Methods for evaluating liver reserve function before hepatectomy / 临床肝胆病杂志

At present, hepatectomy has become the preferred treatment modality for most benign and malignant hepatobiliary diseases. Liver failure is a common complication after hepatectomy, and for malignant diseases, how to remove the lesion to the maximum extent and reduce the incidence rate of liver failure after hepatectomy is the key problem at present. Accurate and adequate preoperative evaluation of liver reserve function can provide a basis for judging the progression, therapeutic outcome, and prognosis of liver diseases. There are currently various methods for evaluating liver reserve function and surgical feasibility, each with its own advantages and disadvantages, and there is still a lack of a single comprehensive evaluation method. This article reviews the characteristics of commonly used evaluation methods and related research advances.

Research advance of preoperative assessment in patients with auto liver transplantation / 中华肝胆外科杂志

Auto liver transplantation (ALT) is a treatment option for patients with liver space-occupying lesion that could not be removed by conventional surgery and severe liver trauma,which also helps alleviate the shortage of donor liver.But many problems like the preoperative assessment,the tolerance of patients to surgery and anesthesia,delayed postoperative recovery of the liver function,primary non-function,liver failure and hepatic encephalopathy and even death still need to be addressed.Thus,it is particularly important to evaluate the operative indication,completely and accurately assess the preoperative liver function and liver function reserve,and reduce the perioperative mortality and complication in order to improve the prognosis of ALT.Combined with literalure and the experience in our center,this paper summarized the research advance of preoperative assessment in patients with ALT.

The impact of different hepatic vascular occlusion methods on hepatic parenchymal function in partial hepatectomy / 中华肝胆外科杂志

Objective To investigate the impact of different hepatic vascular inflow occlusion methods on hepatic parenchymal function in partial hepatectomy.Methods Between 2009 and 2010,62 hepatocellular carcinoma (HCC) patients underwent partial hepatectomy.In 13 patients,partial hepatectomy was carried out without using any inflow occlusion (group A).In 29 patients intermittent Pringle's maneuver (group B) while in 20 patients selective hepatic inflow occlusion (group C) were used.Intraoperative indocyanine green retention rate at 15 minutes (ICGR15) was measured using pulse spectrophotometry before and during hepatectomy. Results (1) Blood loss in group A was greater than group B and C (P=0.016,P=0.001).(2) There was no significant difference in the preoperative ICGR15 values among group A,B and C.The intraoperative ICGR15 for group B was significantly higher than group A and C (P=0.011,P=0.030).(3) A significant correlation was found between the level of ICGR15 and total inflow clamp time (r =0.484,P =0.001) and blood loss (r=0.349,P=0.005),respectively.(4) Compared with group A and B,postoperative liver function recovered significantly faster in group C.Conclusion Selective hepatic inflow occlusion was useful in controlling blood loss and it was beneficial to the hepatic functional reserve in the liver remnant.