应用锝-99m二乙烯三胺五乙酸半乳糖人血清白蛋白肝显像评价胰十二指肠切除术合并梗阻性黄疸患者围手术期肝功能风险。

H Nakano, K Kumada, Y Takekuma, S Hasebe, Y Yoshizawa, M Yamaguchi, D Jaeck
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引用次数: 8

摘要

结论:锝-99m二乙基三胺五乙酸半乳糖人血清白蛋白(Tc-GSA)肝显像可用于预测胰十二指肠切除术后胰、胆道、腹腹部癌合并梗阻性黄疸患者胆道引流及肝功能的预后。背景:据报道,术前梗阻性黄疸是胰十二指肠切除术患者术后严重并发症的重要危险因素。本研究的目的是探讨Tc-GSA肝显像是否可以评估胰、胆道和壶腹癌合并梗阻性黄疸患者的肝功能风险。方法:对18例梗阻性黄疸患者行胆道引流前肝显像检查。Tc-GSA的最大去除率(GSA-Rmax;标准正常值>或= 0.60)。这些患者行胰十二指肠切除术和大范围淋巴结切除术。术前以胆道引流后1周血清胆红素浓度下降情况评价胆道引流的疗效。术后用血清胆红素浓度的升高来评估肝功能,血清胆红素浓度是术前即刻与术后最大胆红素浓度的差值。结果:与GSA-Rmax < 0.60 (3.56 +/- 1.25 mg/Dl/wk, p = 0.042)组相比,GSA-Rmax >或= 0.60组(7.64 +/- 1.09 mg/Dl/wk)术后第1周血清胆红素下降幅度更大。GSA-Rmax >或= 0.60 (0.81 +/- 0.30 mg/dL)的患者术后胆红素升高低于GSA-Rmax < 0.60 (4.00 +/- 0.69 mg/dL, p = 0.0012)的患者。多因素分析显示,GSA-Rmax能显著预测术后胆红素升高(p = 0.020)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perioperative hepatic functional risk assessed with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin liver scintigraphy in patients undergoing pancreaticoduodenectomy complicated by obstructive jaundice.

Conclusion: Liver scintigraphy with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin (Tc-GSA) can be used to predict outcome of biliary drainage and hepatic function after pancreaticoduodenectomy in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice.

Background: Preoperative obstructive jaundice has been reported as a crucial risk factor for serious postoperative complications in patients undergoing pancreaticoduodenectomy. The aim of the present study was to investigate whether Tc-GSA liver scintigraphy can assess hepatic functional risk in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice.

Methods: Liver scintigraphy was performed before biliary drainage in 18 patients with obstructive jaundice. The maximum removal rate of Tc-GSA (GSA-Rmax; standard normal value > or = 0.60) was calculated. These patients underwent pancreaticoduodenectomy with wide lymphadenectomy. The efficacy of preoperative biliary drainage was assessed with the decrease in serum bilirubin concentration in the first week after biliary drainage. Postoperative liver function was assessed with the increase in serum bilirubin concentration, which was the difference between the immediate preoperative and maximal postoperative bilirubin concentrations.

Results: Serum bilirubin decreased more in the first week after biliary drainage in patients with GSA-Rmax > or = 0.60 (7.64 +/- 1.09 mg/Dl/wk) than in patients with GSA-Rmax < 0.60 (3.56 +/- 1.25 mg/DL/wk, p = 0.042). Postoperative bilirubin increased less in patients with GSA-Rmax > or = 0.60 (0.81 +/- 0.30 mg/dL) than in patients with GSA-Rmax < 0.60 (4.00 +/- 0.69 mg/DL, p = 0.0012). Multivariate analysis showed that GSA-Rmax significantly predicted the postoperative bilirubin increase (p = 0.020).

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