Evaluation Of Liver Reserve Function Before And After Transcatheter Arterial Chemoembolization And Investigation On The Correlated Indexes

Objective: To evaluate the changes of liver reserve function due to TACE. Trying to make an easy useful method to estimate liver reserve function perioperation.Materials and Methods: 21 patients of hepatocellular carcinoma on the stages ofⅠa～Ⅱc. 1)Using hyaluronic acid (HA), total bile acid (TBA), prothrombin time (PT), total bilirubin (TBIL), albumin (ALB) to form a liver reserve function classification, as follows: HA＜150ng/ml,PT postpone＜3 seconds,TAB＜15umol/L,TBIL＜34umol/L,ALB＞35g/L score 1, HA150-200ng/ml,PT postpone 3-5seconds,TAB15-42umol/L,TBIL34-51umol/L,ALB 28-35g/L score 2, HA＞200ng/ml,PT postpone＞5 seconds,TAB＞42umol/L,TBIL＞5 lumol/L,ALB＜28g/L score 3, patients were classified as liver reserve function grade 1 (score 5-6), grade 2 (score 7-9), grade 3(score 10-15). To assess the changes of liver reserve function by the liver reserve function score and child-pugh score respectively at the time of 1-3 days before TACE, 3-7 days and 4-6 weeks after TACE. 2) Using hepatic arterial perfusion (HAP), portal perfusion (PVP) and hepatic arterial perfusion index (HPI) obtained by dynamic CT as indexes to estimate liver reserve function at 1-3 days preoperative and 4-6 weeks postoperative. Statistically analyze the changes of liver reserve function under different situations such as embolization level, lipiodol using amount and tumor size and the correlation between hepatic parenchyma perfusion and liver reserve function.Result: 1) Liver reserve function classification was highly correlate to Child-Pugh classification but more sensitive than Child-Pugh classification. 2) Significant changes of the indicators of liver reserve function were seen in the patients who undergone embolization at the level of proper hepatic artery, left hepatic artery or right hepatic artery and seen in the patients with a huge tumor after TACE. It didn't show a significance of the changes between the patients using lipiodol 6～30 ml. 3) HAP and HPI were correlated to HA, PT, TBIL and ALB. PVP was correlated to HA and PT. 4) HAP and HPI increased as the Child-Pugh grade and the liver reserve function grade increased. PVP was extremely lower in Child-Pugh C and liver reserve function grade 3.5) Eiver reserve function score and child-pugh score were significant higher in patient with a high HPI (＞50％). 6) Liver reserve function score and child-pugh score increased as portal perfusion decreased after TACE.Conclusion: 1. TACE can be damageable to liver reserve function. Ultraselective (segmental) embolization was suggested to minimize the damages.2. The liver reserve function classification which was made of HA, TBA, PT, TBIL, ALB, combine with child-pugh classification and liver perfusion CT will be an ease useful method to evaluate liver reserve function.