsequent liver resection were analyzed. Liver function was determined by the LiMAx test (enzymatic capacity of cytochrome P450 1A2). Factors associated with the primary end point PHLF (according to ISGLS definition) were identified through multivariable analysis. Secondary end points were 30-day mortality and morbidity. Results 95 patients received PVE, of which 64 patients underwent major liver resection. PHLF occurred in 7 patients (11%). Calculated postoperative liver function was significantly lower in patients with PHLF than in patients without PHLF (67 vs. 109?μg/kg/h; p?=?0.01). Other factors associated with PHLF by univariable analysis were age, future liver remnant, MELD score, ASA score, renal insufficiency and heart insufficiency. By multivariable analysis, future liver remnant was the only factor significantly associated with PHLF (p?=?0.03). Mortality and morbidity rates were 4.7% and 29.7% respectively. Conclusion Future liver remnant is the only preoperative factor with a significant impact on PHLF. Assessment of preoperative liver function may additionally help identify patients at risk for PHLF. Highlights ? Future liver remnant is the most important predictor of posthepatectomy liver failure. ? Assessment of preoperative liver function by LiMAx test identifies patients at risk for postoperative liver failure. ? Preoperative volume/function analysis should routinely be performed before extended liver resections.
机译：背景技术肝切除术后肝衰竭仍然是危及生命的并发症，并且术前难以预测。这项回顾性队列研究评估了不同术前因素对扩大肝切除和先前门静脉栓塞（PVE）后对肝切除术后肝衰竭（PHLF）的影响。方法分析接受PVE及随后肝切除的患者的特征，肝功能和肝体积。肝功能通过LiMAx测试（细胞色素P450 1A2的酶容量）确定。通过多变量分析确定了与主要终点PHLF相关的因素（根据ISGLS定义）。次要终点是30天的死亡率和发病率。结果95例接受了PVE，其中64例接受了大肝切除术。 PHLF发生在7名患者中（11％）。 PHLF患者的术后肝功能计算值显着低于非PHLF患者（67 vs. 109？g / kg / h; p？=？0.01）。通过单变量分析与PHLF相关的其他因素是年龄，未来肝残余，MELD评分，ASA评分，肾功能不全和心脏功能不全。通过多变量分析，将来的肝残余是与PHLF显着相关的唯一因素（p？=？0.03）。死亡率和发病率分别为4.7％和29.7％。结论未来的肝脏残留是影响PHLF的唯一术前因素。术前肝功能的评估可能还有助于确定有PHLF危险的患者。强调 ？未来的肝脏残留是肝切除术后肝衰竭的最重要预测指标。 ？通过LiMAx测试评估术前肝功能可确定有术后肝衰竭风险的患者。 ？在扩大肝脏切除之前，应常规进行术前体积/功能分析。

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