肝硬度检测在肝切除围手术期的应用

Application of liver stiffness measurement during perioperative period of hepatectomy

目的 探讨术前利用瞬时弹性成像行肝硬度检测(liver stiffness measurement, LSM)在肝切除围手术期中的作用。方法 回顾性收集华中科技大学同济医学院附属同济医院肝脏外科中心2021年9月至2021年12月行肝切除术并在术前利用瞬时弹性成像行LSM的病例,按LSM值12 kPa为临界值将病例分为肝硬化组(LSM≥12 kPa)和对照组(LSM<12 kPa),统计分析组间围手术期情况及术后并发症的差异,然后通过logistic回归分析与术后并发症相关的危险因素。结果 肝硬化组(34例)与对照组(46例)比较,以下指标更高:总胆红素[(15.19±10.23)μmol/L比(10.74±5.85)μmol/L,P=0.029],谷丙转氨酶[(34.26±19.33) U/L比(24.09±11.91) U/L,P=0.010],谷草转氨酶[(39.71±19.57) U/L比(24.26±11.26) U/L,P<0.001];而以下指标较低:血小板计数[(140.10±77.93)×10^(9)/L比(189.80±81.62)×10^(9)/L,P=0.008],白蛋白[(38.18±3.48) g/L比(40.31±5.14) g/L,P=0.032]。同时肝硬化组与对照组比较,肝硬化组更倾向于行开腹手术[61.8%(21/34)比30.4%(14/46),P=0.005],术后具有更高的严重并发症发生率[38.2%(13/34)比2.2%(1/46),P<0.001]及更长的术后住院时间[(10.88±5.61) d比(8.15±3.17) d,P=0.015]。logistic回归分析表明LSM≥12 kPa[OR=1.069, 95%CI(1.022,1.126),P=0.006]是出现严重并发症的独立危险因素。结论 肝硬度值是评估病人围手术期情况的重要指标,肝切除术后需重点关注LSM≥12 kPa病人的并发症情况。

Objective To explore the role of preoperative liver stiffness measurement by transient elastography during perioperative period of hepatectomy.Methods Serial cases of hepatectomy performed at Tongji Hospital were retrospectively reviewed from September 2021 to December 2021.Liver stiffness was detected preoperatively by transient elastography.They were assigned into two groups of cirrhosis and control according to the critical value of 12 kPa of liver stiffness.The inter-group differences in perioperative conditions and postoperative complications were statistically analyzed.Then risk factors associated with postoperative complications were analyzed by logistic regression.Results Compared with control group(n=46),cirrhosis group(n=34)had higher levels of bilirubin[(15.19±10.23)vs.(10.74±5.85)μmol/L,P=0.029],alanine aminotransferase[(34.26±19.33)vs.(24.09±11.91)U/L,P=0.010]and aspartate aminotransferase[(39.71±19.57)vs.(24.26±11.26)U/L,P<0.001],as well as lower levels of platelet[(140.10±77.93)×10^(9)/L vs.(189.80±81.62)×10^(9)/L,P=0.008]and albumin[(38.18±3.48)vs.(40.31±5.14)g/L,P=0.032].Cirrhosis group were more likely to undergo open surgery[61.8%(21/34)vs.30.4%(14/46),P=0.005]with a higher rate of major complications[38.2%(13/34)vs.2.2%(1/46),P<0.001]and a longer postoperative hospital stay[(10.88±5.61)vs.(8.15±3.17)days,P=0.015].Logistic regression analysis indicated that LSM≥12 kPa[OR=1.069,95%CI(1.022,1.126),P=0.006]was an independent risk factor for major complications.Conclusion Liver stiffness value is an important indicator for evaluating perioperative condition of patients.And it is necessary to focus upon the complications of patients with LSM≥12 kPa after hepatectomy.