优化ALPPS第二阶段的时间与APRI/ALBI得分 - - 一项国际性的多中心队列研究
Jan Philipp Jonas1, Philip Christoph Müller1,2, Michael Linecker3
1Swiss HPB & Transplant Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Hepatobiliary surgery and nutrition
|October 17, 2025
概括
血小板与AST比率指数 (APRI) /白蛋白与白素指数 (ALBI) 评分有效预测肝切除术后的肝功能衰竭和肝分裂和分期肝切除术 (ALPPS) 的门静脉结合后的发病率. 这一分数有助于优化ALPPS第二阶段的时间,以提高患者的安全性.
科学领域:
- 肝胆道手术 肝胆道手术
- 手术瘤学手术瘤学
- 肝脏移植 肝脏移植
背景情况:
- 阶段性肝切除术 (ALPPS) 相关性肝分裂和门静脉结合用于无法切除的肝瘤.
- 肝切除术后肝衰竭 (PHLF) 是ALPPS后的一个主要风险.
- AST与血小板比率指数 (APRI) /白蛋白与白素指数 (ALBI) 评分监测肝功能.
研究的目的:
- 评估APRI/ALBI评分对PHLF和ALPPS后的外科手术期间发病率的预测能力.
- 用APRI/ALBI评分来确定ALPPS第二阶段的最佳时间.
主要方法:
- 一项多中心队列研究包括来自国际ALPPS注册表 (2012-2020) 的464名患者.
- 在外科手术期间监测APRI/ALBI得分.
- 用后勤回归和ROC分析评估PHLF,90天死亡率和严重发病率的预测值,与ALPPS徒劳风险评分进行比较.
主要成果:
- 临床相关的PHLF (B+C) 发生在7.5%的患者中,其中死亡率为63%.
- 第二阶段前的APRI/ALBI得分显著预测了PHLF (AUC=0.78),90天死亡率 (AUC=0.67),以及严重的发病率 (AUC=0.65).
- 结合APRI/ALBI和徒劳风险得分的综合模型进一步改善了PHLF预测 (AUC=0.81).
结论:
- 通过APRI/ALBI评分,可以简单,动态地监测ALPPS第一阶段之后的肝功能恢复.
- 在第二阶段之前APRI/ALBI得分恢复不足与增加PHLF,死亡率和发病率有关.
- 结合APRI/ALBI的风险模型可以优化ALPPS第二阶段的时间,提高程序安全.
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