Application value of the liver stiffness measurement on complications after hepatectomy / 中华消化外科杂志

ABSTRACT

Objective To explore the application value of the liver stiffness measurement (LSM) on complications after hepatectomy.Methods The retrospective case-control study was conducted.The clinical data of 121 hepatocellular carcinoma (HCC) patients who underwent hepatectomy in the Mianyang Central Hospital from January 2011 to April 2017 were collected.All 121 patients received LSM using Fibro Scan,and 81 undergoing laparoscopic liver resection (LR) and 40 undergoing open liver resection (OR) were respectively allocated into the LR and OR groups.Observation indicators(1) comparisons of intra-and post-operative situations;(2) risk factors analysis affecting postoperative complication of HCC patients;(3) area under the curve (AUC) of LSM and postoperative complications;(4) comparisons of intra-and post-operative situations,when LSM ≤17.5 kPa;(5) comparisons of intra-and post-operative situations,when LSM ＞ 17.5 kPa;(6)comparisons of intra-and post-operative situations between patients with LSM ≤ 17.5 kPa and LSM ＞ 17.5 kPa in the LR group.Measurement data were represented as x±s,and mean comparisons between groups were done using the t test.Comparisons of count data and univariate analysis were analyzed using the chi-square test and Fisher exact probability.The multivariate analysis was done using the logistic regression model,using P＜0.01 as a inclusion criteria in the univariate analysis.The critical value of postoperative complication was calculated using the receiver operating characteristic curve (ROC).Results (1) Comparisons of intra-and post-operative situationsall the 121 patients underwent successful surgery,including 4 with conversion to open surgery in the LR group.Cases with Pringle manner were 51 in the LR group and 17 in the OR group,with a statistically significant difference (x2 =4.555,P＜0.05).Operation time,volume of intraoperative blood loss,case with intraoperative blood transfusion,Ishak score of 1-3 and 4-6 scores,postoperative complications and duration of hospital stay were respectively (248±78)minutes,(292±229)mL,14,14,67,29,(12±7)days in the LR group and (221±78)minutes,(281± 194)mL,9,9,31,10,(13±6)days in the OR group,with no statistically significant difference between groups (t =1.843,0.282,x2 =0.473,0.473,1.431,t =0.075,P＞0.05).(2) Risk factors analysis affecting postoperative complication of HCC patients39 of 121 patients had postoperative complications.Results of univariate analysis showed that retention 15-minute rate of indocyanine green (ICG R15),LSM,volume of intraoperative blood loss and Ishak score were risk factors affecting postoperative complication of HCC patients (x2 =7.161,32.490,7.725,2.863,P＜0.l).Results of multivariate analysis showed that LSM ＞ 15.0 kPa was an independent risk factor affecting postoperative complication of HCC patients [odds ratio (OR) =6.906,95％ confidence interval (CI)2.307-20.672,P＜0.05].(3) AUC of LSM and postoperative complicationwhen LSM of postoperative complication ＞ 17.5 kPa,sensitivity,specificity and AUC were respectively 64.1％,85.4％ and 0.749 (95％CI0.662-0.824,P＜0.05).(4) Comparisons of intra-and post-operative situations,when LSM ≤ 17.5 kPaduration of hospital stay was respectively (10±5) days in the LR group and (13±7) days in the OR group,with a statistically significant difference between groups (t--2.389,P＜0.05).(5) Comparisons of intra-and post-operative situations,when LSM ＞ 17.5 kPaoperation time,volume of intraoperative blood loss,cases with postoperative complications and hepatic dysfunction were respectively (277±76)minutes,(505±232)mL,21,17 in the LR group and (212-± 109) minutes,(328±250) mL,4,2 in the OR group,with statistically significant differences between groups (t=2.060,2.057,P＜0.05).(6) Comparisons of intra-and post-operative situations between patients with LSM ≤ 17.5 kPa and LSM ＞ 17.5 kPa in the LR groupoperation time,volume of intraoperative blood loss,cases with postoperative complications and hepatic dysfunction and duration of hospital stay were respectively (236±76)minutes,(197± 153)mL,8,3,(10±5)days in the LR group and (277± 76)minutes,(505±232) mL,21,17,(16±9)days in the OR group,with statistically significant differences between groups (t=0.657,3.398,x2 =36.547,36.475,t=17.414,P＜0.05).Conclusion LSM is an independent risk factor affecting postoperative compfications after hepatectomy,when LSM ＞ 17.5 kPa,LR is associated with higher incidence of postoperative complications compared with OR.