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Objective To explore the relationship between the values of total tumor perfusion parameters in primary hepatocellular carcinoma and tumor volume and peritumoral perfusion parameters,and analyze its correlation with liver ChildPugh classification.Methods Forty-seven patients with primary liver cancer in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2015 were selected to perform 320 row volume CT perfusion imaging.The parameters of hepatic artery perfusion(HAP),portal vein perfusion(PVP) and hepatic perfusion index(HAPI) in tumor and peritumoral liver tissues were calculated based on total tumor measurement.The relationship between tumor perfusion parameters and ChildPugh classification of liver function,tumor volume and total tumor perfusion parameters,total tumor perfusion parameters and peritumoral perfusion parameters were analyzed.Results There was no correlation between tumor volume and total tumor perfusion parameters,peritumoral perfusion parameters (P ＞ 0.05),and there was no correlation between total tumor perfusion parameters and peritumoral perfusion parameters(P ＞0.05).There were significant differences between HAP,PVP and HAP of total tumor perfusion in different liver Child-Pugh classifications(P ＜ 0.05).With the increase of Child-Pugh classification of liver function,the HAP and HAPI of tumor gradually increased while PVP gradually decreased (P ＜ 0.05).Conclusions There is no correlation between tumor volume,total tumor perfusion parameters and peritumoral perfusion parameters.There is also no correlation between total tumor perfusion parameters and peritumoral perfusion parameters.There are significant differences in perfusion parameters between different Child-Pugh classifications of liver function,and the perfusion parameters obtained by the total tumor measurement can be used as the imaging indexes to reflect liver reserve function.
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Objective To evaluate hepatic functional reserve and operational risks of primary hepatic carcinoma in Child A using functional CT.Methods In 128 cases of primary hepatic carcinoma of Child A undergoing hepatoectomy and identified by pathology, CT perfusion scanning and measurement of remannent hepatic volume were done before operation and whole patients were divided in-to acute hepatic failure group(AHF group,33 cases)and non-acute hepatic failure(non-AHF group,95 cases).All variables were ana-lyzed by one way analysis of variance(one-way ANOVA)firstly.The variables with significance (P<0.05)were analyzed with Step-wise Logistic regression further.Results One-way ANOVA result:There were significant difference between two groups in RHVS measured by CT,PVP,HBF,HBV,serum creatinine,thrombinogen activity,total bilirubin and intraoperative blood loss (P<0.05).The StepwiseLogistic regression analysis demonstrated that decreased RHVS and the lowed PVP were the independent risk factors of AHF complicated to hepatoectomy of primary hepatic carcinoma(P<0.01).Conclusion Hepatic functional reserve and operational risks of primary hepatic carcinoma could be j udged with functional CT before operation .
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Asialogycoprotein receptor (ASGPR) is a specific receptor of mammalian hepatocytes,exclusively up-take the glycoprotein in the blood.The number of ASGPR correlates significantly with liver function,and the reduction of the number of ASGPR suggest liver dysfunction.Decreased ASGPR in patients with liver cirrhosis or portal hypertension or hepatocellar carcinoma,lead to varying degrees of liver dysfunction,which made it more susceptible to post operative complications.liver ASGPR scintigraphy with Technetium-99 m DTPA-galactosyl human serum albumin (99m Tc-GSA),combinating with single photon emission computed tomography (SPECT) technology can assess the functional reserve of remnant liver and predict incidence of postoperative complications,then assist to evaluate the use fulness for clinically surgical decisions.Current situation and progress of 99mTc-GSA SPECT imaging in hepatic surgery were reviewed in the paper.
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Liver resection is the most efficiency measure to treat the liver cancer at present. About 80% patients with liver cancer encounter inordinately hepatocirrhosis. The regeneration of liver tissue in the patients with hepatocirrhosis is poor, liver functional reserve reduces, those patients with liver cancer combined with hepotocirrhosis will face greater risks when they receive hepatoectomy. Liver failure is the leading cause of death after hepatic resection. So we must attach importance to the assessment of liver functional reserve before operation. Here this article mostly summarizes the comprehensive assessment of hepatic functional reserve before operation in liver cancer patients.
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Objective To investigate the value of quantitative assessment of hepatic fibrosis and indocyanine green measurement in predicting hepatic functional reserve in rats with liver cirrhosis.Methods Female Wister rats were divided into normal control and cirrhotic group,and cirrhotic models were established.Quantitative assessment of hepatic fibrosis was done by use of computer-assisted digital image analysis,and R15ICG was measured.Results Differences of R15ICG and quantitative assessment of hepatic fibrosis between the two groups at 8 and 10 weers after hepatic fibrosis model was established were statistically significant(P
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BACKGROUND: Central bisegmentectomy (CBS) of the liver is a resection of the medial and anterior segments for preserving more liver parenchyma and reaching the goal of a curative resection simultaneously. PURPOSE: In this paper, we describe the indications and the techniques for this surgical procedure. PATIENTS AND METHODS: We reviewed the case histories of 14 patietns who had undergone a CBS, including 9 with a hepatocellular carcinoma, 4 with hilar bile-duct cancer, 1 with metastatic colon cancer, and 1 with gallbladder cancer. Eight patients had undergone a CBS with an operating time of only 353 minutes; 5 cases had undergone a CBS and a caudate lobectomy plus bile-duct resection, requiring an operating time of 762 minutes. A hepaticojejunostomy to right posterior hepatic duct was added to one CBS case because of intrahepatic ductal variation. The surgical technique for the CBS only procedure was as follows: demarcation of the dissection line with a selective block of the glissonian cord, division of the medial and the lateral segments along the falciform ligament to expose the left hepatic vein, and division of the anterior and the posterior segments along the right hepatic vein. In the combined bile-duct-resection cases, complete dissection of the hepatoduodenal ligament and biliary reconstruction were added. RESULTS: The extent of liver resection, as estimated by CT volumetry, was about 42%, and the mean value of the real weights of the specimens was 474 gm. The preoperative hepatic function showed a 9.3% indocyanine-green retention rate at 15 minutes, and 5 out of 9 hepatocellular carcinoma cases revealed concomitant liver cirrhosis. For CBS and additional procedures, the curative resection rate reached 93%, and the survival rate was favorable. There were no operative mortalities or hepatic failures. CONCLUSIONS: For selected cases of centrally located liver tumors or hilar bile-duct cancer with limited hepatic reserve, CBS may provide a safe, curative resection.
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Humans , Carcinoma, Hepatocellular , Colonic Neoplasms , Gallbladder Neoplasms , Hepatic Duct, Common , Hepatic Veins , Ligaments , Liver Cirrhosis , Liver , Mortality , Survival Rate , Weights and MeasuresABSTRACT
700 mL/min).Conclusion The CLh-s could be correlated with operation complications,and be considered as an effective supplement to evaluate hepatic functional reserve when combined with ICGR15 and Child-Pugh classification. It could be used to evaluate liver functional reserve more effectively and reliably.