Confirmation Of Definition Of Posthepatectomy Liver Dysfunction And Formula Of Safe Volume In Hepatic Resection In Marked Obstructive Jaundice Status

Objective:(1) To verify the definition (the TB7>104.35μmol/l and the "b" value>-0.032) of posthepatectomy liver dysfunction in marked obstructive jaundice status by retrospective analysis of clinical datas of hilar cholangiocarcinoma underwent major hepatic resection, and to explore the directive significance to the clinical work.(2) To verify accuracy of formula (SRLVR=0.086×LnPBV+0.013) of safe volume in hepatic resection in marked Obstructive jaundice status, and to explore the feasibility of formula used in clinical work.Methods:(1) Preoperative factors, postoperative factors and early complications of patients with the treatment of major hepatic resection of hilar cholangiocarcinoma in Department of Hepatobiliary Surgery of General Hospital of PLA from May2011to September2013were respectively studied. According to the definition of posthepatectomy liver dysfunction in marked obstructive jaundice status,102cases with hilar cholangiocarcinoma were divided into posthepatectomy liver dysfunction group (PHLD group) and non posthepatectomy liver dysfunction group (Non-PHLD group). Comparison between the two groups and analysis of the clinical practice was made.(2) Intraoperative factors postoperative factors and early complications of patients above-mentioned were respectively studied. According to the formula of safe volume in hepatic resection in marked obstructive jaundice status,102cases with hilar cholangiocarcinoma were divided into the conformity group and inconformity group to "SRLVR" formula. The accuracy of the "SRLVR" formula was analysed.Results:(1) We got the posthepatectomy liver dysfunction group (PHLD group), with15cases and no posthepatectomy liver dysfunction group (Non-PHLD group) with87cases from102patients with hilar cholangiocarcinoma. There was significant difference in postoperative INR, ALT, AST, postoperative complications, infectious complications, major complications, mean length of hospital stay and tumor recurrence between the difference two groups (P<0.05). There was no significant difference in preoperative INR, ALB, ALT and AST between the difference two groups (P>0.05).(2) We got the conformity group with79cases and inconformity group with23cases to "SRLVR" formula from102patients with hilar cholangiocarcinoma. The incidence of posthepatectomy liver dysfunction in the conformity group was far less than that in inconformity group to "SRLVR" formula (P <0.001). Vascular resection and reconstruction and hepatic pedicle clamping were independent risk factors to posthepatectomy liver dysfunction (P<0.05). There was significant difference in postoperative INR, ALT, postoperative complications (including infectious complications and major complications) and mean length of hospital stay between the difference two groups (P<0.05). The sensitivity of "SRLVR" formula predicting the occurrence of posthepatectomy liver dysfunction was80%.Conclusions:(1) The definition (the TB7>104.35μmol/l and the "b" value>-0.032) can be used as the gold standard of posthepatectomy liver dysfunction in marked obstructive jaundice status, and had good guiding significance to the clinical work.(2) The formula (SRLVR=0.086×LnPBV+0.013) of safe volume in hepatic resection in marked Obstructive jaundice status was safe and effective. It could help the surgeon to make an operation plan, and reduce the incidence of posthepatectomy liver dysfunction. The formula has the feasibility to use in clinical work.