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Evaluation of Liver Function and the Role of Biliary Drainage before Major Hepatic Resections
Visceral Medicine ( IF 1.9 ) Pub Date : 2020-12-11 , DOI: 10.1159/000512439
Yuzo Yamamoto 1
Affiliation  

Background: Prevention of posthepatectomy liver failure is a prerequisite for improving the postoperative outcome of perihilar cholangiocarcinoma. From this perspective, appropriate assessment of future liver remnant (FLR) function and the optimized preparation are mandatory. Summary: FLR volume ratio using CT volumetry based on 3-dimensional vascular imaging is the current assessment yardstick and is sufficient for assessing a normal liver. However, in a liver with underling parenchymal disease such as fibrosis or prolonged jaundice, weighing up the degree of liver damage against the FLR volume ratio is necessary to know the real FLR function. For this purpose, the indocyanine green (ICG) clearance test, monoethylglycinexylidide (MEGX) test, liver maximum capacity (LiMAX) test, 99mTc-labeled galactosyl human serum albumin (99mTc-GSA) scintigraphy, albumin-bilirubin (ALBI) grade, and ALPlat (albumin × platelets) criterion are used. After the optimization of FLR function by means of portal vein embolization or associating liver partition and PVL (portal vein ligation) for staged hepatectomy (ALPPS), SPECT scintigraphy with either 99mTc-GSA or 99mTc-mebrofenin compensates for misestimation due to the regional heterogeneity of liver function. The role of preoperative biliary drainage has long been debated, with the associated complications having led to a lack of approval. However, the recent establishment of safety and an improvement in success rates of endoscopic biliary drainage seem to be changing the awareness of the importance of biliary drainage. Key Messages: Appropriate selection of an assessment method is of prime importance to predict the FLR function according to the preoperative condition of the liver. Preoperative biliary drainage in patients with perihilar cholangiocarcinoma is gaining support due to the increasing safety and success rate, especially in patients who need optimization of their liver function before hepatectomy.
Visc Med


中文翻译:

肝大切除术前肝功能评估和胆道引流的作用

背景:预防肝切除术后肝功能衰竭是改善肝门周围胆管癌术后预后的先决条件。从这个角度来看,必须对未来的残肝 (FLR) 功能进行适当评估和优化准备。摘要:使用基于 3 维血管成像的 CT 体积法的 FLR 体积比是当前的评估标准,足以评估正常肝脏。然而,对于伴有纤维化或黄疸延长等潜在实质疾病的肝脏,需要权衡肝损伤程度与 FLR 体积比,才能了解真正的 FLR 功能。为此目的,吲哚菁绿(ICG)清除试验、单乙基甘氨酸酯(MEGX)试验、肝脏最大容量(LiMAX)试验, 99m使用 Tc 标记的半乳糖基人血清白蛋白 ( 99m Tc-GSA) 闪烁显像、白蛋白-胆红素 (ALBI) 分级和 ALPlat(白蛋白 × 血小板)标准。在通过门静脉栓塞或联合肝分区和 PVL(门静脉结扎)进行分期肝切除术 (ALPPS) 优化 FLR 功能后,使用99m Tc-GSA 或99m进行 SPECT 闪烁扫描由于肝功能的区域异质性,Tc-mebrofenin 弥补了错误估计。术前胆道引流的作用长期以来一直存在争议,相关并发症导致缺乏批准。然而,最近确立的安全性和内镜胆道引流成功率的提高似乎正在改变人们对胆道引流重要性的认识。关键信息:根据肝脏的术前状况选择合适的评估方法对于预测 FLR 功能至关重要。由于安全性和成功率的提高,肝门周围胆管癌患者的术前胆汁引流获得了支持,特别是在肝切除术前需要优化肝功能的患者。
粘性医学
更新日期:2020-12-11
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