The Preliminary Study Of Real-time Tissue Elastography And Major Complications After Hepatectomy

Background and ObjectiveCirrhosis is an important risk factor for the occurrence of adverse hepatectomy postoperative, liver fibrosis or cirrhosis can lead to reduced liver function, affect liver function reserve. In addition, studies show that the impact of liver fibrosis and cirrhosis of liver regeneration. Over the past decade, with the improvement of surgical techniques and perioperative quality of care, the incidence of complications after hepatectomy has improved. However, the complication rate is still high which patients with hepatic fibrosis or cirrhosis in postoperative.Currently, the liver biopsy is recognized as gold standard in diagnosis of liver fibrosis or cirrhosis, it can be more accurate assessment of the extent of liver fibrosis preoperative, but there are still many limitations such as invasive, poor repeatability, sampling error and so on. The conventional two-dimensional ultrasound, as a clinical imaging method, is widely used in diagnosis liver diseases which is simple, non-invasive, safe and good reproducibility. However, due to its subjectivity, it is difficult to do quantitative analysis in the assessment of liver fibrosis and cirrhosis.Real-time tissue elasticity (RTE), as a semi-quantitative method, makes up for a shortfall. RTE imaging principle is the use of biological tissue has different hardness, using external or internal forces to compress on the subject tissue, then to compare before and after compression change to obtain tissue stiffness. And then use ultrasound probe receiving signals to be color-coded deformation imaging, image color distribution reflect the stiffness situation. Blue represents the hard tissue; the red part represents the soft tissue, green is in between.Initially, RTE is use of color of the image distribution to score, the higher the proportion of blue represents the higher score, but it is still lack of uniform standards in diagnosis of diffuse liver disease. In recent years, with the development of ultrasound elastography technology,the strain histogram achieve a quantitative analysis of the RTE, the strain histogram is based on RTE and digitized analysis elasticity image obtain liver fibrosis index (LFI). LFI Obtain high diagnostic value in the stages of liver fibrosis and early cirrhosis, it has sensitivity and specificity of diagnosis of advanced fibrosis and cirrhosis up to 80%-90%. However, the study of using LFI in hepatic fibrosis patients associated with hepatectomy major complications is less.Thus, this study intends to collect patients who has liver lesions and underwent surgical. To make RTE strain histogram obtained LFI before surgery and analysis complications. This is preliminary study in relations between LFI and major postoperative complications in patients with liver lesions and whether LFI can predict the major complicationsMethodA retrospective analysis from January 2013 to May 2014,185 cases of patients with liver lesions and underwent surgical in our hospital. Each patients were underwent real-time tissue elastography strain histogram preoperative. After surgery the clinical data were collected including the laboratory tests, surgical records and pathology. The major complications are according to a modified Clavien classification complications and defined as grade III and above complications. To discuss the occurrence of major complications and the relationship between LFI and major postoperative complications.Result1,185 cases were divided into groups according to pathological. They were noncirrhotic group total of 142 cases (71.3%) and cirrhosis group 53 cases (28.7%).2, LFI diagnosis cirrhosis of the area under the ROC curve was 0.853 (95% CI 0.790-0.916, p<0.001), get the calculated cutoff value was 3.09, the sensitivity of 73.6%, specificity of 88.6% and accuracy rate 84.3%.3, Major complications in this study were a total of 29 cases (15.6%), mainly concentrated in the Grade Ⅲ complication, no deaths perioperative.4, LFI diagnosis major complications of the area under the ROC curve was 0.851 (95% CI 0.778-0.924, p<0.001). The calculated cutoff value was 3.26, the sensitivity of 72.4% specificity of 85.9% and accuracy rate 83.8%.5,To obtain non-single tumor, intraoperative blood loss> 300ml, albumin (Alb)≤34g /L, LFI> 3.26 were an independent risk factor in patients with major complications by multivariate logistic analysis.6, In primary liver cancer group, albumin (Alb)<34g/L and LFI> 3.26 were an independent risk factor for major complications by multivariate logistic analysis; In non-primary liver cancer group, every factor was not statistically significant in univariate analysis.7, In primary liver cancer group, patients were take different thresholds of LFI and have positive correlation with Incidence of major complications.Conclusion:When LFI> 3.26, the liver lesions with hepatectomy occurred major postoperative complications was high. LFI measurements before surgery can help evaluate the risk of major complications in patients who has liver lesions and went surgical. And In primary liver cancer group LFI has positively correlation with major complication rate. There is some clinical value for pre-operative assessment liver function,...