确定安全肝切除术的未来肝脏残留量最小值
John A Steinharter1, Joanne Chou2, Crisanta H Ilagan1,3
1Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Journal of the American College of Surgeons
|January 27, 2026
概括
适当的未来肝脏残留体积 (FLRV%) 对于减少肝切除术后肝功能衰竭 (PHLF) 至关重要. 安全的FLRV%值因肝脏质量而异:正常肝脏≥30%,肝脏损伤≥50%,影响PHLF相关的发病率.
科学领域:
- 肝胆道手术是肝胆道的手术.
- 手术瘤学手术瘤学
- 肝脏移植 肝脏移植
背景情况:
- 肝切除术后肝衰竭 (PHLF) 是肝切除后的一个重大风险.
- 足够的未来肝脏残留体积 (FLRV%) 是预防PHLF的一个关键因素.
- 确定安全的FLRV%值对于患者的治疗结果至关重要.
研究的目的:
- 评估FLRV%与严重 (4/5级) 发病率之间的关联.
- 确定安全的FLRV%值,以预防PHLF相关和非PHLF相关的肝切除术后的主要发病率.
主要方法:
- 对1,748名因恶性瘤而接受大肝切除术的患者 (2000-2020年) 的回顾性分析.
- 评估FLRV%,发病率分级和发病原因 (与PHLF相关的与非PHLF相关的).
- 将患者分为正常肝脏 (NL) 和肝脏受损 (IL) 组;数据分为培训和测试队列,用于值验证.
主要成果:
- 在FLRV%和4/5级PHLF相关的发病率之间发现了显著的反向关联 (OR:每10%增加0.61,p=0.002).
- 在FLRV%和非PHLF相关的4/5级发病率 (OR:0.95,p=0.65) 之间没有发现显著的关联.
- 已确立的安全最低FLRV%的门:NL≥30%和IL≥50%.
结论:
- FLRV%与PHLF相关的发病率有很强的相关性,这突出了其在肝脏残留品质方面的重要性.
- 安全切除的限值取决于肝脏的质量,肝脏受损需要更高的门.
- 大约50%的严重发病率与PHLF无关,并且不受FLRV%的影响.
相关概念视频
Guidelines and Strategies for Safe Computer Charting
2.7K
The guidelines and strategies provided by the American Nurses Association (ANA) and the Canadian Nurses Association (CNA) offer essential principles for ensuring safe and secure computer charting systems in healthcare settings. Let's break down each recommendation:
Maintain Confidentiality and Security:
Maintain Confidentiality and Security:
2.7K
Constant Volume Calorimetry
30.7K
Calorimeters are useful to determine the heat released or absorbed by a chemical reaction. Coffee cup calorimeters are designed to operate at constant (atmospheric) pressure and are convenient to measure heat flow (or enthalpy change) accompanying processes that occur in solution at constant pressure. A different type of calorimeter that operates at constant volume, colloquially known as a bomb calorimeter, is used to measure the energy produced by reactions that yield large amounts of heat and...
30.7K
Volume of Distribution
1.2K
The apparent volume of distribution (Vd) is a crucial pharmacokinetic parameter representing the hypothetical body fluid volume into which a drug disperses. It is calculated based on the total amount of drug in the body (estimated from the administered dose and bioavailability) divided by the plasma drug concentration. The total amount of drug in the body does not directly refer to the dose given but is derived by accounting for absorption, distribution, metabolism, and excretion processes.
1.2K
Work Done During Volume Change
5.1K
In mechanics, work is done on an object when the force acting on it displaces the object. In thermodynamics, work done on a system can be estimated when the system's volume changes during any thermodynamic process.
Consider a gas confined to a cylinder fitted with a movable piston at one end. If the gas expands from volume V1 to volume V2, it exerts a force on the piston, such that the piston moves by a distance dr.
The work done by the gas on the piston can be expressed as
Consider a gas confined to a cylinder fitted with a movable piston at one end. If the gas expands from volume V1 to volume V2, it exerts a force on the piston, such that the piston moves by a distance dr.
The work done by the gas on the piston can be expressed as
5.1K
Respiratory Volumes
3.0K
Respiratory volumes are crucial metrics, meticulously measured to quantify the air exchanged in and out of the lungs during various phases of the breathing cycle. These precise measurements are vital for assessing lung function, diagnosing respiratory conditions, and monitoring overall respiratory health. Each parameter provides specific insights into the mechanics of breathing and the functional capacity of the lungs.
Tidal Volume (TV) Tidal volume (TV) is the air inhaled or exhaled in a...
Tidal Volume (TV) Tidal volume (TV) is the air inhaled or exhaled in a...
3.0K
Regulation of Stroke Volume
5.1K
The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
5.1K


