Analysis Of Relative Factors Affecting Early Remnant Liver Regeneration After Major Hepatectomy

Objective: To observe and analyze the remnant liver regeneration of patients with major hepatectomy(standard left/right hepatectomy,enlarged left/right hepatectomy,irregular left/right hepatectomy)within 3 months after the operation;To explore the relevant clinical imaging and biochemical pathological factors affecting remnant liver regeneration.In order to provide clinical basis for the prevention of complications after major hepatectomy,the accurate formulation of preoperative surgical plan and the accurate prediction of postoperative remnant liver regeneration.Method: Retrospective analysis was performed on the clinical data of patients who underwent major hepatectomy(including standard left/right hepatectomy,extended left/right hepatectomy,and irregular left/right hepatectomy)in the department of hepatobiliary surgery and organ transplantation of our hospital from January 2014 to December 2018.A total of 53 patients with incomplete clinical data were included in this study.All the 53 patients underwent hepatogallbladder thin layer enhanced CT or liver enhanced MRI before and within 3 months after operation.Myrian software system from Germany was used to conduct three-dimensional liver reconstruction in patients with preoperative and postoperative medical imaging examination.The total volume of the liver,the volume of the liver to be removed,the volume of the reserved liver,and the volume of the liver within 3 months after hepatectomy were measured.To compare and analyze the clinical imaging and biochemical pathological indexes related to the rate of monthly reserved liver hyperplasia and the patients before,during and after operation.Univariate and multivariate analyses were carried out to investigate the clinical imaging and biochemical pathologic factors that clearly affect the significant correlation of reserved liver regeneration after major hepatectomy.Results: The rate of remnant liver hyperplasia at 1,2 and 3 months after major hepatectomy was 37.26±12.96%,55.14±20.43% and 84.10±20.33%,respectively,indicating that reserved liver regeneration mainly occurred within 3 months,and the regeneration was more obvious in the first month after surgery.The results of single factor analysis showed that age(P=0.010),preoperative PT(P=0.002),preoperative PTA(P=0.042),preoperative creatinine(P=0.021),the standard liver ratio of the reserved liver(P=0.006),the presence or absence of cirrhosis(P=0.042)and the abdominal water volume(P=0.004)on the 7th day after the operation had significant differences(P <0.05).The results of multivariate Logistic analysis showed that age(P=0.023,OR=0.080),preoperative PT(P=0.009,OR=0.049),standard liver volume ratio(P=0.007,OR=0.001),and abdominal water volume on the 7th day after surgery(P=0.038,OR=0.092)were significantly correlated independent risk factors for early remnant liver regeneration after major hepatectomy(P < 0.05).Conclusion: After major hepatectomy,reserved liver hyperplasia mainly occurred within3 months,and the regeneration was more obvious in the first month after surgery.Patient age,preoperative PT,reserved liver/standard liver volume ratio,and abdominal water volume on day 7 after surgery were independent risk factors for early remnant liver regeneration after major hepatectomy.The above results provide important clinical basis for the prevention of complications after major hepatectomy,the accurate formulation of preoperative surgical plans and the accurate prediction of postoperative remnant liver regeneration.