The Application Of Standard Remnant Liver Volume To Assessment Of Cirrhotic Liver Function Reserve

Objective: To investigate the effect of standard remnant liver volume(SRLV)on liver insufficiency after hepatectomy in cirrhotic patients withhepatocellular carcinoma (HCC).Methods: Sixty-seven HCC patients with liver cirrhosis were involved inthis study.The following parameters were obtained in all cases:total livervolume (TLV), surgical resected liver volume by surgery,body surface area(BSA),remnant liver volume (RLV)and SRLV. Compared analysis ofrelationship between liver insufficient and the parameters as well as the age ofpatients, duration of operation and blood lose etc.was carried out,in order toestablish the security threshold of SRLV.Results: According to the postoperative liver function,the patients weredivided into2groups: Group A,52cases with mild liver dysfunction;GroupB,15cases among them12with moderate and3with severe liverinsufficiency.Statistical analysis showed that the difference of TLV, duration ofoperation, intra-operative blood lose and age between Group A and B wereinsignificant(P＞0.05).However,that of RLV and SRLV were significant(P＜0.05). The average SRLV in Group A was562±89ml/m2and that was410±87ml/m2in Group B (P＜0.01). The security threshold of SRLV was438ml/m2calculated by receiver operating characteristic (ROC)in our patients. A furtherrandomized study on sixty HCC patients underwent hepatectomy showed that when SRLV was＞438ml/m2the incidence of moderate and severe liverinsufficiency was only8.5%, but when SRLV≦438ml/m2the incidence of thatwas92.3%(P＜0.01).Conclusions: It is suggested from our present study that SRLV is a goodpredictor for post-operative liver function reserve in patients with cirrhoticHCC.Its security threshold is438ml/m2,and the risk of occurring hepaticfailure will be high postoperatively when patient，s SRLV is less than this value.