Construction Of SRLV And Hepatic Fibrosis Indexes To Evaluate The Safety Of Liver Tumor Surgery

Objective: By studying the relationship between standard residual liver volume(SRLV,standard remnant liver volume)and the index of liver fibrosis,the critical value of safe SRLV for predicting patients with different degrees of liver fibrosis before operation was established.Methods: The clinical data of 60 patients who underwent hepatectomy for liver tumor in the Department of Hepatobiliary surgery of Yi Ji Shan Hospital affiliated to Wannan Medical College from September 2017 to September 2019 were collected.The standard residual liver volume(SRLV)was calculated by measuring the total liver volume(TLV),pre-cut volume(PCV),residual liver volume(RLV)and combined surface area(BSA).The standard remnant liver volume(SRLV)was calculated by using the threedimensional visualization system(IQQA)to measure the total liver volume(RLV),the pre-cut volume(RLV)and the combined surface area(BSA).Firstly,the ROC curve areas of four liver fibrosis scoring indexes,aspartate aminotransferase / platelet ratio index(aspartate aminotransferase to platelet ratio index,APRI),Frons index,FIB4 index(fibrosis index based on the four factors,FIB4)and S index,were calculated and compared,and the best score index for evaluating the efficacy of liver cirrhosis was obtained.Secondly,according to the cutoff value of the optimal score index ROC curve,the patients were divided into two groups: A group(score index> cutoff value),B group(score index < cutoff value),calculated the critical value of standard residual liver volume(SRLV,standard remnant liver volume)of patients with liver insufficiency in group A and group B respectively.The clinical indexes of age,sex,body surface area,liver epidemiology(HBV/HCV),basic disease,ASA,ALT,AST,TBIL,GGT,albumin,PT,INR,platelet,operation time,intraoperative blood loss,TLV,RLV and SRLV were compared between the two groups.The results of optimal hepatic fibrosis index grouping and postoperative pathological results and the consistency of three-dimensional reconstruction of liver precut volume(PELV)and drainage method were analyzed,and the clinical application value of the critical value of safe SRLV of liver insufficiency after liver tumor operation was evaluated according to the optimal liver fibrosis index.Results: There was a strong correlation between three-dimensional simulated preresected liver volume and actual hepatectomy volume(R = 0.966).The regression equation was as follows: actual resected liver volume(AELV)= 1.012 × predicted resected liver volume(PELV)+ 30.19(R = 0.966),PELV < 0.05),PELV was consistent with AELV(ICC = 0.964),and the results were statistically significant(p < 0.05).When the critical value of hepatic fibrosis index FIB4 was 2.470,the area under the curve of diagnosed cirrhosis was 0.836,which was better than that of APRI,Frons and S index(the area under the curve was 0.731,0.785 and 0.780,respectively),and the Z values were 3.612,2.060 and 2.162,respectively(P < 0.05).According to the critical value of FIB4 2.470,the patients were divided into two groups: A group(FIB4 ≥ 2.470),B group(FIB4 < 2.470).The preoperative age of the two groups :(63.18+8.67)years old in group A and(62.59+7.59)years old in group B,P > 0.05;Gender:24 males and 12 females in group A,15 males and 9 females in group B,P > 0.05;BSA: A group(1.78+0.15)m2,B group(1.80+0.1)m2,P > 0.05;Liver epidemic(HBV/HCV): A group 16(12 / 4),group B 8(6 / 2),P > 0.05;The basic diseases :15 patients with cardiovascular disease,6 patients with diabetes in group A,9 patients with cardiovascular disease and 2 patients with diabetes in group B(P > 0.05);ASA: there were 20 patients with grade I,16 patients with grade II in group A,17 patients with grade I and 7 patients with grade II in group B,P > 0.05;ALT:A group(35.74 +4.12)U/L,B group(32.68+7.25)U/L,P > 0.05;TBIL:A group(19.67 +10.84)umol/L,B group(12.53+6.08)umol/L;AST:A group(28.70 +3.10)U/L,B group(24.60+5.10)U/L,P > 0.05;GGT:A group(63.0 +15.2))U/L,B group(50.2+7.8)U/L,P > 0.05;Albumin: A group(39.23 ±4.58)g,B group(44.15 +20.45)g,P > 0.05;Platelet count: A group(255.3+29.4)x109/ L,B group(225.5+14.4)x109 /L,P > 0.05;the differences of the above data are not statistically significant,and the two groups of data are comparable.Reconstruction data: TLV:A group(1085.34+151.55)ml,B group(1158.87+178.98)ml,P < 0.05;tumor volume: A group(340.62+61.46)ml,B group(478.54+156.29)ml,P < 0.05;PELV:A group(686.71+130.72)ml,B group(896.15+209.88)ml,P < 0.05;%RLV: A group(53.68+8.03)%,B group(42.34+8.58)%,P < 0.05;SRLV:A group(495.97+64.06)ml,B group(377.55+59.05)ml,P < 0.05,the above differences were statistically significant.The critical value of FIB4 grouped by 2.470 was consistent with that according to pathological results(Kappa value = 0.610,p < 0.05),and the critical values of postoperative safe SRLV of two groups of patients with liver tumor were calculated,which were 0.461L/m2 and 0.403L/m2,respectively.Conclusion: The best index for evaluating the degree of liver fibrosis was FIB4,when the critical value of 2.470 was used to evaluate the critical value of safe SRLV for cirrhotic and non-cirrhotic patients was 0.461 and 0.403L/m2,respectively.