| Objective To investigate a method for assessment of hepatic functional reserve for successful hepatectomy in Chinese patients with HBV-related hepatocellular carcinoma.Methods We studied 129 patients underwent resection of HBV-related hepatocellular carcinoma and compared the predictive values of three assessment of hepatic functional.Results Thirteen patients (10 percent) suffered liver failure and one (0.8 percent) died in hospital. The frequency of major hepatectomy, ages and indocyanine green retention rate at 15 min (ICGR15) were significantly higher, in patients with liver failure than in those without. The decision tree method and the ICGR15 method have values of assessment of liver function for successful hepatectomy(P <0.01). The sensitivity, specificity, the positive predictive value and the negative predictive value of decision tree method were 95%,84%,64%,98%, higher than ICGR15 method. Conclusions The decision tree method and is useful for evaluating the hepatic functional reserve for hepatectomy in patients with HBV-related hepatocellular carcinoma.Objective To assess the change of Indocyanine green retention rate at 15 min in hepatectomy and the onset of post-hepatectomy liver insufficiency. Methods ICGR15 was measured in real time by using pulse spectrophotometry before and during hepatectomy in 31 patients with hepatitis B virus-related cirrhosis who underwent various types of hepatectomies for hepatocellular carcinoma (HCC). Results Seven of 31 the patients (22.5%) developed post-hepatectomy liver insufficiency. In a logistic regression model, the ICGR15 value in operations was the only significant predictor of postoperative liver insufficiency (p=0.035). An ICGR15op value of 17.15% was the cut-off value for post-hepatectomy liver insufficiency by a Receiver Operating Characteristic (ROC) curve. There was a significant increase in ICGR15 value. Significant correlation was found between the increase in ICGR15 value and total clamp time, blood lose and resected liver volume. Conclusions The ICGR15op value based on the combination of residual liver function and the injured by surgery is useful in predicting the postoperative insufficiency.Objective To investigate the protective effects of S-adenosyl-L-methionine (SAMe) therapy on post-hepatectomy residual liver function. Methods We studied 59 patients underwent resection of hepatocellular carcinoma. 29 paients were randomly assigned to receive postoperative intracenous SAMe treatment, and 30 were randomly assigned to a control group. The postoperative SAMe therapy consisted of SAMe 1000mg given intravenously for 5 days. The other postoperative treatment was standardized. Results At inclusion into the trial no significant differences were observed between the two groups with respect to sex, age, previous episodes of major complications of cirrhosis, Child classification and postoperative liver function tests, introperative blood lose, total time of hilar blocking and the extent of liver resection. The overall post-operative liver insufficiency at the end of the trial decreased from 26.7% in the control group to 6.9% in the SAMe group, and the difference was statistically significant (P=0.040). When patients with clamp time of hilar blocking less than 15 min were excluded from the analysis, the Serum total bilirubin on 5 and 7 preoperatively and he maximum value of postoperative Serum total bilirubin were significantly greater in the control group than in the SAMe group (P=0.049; P=0.030; P=0.040). Conclusions The present results indicate that the post-operative SAMe therapy may protect residual liver function in patients underwent hepatectomy, especially in those with long clamp time. |
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