The Value Of 2D SWE In Evaluating The Safety Of Hepatectomy In Patients With Hepatocellular Carcinoma

Objective:To explore the quantitative detection of liver stiffness by two-dimensional shear wave elastography(2D SWE),based on the existing clinical study on the detection of indocyanine green(ICG)excretion test as the main quantitative liver reserve function test,it is used to help evaluate the safety of liver cancer resection surgery.Methods:A retrospective analysis was performed on 54 patients who underwent partial hepatic resection at the Department of Hepatobiliary and Pancreatic Surgery of Deyang People’s Hospital from November 2021 to November 2022.All patients completed routine perioperative examinations within 1 week before surgery,and 23 patients completed ICG excretion test before surgery,and added 2D SWE to detect liver stiffness and determine the degree of liver cirrhosis,named 2D SWE+ICG group;The other 31 patients underwent only the indocyanine green excretion test,named the ICG group.The preoperative ICG R15 value,liver stiffness(elasticity index),total bilirubin,transaminases,serum albumin,prothrombin time,international standard ratio,etc.were collected,and the patient’s surgical resection range,intraoperative blood loss,operation time,etc.,as well as the postoperative patient’s re-examination of total bilirubin,prothrombin time,international standard ratio,etc.,according to the post-hepatectomy liver failure proposed by the International Hepatobiliary Surgery Research Group in2011,PHLF)to determine whether PHLF occurs.The analysis of the relevant factors of PHLF occurrence was based on Logistic regression,and the evaluation value of liver stiffness measured by 2D SWE on PHLF occurrence was analyzed.Results:All patients were cured and discharged from the hospital,and there were no major bleeding and no deaths after surgery.There were no significant differences in age,preoperative ICG R15 value,TBIL,ALT,AST,PT,ALB,male to female ratio,proportion of underlying liver disease,child-Pugh grade,proportion of hypertension,diabetes mellitus,abnormal proportion of alpha-fetoprotein,tumor diameter distribution,single and multiple tumors(P>0.05).The incidence of liver failure after hepatectomy was 27.78%(15/54)in 54 patients,of which the total incidence of postoperative liver failure in the 2D SWE+ICG group was 13.04%(3/23),all of which were grade A liver failure.The total incidence of postoperative liver failure in the ICG group was 38.71%(12/31),of which the incidence of grade A liver failure was 29.03%(9/31)and the incidence of grade B liver failure was 9.68%(3/31),and the incidence of postoperative liver failure between the two groups was significantly different(P<0.05).The proportion of large-scale liver resection in the 2D SWE+ICG group was 6/23,the proportion of large-scale liver resection in the ICG group was 17/31,and the proportion of large-scale liver resection in the 2D SWE+ICG group was lower than that in the ICG group.Binary logistic regression was used to analyze the relevant factors affecting the occurrence of PHLF,and the results showed that large-scale liver resection had a significant effect on the occurrence of PHLF(P<0.05),and further analysis showed that the liver hardness measured by 2D SWE had a significant effect on large-scale liver resection(P<0.05).Conclusion:Increase 2D SWE to detect liver stiffness,determine the degree of liver cirrhosis,assist indocyanine green excretion test to evaluate the patient’s liver reserve function,so that the patient’s liver reserve function can be more fully evaluated,affect the surgeon to formulate a liver resection surgical plan,while ensuring the complete resection of the tumor,reduce the scope of resection,thereby reducing the risk of severe liver failure after surgery,which is of great value to ensure the safety of liver cancer patients.