AIM： To explore a method for quantitative assessment of hepatic functional reserve by combining computed tomography （CT） volumetry with CT grading of liver cirrhosis before liver resection in patients with hepatoce...AIM： To explore a method for quantitative assessment of hepatic functional reserve by combining computed tomography （CT） volumetry with CT grading of liver cirrhosis before liver resection in patients with hepatocellular carcinoma. METHODS： CT images of 55 patients undergoing liver resection were studied prospectively. The degree of liver cirrhosis was referred as ＂CT grade＂ and the percentage of remnant liver volume （PRLV） [PRLV = predicted RLV/predicted total liver volume （PTLV） × 100%; PTLV （mL） = 121.75 ＋ 16.49 × body mass （kg）] were calculated by adding slice by slice of CT liver images. The postoperative RLV, pathologic stages of liver fibrosis in non-tumor area and survival time in these cases were analyzed. RESULTS： There was a significant difference in survival time between the group with PRLV ≤ 50% and the group with PRLV 〉 50% （X^2= 4.988, P = 0.026）, and between the group with CT grade 0/1 and the group with CT grade 2/3 （X^2= 5.429, P = 0.026）. With combination of the both parameters, an oblique line was identified according to the distribution of 32 survivors versus 23 deceased subjects. The mortality rate above the line was 7.1% （1/14）, and that below the line was 53.7% （22/41）, indicating a significant difference between the two rates （X^2 = 9.281, P = 0.002, P 〈 0.05）. CONCLUSION： PRLV and CT grades are significantly correlated with hepatic functional reserve. The predicted line using these two parameters is useful in candidates undergoing liver resection for judging hepatic functional reserve.展开更多
BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-relat...BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year.Consequently,how to control portal hypertension,improve liver functional reserve,and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention.Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt(TIPS),the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcoholinduced and immune cirrhosis,which may be related to the effective etiological treatment.AIM To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China(2019)in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS.METHODS The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively.According to different anti-viral drugs,the patients were divided into entecavir(ETV)(n=70),tenofovir alafenamide fumarate(TAF)(n=32),and tenofovir disoproxil fumarate(TDF)(n=35)groups.The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma,survival,and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated.RESULTS At 24 mo after surgery,the Child-Pugh score in the TAF group(6.97±0.86)was lower than that in the TDF(7.49±0.82;t=-2.52,P=0.014)and ETV groups(7.64±1.17;t=-2.92,P=0.004).The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72±1.5,which was lower than that in the TDF(10.74±2.33;t=-2.09,P=0.040)and ETV groups(10.97±2.17;t=-2.93,P=0.004).At 24 mo after surgery,the estimated glomerular filtration rate(eGFR)in the TAF group(104.41±12.54)was higher than that in the TDF(93.54±8.97)and ETV groups(89.96±9.86)(F=21.57,P<0.001).CONCLUSION At 24 mo after surgery,compared with TDF and ETV,TAF has significant advantages in the improvement of liver functional reserve and eGFR.展开更多
AIM To provide a simple surrogate marker predictive of liver cirrhosis(LC).METHODS Specimens from 302 patients who underwent resection for hepatocellular carcinoma between January 2006 and December 2012 were retrospec...AIM To provide a simple surrogate marker predictive of liver cirrhosis(LC).METHODS Specimens from 302 patients who underwent resection for hepatocellular carcinoma between January 2006 and December 2012 were retrospectively analyzed. Based on pathologic findings, patients were divided into groups based on whether or not they had LC. Parameters associated with hepatic functional reserve were compared in these two groups using MannWhitney U-test for univariate analysis. Factors differing significantly in univariate analyses were entered into multivariate logistic regression analysis.RESULTS There were significant differences between the LC group(n = 100) and non-LC group(n = 202) in prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin, albumin, cholinesterase, type Ⅳ collagen, hyaluronic acid, indocyanine green retention rate at 15 min, maximal removal rate of technitium-99 m diethylene triamine pentaacetic acid-galactosyl human serum albumin and ratio of mean platelet volume to platelet count(MPV/PLT). Multivariate analysis showed that prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin and hyaluronic acid, and MPV/PLT ratio were factors independently predictive of LC. The area under the curve value for MPV/PLT was 0.78,with a 0.8 cutoff value having a sensitivity of 65% and a specificity of 78%.CONCLUSION The MPV/PLT ratio, which can be determined simply from the complete blood count, may be a simple surrogate marker predicting LC.展开更多
Objective: To evaluate retrospectively the feasibility and effect of hepatic trisegmentectomy in therapy of huge neoplasms of the liver. Methods: From July 1993 to October 1999, 29 pa- tients with huge hepatic neoplas...Objective: To evaluate retrospectively the feasibility and effect of hepatic trisegmentectomy in therapy of huge neoplasms of the liver. Methods: From July 1993 to October 1999, 29 pa- tients with huge hepatic neoplasms underwent hepatic trisegmentectomy. Of these, 23 patients suffered from primary liver cancer, 1 hepatic infiltration of gallbladder cancer, 1 metastasis of colon cancer, 1 hepatic angiosarcoma, 1 hepatic neurofibroma, and 2 huge liver cysts. Twenty-six patients were subjected to right trisegmentectomy and the rest 3 left triseg- mentectomy. All trisegmentectomies were performed under normothermic interruption of the porta hepatis at single time and these interruptions lasted 15 to 40 minutes. Results: The relatively good effect was seen in our se- ries. The 1-, 3-, 5-year survival rates for primary liver cancer patients were 63.6%, 36.4% and 27.3 %, respectively. The survival period for the pa- tients with hepatic infiltration of gallbladder cancer and liver metastasis of colon cancer was 6 months. Those with hepatic angiosarcoma, hepatic neurofi- broma and huge liver cysts have been surviving 35, 26, 25 and 40 months, respectively. Major complica- tions were noted in 5 patients, and one (3.4%, 1/29) died. Conclusion: Hepatic trisegmentectomy is safe and ef- fective in treatment of huge hepatic neoplasms if its indications and operative techniques are properly mastered.展开更多
本文推荐了一种术中主要按照肝表面最大硬化结节大小评估肝硬化程度的分级标准。肝脏表面最大硬化结节直径<0.4 cm 为轻度肝硬化;0.4～0.8 cm 为中度肝硬化;>0.8 cm,或肝脏明显缩小变形,为重度肝硬化。按照此标准分级,统计表明随...本文推荐了一种术中主要按照肝表面最大硬化结节大小评估肝硬化程度的分级标准。肝脏表面最大硬化结节直径<0.4 cm 为轻度肝硬化;0.4～0.8 cm 为中度肝硬化;>0.8 cm,或肝脏明显缩小变形,为重度肝硬化。按照此标准分级,统计表明随着肝硬化程度的加重,尽管手术切除的肝组织量减少,但术后出现肝功不全(尤其是重度肝功不全)发生率逐渐增加。提示根据我们的标准进行肝硬化的分级,术中评估肝储备功能有临床实用价值,有助于选择适当的手术方式,减少肝功能衰竭的发生。展开更多
基金Supported by the Natural Science Foundation of Hainan Province, No. 30527
文摘AIM： To explore a method for quantitative assessment of hepatic functional reserve by combining computed tomography （CT） volumetry with CT grading of liver cirrhosis before liver resection in patients with hepatocellular carcinoma. METHODS： CT images of 55 patients undergoing liver resection were studied prospectively. The degree of liver cirrhosis was referred as ＂CT grade＂ and the percentage of remnant liver volume （PRLV） [PRLV = predicted RLV/predicted total liver volume （PTLV） × 100%; PTLV （mL） = 121.75 ＋ 16.49 × body mass （kg）] were calculated by adding slice by slice of CT liver images. The postoperative RLV, pathologic stages of liver fibrosis in non-tumor area and survival time in these cases were analyzed. RESULTS： There was a significant difference in survival time between the group with PRLV ≤ 50% and the group with PRLV 〉 50% （X^2= 4.988, P = 0.026）, and between the group with CT grade 0/1 and the group with CT grade 2/3 （X^2= 5.429, P = 0.026）. With combination of the both parameters, an oblique line was identified according to the distribution of 32 survivors versus 23 deceased subjects. The mortality rate above the line was 7.1% （1/14）, and that below the line was 53.7% （22/41）, indicating a significant difference between the two rates （X^2 = 9.281, P = 0.002, P 〈 0.05）. CONCLUSION： PRLV and CT grades are significantly correlated with hepatic functional reserve. The predicted line using these two parameters is useful in candidates undergoing liver resection for judging hepatic functional reserve.
文摘BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year.Consequently,how to control portal hypertension,improve liver functional reserve,and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention.Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt(TIPS),the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcoholinduced and immune cirrhosis,which may be related to the effective etiological treatment.AIM To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China(2019)in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS.METHODS The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively.According to different anti-viral drugs,the patients were divided into entecavir(ETV)(n=70),tenofovir alafenamide fumarate(TAF)(n=32),and tenofovir disoproxil fumarate(TDF)(n=35)groups.The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma,survival,and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated.RESULTS At 24 mo after surgery,the Child-Pugh score in the TAF group(6.97±0.86)was lower than that in the TDF(7.49±0.82;t=-2.52,P=0.014)and ETV groups(7.64±1.17;t=-2.92,P=0.004).The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72±1.5,which was lower than that in the TDF(10.74±2.33;t=-2.09,P=0.040)and ETV groups(10.97±2.17;t=-2.93,P=0.004).At 24 mo after surgery,the estimated glomerular filtration rate(eGFR)in the TAF group(104.41±12.54)was higher than that in the TDF(93.54±8.97)and ETV groups(89.96±9.86)(F=21.57,P<0.001).CONCLUSION At 24 mo after surgery,compared with TDF and ETV,TAF has significant advantages in the improvement of liver functional reserve and eGFR.
文摘AIM To provide a simple surrogate marker predictive of liver cirrhosis(LC).METHODS Specimens from 302 patients who underwent resection for hepatocellular carcinoma between January 2006 and December 2012 were retrospectively analyzed. Based on pathologic findings, patients were divided into groups based on whether or not they had LC. Parameters associated with hepatic functional reserve were compared in these two groups using MannWhitney U-test for univariate analysis. Factors differing significantly in univariate analyses were entered into multivariate logistic regression analysis.RESULTS There were significant differences between the LC group(n = 100) and non-LC group(n = 202) in prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin, albumin, cholinesterase, type Ⅳ collagen, hyaluronic acid, indocyanine green retention rate at 15 min, maximal removal rate of technitium-99 m diethylene triamine pentaacetic acid-galactosyl human serum albumin and ratio of mean platelet volume to platelet count(MPV/PLT). Multivariate analysis showed that prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin and hyaluronic acid, and MPV/PLT ratio were factors independently predictive of LC. The area under the curve value for MPV/PLT was 0.78,with a 0.8 cutoff value having a sensitivity of 65% and a specificity of 78%.CONCLUSION The MPV/PLT ratio, which can be determined simply from the complete blood count, may be a simple surrogate marker predicting LC.
文摘Objective: To evaluate retrospectively the feasibility and effect of hepatic trisegmentectomy in therapy of huge neoplasms of the liver. Methods: From July 1993 to October 1999, 29 pa- tients with huge hepatic neoplasms underwent hepatic trisegmentectomy. Of these, 23 patients suffered from primary liver cancer, 1 hepatic infiltration of gallbladder cancer, 1 metastasis of colon cancer, 1 hepatic angiosarcoma, 1 hepatic neurofibroma, and 2 huge liver cysts. Twenty-six patients were subjected to right trisegmentectomy and the rest 3 left triseg- mentectomy. All trisegmentectomies were performed under normothermic interruption of the porta hepatis at single time and these interruptions lasted 15 to 40 minutes. Results: The relatively good effect was seen in our se- ries. The 1-, 3-, 5-year survival rates for primary liver cancer patients were 63.6%, 36.4% and 27.3 %, respectively. The survival period for the pa- tients with hepatic infiltration of gallbladder cancer and liver metastasis of colon cancer was 6 months. Those with hepatic angiosarcoma, hepatic neurofi- broma and huge liver cysts have been surviving 35, 26, 25 and 40 months, respectively. Major complica- tions were noted in 5 patients, and one (3.4%, 1/29) died. Conclusion: Hepatic trisegmentectomy is safe and ef- fective in treatment of huge hepatic neoplasms if its indications and operative techniques are properly mastered.
文摘本文推荐了一种术中主要按照肝表面最大硬化结节大小评估肝硬化程度的分级标准。肝脏表面最大硬化结节直径<0.4 cm 为轻度肝硬化;0.4～0.8 cm 为中度肝硬化;>0.8 cm,或肝脏明显缩小变形,为重度肝硬化。按照此标准分级,统计表明随着肝硬化程度的加重,尽管手术切除的肝组织量减少,但术后出现肝功不全(尤其是重度肝功不全)发生率逐渐增加。提示根据我们的标准进行肝硬化的分级,术中评估肝储备功能有临床实用价值,有助于选择适当的手术方式,减少肝功能衰竭的发生。
