rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2409-2231-2015-2-1-13-20rpmj-33Research ArticleОригинальные статьи. Онкология, лучевая терапияOriginal Articles. ОncologyМЕТОДЫ ОЦЕНКИ ФУНКЦИОНАЛЬНОГО СТАТУСА ПЕЧЕНИ ПРИ ПЛАНИРОВАНИИ АНАТОМИЧЕСКИХ РЕЗЕКЦИЙ ПО ПОВОДУ ПЕРВИЧНЫХ И МЕТАСТАТИЧЕСКИХ ОПУХОЛЕЙ: СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫ, СОБСТВЕННЫЙ ОПЫТ И ПЕРСПЕКТИВЫMETHODS OF EVALUATION OF THE FUNCTIONAL STATUS OF THE LIVER IN THE PLANNING OF ANATOMICAL RESECTIONS ABOUT PRIMARY AND METASTATIC TUMORS: CURRENT STATE OF THE PROBLEM, THEIR OWN EXPERIENCE AND PERSPECTIVESСидоровД. В.SidorovD. V.РубцоваН. А.RubtsovaN. A.ЛеонтьевА. В.LeontyevA. V.

к.м.н, заведующий отделением радионуклидной диагностики, врач-радиолог МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИРЦ» Минздрава России

PhD., head of department of  radionuclide diagnostics, radiologist P. Hertsen MORI

ЛожкинМ. В.LozhkinM. V.

к.м.н., старший научный сотрудник отделения абдоминальной онкологии  МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИРЦ» Минздрава России

PhD., senior researcher of department of abdominal oncology P. Hertsen MORI

ПетровЛ. О.PetrovL. O.leonid_petrov@mail.ruЛазутинаТ. Н.LazutinaT. N.ПыловаИ. В.PylovaI. V.КоролевП. А.KorolevP. A.ИсаеваА. Г.IsaevaA. G.МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИРЦ» Минздрава России (Москва, Российская Федерация) 125284, Российская Федерация, г. Москва, 2-ой Боткинский проезд, дом 3РоссияP. Hertsen MORI (Moscow, Russian Federation) 3, 2 Botkinskiy proezd, Moscow , Russian Federation,125284Russian FederationГБОУ ВПО Первый МГМУ им. И.М. Сеченова (Москва, Российская Федерация) 119991, Российская Федерация, г. Москва, ул. Трубецкая, д. 8, стр. 2РоссияSBEY HPO M.I. Sechenov First MSMU 8-2, Trubetskaya, Moscow, Russian Federation, 119991Russian Federation201515032015211320Copyright © Сидоров Д.В., Рубцова Н.А., Леонтьев А.В., Ложкин М.В., Петров Л.О., Лазутина Т.Н., Пылова И.В., Королев П.А., Исаева А.Г., 20152015Сидоров Д.В., Рубцова Н.А., Леонтьев А.В., Ложкин М.В., Петров Л.О., Лазутина Т.Н., Пылова И.В., Королев П.А., Исаева А.Г.Sidorov D.V., Rubtsova N.A., Leontyev A.V., Lozhkin M.V., Petrov L.O., Lazutina T.N., Pylova I.V., Korolev P.A., Isaeva A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/33Цель исследования

Цель исследования. Установить зависимость между показателями функционального резерва печени по данным 13С-метацетинового дыхательного теста и результатами динамической сцинтиграфии печени у больных с первичными и метастатическими злокачественными опухолями печени.

Материалы и методы

Материалы и методы.Метацитиновый дыхательный тест и динамическая гепатосцинтиграфия проводились у 53 онкологических пациентов с первичными и метастатическими злокачественными опухолями печени. Группа больных состояла из 48 (90,6%) пациентов с метастазами колоректального рака в печени и 5 (9,4%) пациентов с первичным раком печени. Для сравнения полученных  неоднородных данных применялась унифицированная шкала оценки результатов.

Основные результаты

Основные результаты.В результате статистической обработки полученных результатов, была установлена сильная прямая положительная корреляция (r = 0.706) между показателями 13С-метацетинового дыхательного теста и результатами динамической гепатосцинтиграфии.

Objective

Objective. Background 99mTc-technephyt hepatobiliary scintigraphy (HBS) and 13C-methacetin breath test were used as a quantitative methods to evaluate liver function. The aim of this study was to compare future remnant liver function assessed by 99mTc-technephyt dynamic hepatobiliary scintigraphy with results of methacetin breath test in the prediction of liver failure after major liver resection.

 Materials and methods

 Materials and methods. Methacetin breath test and 99mTc-technephyt hepatobiliary scintigraphy were performed prior to major resection in 53 high-risk patients, including 48 patients with hepatic metastases from colorectal cancer and 5 patients with hepatocellular carcinoma . Liver function determined with HBS was compared with methacetin breath test by unified scale.

Results

Results.  A strong positive association (r = 0.706) was found between 13C-methacetin breath test determined with 99mTc-technephyt hepatobiliary scintigraphy

Conclusions

Conclusions.  Preoperative 99mTc-technephyt hepatobiliary scintigraphy with 13C-methacetin breath test are a valuable techniques to estimate the risk of postoperative liver failure.They offers a unique combination of functional liver uptake and excretion with the ability to assess the preoperative liver function reserve and to estimate the remnant liver function preoperatively . This combination might significantly improve preoperative evaluation and postoperative outcomes in liver surgery.

резекции печенипострезекционная печеночная недостаточностьпеченочные функциональные тестыLiver resectionLiver failureLiver function testsReferencesВишневский В. А., Федоров В. Д., Подколзин А. В. Функционально-морфологические изменения печени после ее резекции // Хирургия. 1993. № 3. С. 62-67.Вишневский В. А., Федоров В. Д., Подколзин А. В. Функционально-морфологические изменения печени после ее резекции // Хирургия. 1993. № 3. С. 62-67.Свиридова С.П., Патютко Ю.И., Горожанская Э.Г., Симонова О.В., Матвеева И.И. Пострезекционная печеночная недостаточность у онкологических больных. // Вестник интенсивной терапии. 2010. № 4. С. 54-58.Свиридова С.П., Патютко Ю.И., Горожанская Э.Г., Симонова О.В., Матвеева И.И. Пострезекционная печеночная недостаточность у онкологических больных. // Вестник интенсивной терапии. 2010. № 4. С. 54-58.Afolabi P., Wright M., Wootton S.A., Jackson A.A. Clinical utility of 13C-liver-function breath tests for assessment of hepatic function. // Dig Dis Sci. 2013. V.58. N1 P. 33-41. doi: 10.1007/s10620-012-2340-z. Epub 2012 Aug 17.Afolabi P., Wright M., Wootton S.A., Jackson A.A. Clinical utility of 13C-liver-function breath tests for assessment of hepatic function. // Dig Dis Sci. 2013. V.58. N1 P. 33-41. doi: 10.1007/s10620-012-2340-z. Epub 2012 Aug 17.Andreou A., Brouquet A., Abdalla E.K. et al.. Repeat hepatectomy for recurrent colorectal liver metastases is associated with a high survival rate. // HPB (Oxford). 2011. V.13. P. 774–782.Andreou A., Brouquet A., Abdalla E.K. et al.. Repeat hepatectomy for recurrent colorectal liver metastases is associated with a high survival rate. // HPB (Oxford). 2011. V.13. P. 774–782.Chen X., Zhai J., Cai X., et al. Severity of portal hypertension and prediction of postoperative liver failure after liver resection in patients with Child-Pugh grade A cirrhosis. // Br J Surg. 2012. V.99. N12. P. 1701-1710.Chen X., Zhai J., Cai X., et al. Severity of portal hypertension and prediction of postoperative liver failure after liver resection in patients with Child-Pugh grade A cirrhosis. // Br J Surg. 2012. V.99. N12. P. 1701-1710.Dan R.G., Creţu O.M., Mazilu O., et al. Postoperative morbidity and mortality after liver resection. Retrospective study on 133 patients. // Chirurgia (Bucur). 2012. V.107. N6. P. 737-741.Dan R.G., Creţu O.M., Mazilu O., et al. Postoperative morbidity and mortality after liver resection. Retrospective study on 133 patients. // Chirurgia (Bucur). 2012. V.107. N6. P. 737-741.de Graaf W., van Lienden K.P., Dinant S. Assessment of future remnant liver function using hepatobiliary scintigraphy in patients undergoing major liver resection. // J Gastrointest Surg. 2010. V.14. N2. P. 369–378.de Graaf W., van Lienden K.P., Dinant S. Assessment of future remnant liver function using hepatobiliary scintigraphy in patients undergoing major liver resection. // J Gastrointest Surg. 2010. V.14. N2. P. 369–378.Dello S.A., Stoot J.H., van Stiphout R.S., et al. Prospective volumetric assessment of the liver on a personal computer by nonradiologists prior to partial hepatectomy. // World J Surg. 2011. V.35. N2. P. 386-392. doi: 10.1007/s00268-010-0877-6Dello S.A., Stoot J.H., van Stiphout R.S., et al. Prospective volumetric assessment of the liver on a personal computer by nonradiologists prior to partial hepatectomy. // World J Surg. 2011. V.35. N2. P. 386-392. doi: 10.1007/s00268-010-0877-6Du Z.G., Li B., Wei Y.G., et al. A new scoring system for assessment of liver function after successful hepatectomy in patients with hepatocellular carcinoma. // Hepatobiliary Pancreat Dis Int. 2011. V.10. N3. P. 265-269.Du Z.G., Li B., Wei Y.G., et al. A new scoring system for assessment of liver function after successful hepatectomy in patients with hepatocellular carcinoma. // Hepatobiliary Pancreat Dis Int. 2011. V.10. N3. P. 265-269.Gupta S., Chawla Y., Kaur J., et al. Indocyanine green clearance test (using spectrophotometry) and its correlation with model for end stage liver disease (MELD) score in Indian patients with cirrhosis of liver. // Trop Gastroenterol. 2012. V.33. N2. P. 129-134.Gupta S., Chawla Y., Kaur J., et al. Indocyanine green clearance test (using spectrophotometry) and its correlation with model for end stage liver disease (MELD) score in Indian patients with cirrhosis of liver. // Trop Gastroenterol. 2012. V.33. N2. P. 129-134.Häusler S., Heger M., van Ginhoven T.M., et al. Transporters involved in the hepatic uptake of (99m)Tc-mebrofenin and indocyanine green. // Hepatol. 2011. V.54 N4. P. 738-745. doi: 10.1016/j.jhep.2010.07.047. Epub 2010 Oct 1.Häusler S., Heger M., van Ginhoven T.M., et al. Transporters involved in the hepatic uptake of (99m)Tc-mebrofenin and indocyanine green. // Hepatol. 2011. V.54 N4. P. 738-745. doi: 10.1016/j.jhep.2010.07.047. Epub 2010 Oct 1.Hemming A.W., Scudamore C.H., Shackleton C.R., et al. Indocyanine green clearance as a predictor of successful hepatic resection in cirrhotic patients. // Am J Surg. 1992. V.163. N.5: P. 515-518.Hemming A.W., Scudamore C.H., Shackleton C.R., et al. Indocyanine green clearance as a predictor of successful hepatic resection in cirrhotic patients. // Am J Surg. 1992. V.163. N.5: P. 515-518.Inal M.T., Memiş D., Kargi M., Sut N. Prognostic value of indocyanine green elimination assessed with LiMON in septic patients // J Crit Care. 2009. V.24. N3 P. 329-334. doi: 10.1016/j.jcrc.2008.11.012. Epub 2009 Feb 12.Inal M.T., Memiş D., Kargi M., Sut N. Prognostic value of indocyanine green elimination assessed with LiMON in septic patients // J Crit Care. 2009. V.24. N3 P. 329-334. doi: 10.1016/j.jcrc.2008.11.012. Epub 2009 Feb 12.Festi D., Capodicasa S., Sandri L., et al. Measurement of hepatic functional mass by means of 13C-methacetin and 13C-phenylalanine breath tests in chronic liver disease: comparison with Child-Pugh score and serum bile acid levels. // World J Gastroenterol. 2005. V.11. N1. P. 142-148.Festi D., Capodicasa S., Sandri L., et al. Measurement of hepatic functional mass by means of 13C-methacetin and 13C-phenylalanine breath tests in chronic liver disease: comparison with Child-Pugh score and serum bile acid levels. // World J Gastroenterol. 2005. V.11. N1. P. 142-148.Kasicka-Jonderko A., Nita A., Jonderko K., et al. C-methacetin breath test reproducibility study reveals persistent CYP1A2 stimulation on repeat examinations. // World J Gastroenterol. 2011. V. 17. N45. P. 4979-4986. doi: 10.3748/wjg.v17.i45.4979.Kasicka-Jonderko A., Nita A., Jonderko K., et al. C-methacetin breath test reproducibility study reveals persistent CYP1A2 stimulation on repeat examinations. // World J Gastroenterol. 2011. V. 17. N45. P. 4979-4986. doi: 10.3748/wjg.v17.i45.4979.Lin T.Y., Lee C.S., Chen C.C., et al. Regeneration of human liver after hepatic lobectomy studied by repeated liver scanning and repeated needle biopsy //Ann Surg. 1979. V.190. N1. P. 48-53.Lin T.Y., Lee C.S., Chen C.C., et al. Regeneration of human liver after hepatic lobectomy studied by repeated liver scanning and repeated needle biopsy //Ann Surg. 1979. V.190. N1. P. 48-53.Lock J.F., Kotobi A.N., Malinowski M., et al. Predicting the prognosis in acute liver failure: results from a retrospective pilot study using the LiMAx test. // Ann Hepatol. 2013 V.12. N4. P.556-562.Lock J.F., Kotobi A.N., Malinowski M., et al. Predicting the prognosis in acute liver failure: results from a retrospective pilot study using the LiMAx test. // Ann Hepatol. 2013 V.12. N4. P.556-562.Liu Y.X., Huang L.Y., Wu C.R., Cui J. Measurement of liver function for patients with cirrhosis by 13C-methacetin breath test compared with Child-Pugh score and routine liver function tests //Chin Med J (Engl). 2006. V. 119 N18. P. 1563-1566.Liu Y.X., Huang L.Y., Wu C.R., Cui J. Measurement of liver function for patients with cirrhosis by 13C-methacetin breath test compared with Child-Pugh score and routine liver function tests //Chin Med J (Engl). 2006. V. 119 N18. P. 1563-1566.Michalopoulos G.K. Regeneration after Partial Hepatectomy. Critical Analysis of Mechanistic Dilemmas. // Am J Pathol. 2010. V.176. N.1, P. 2–13.Michalopoulos G.K. Regeneration after Partial Hepatectomy. Critical Analysis of Mechanistic Dilemmas. // Am J Pathol. 2010. V.176. N.1, P. 2–13.Müller S.A., Tarantino I., Cora, et al.,a M., et al. A rapid and accurate new bedside test to assess maximal liver function: a case report. // Patient Saf Surg. 2013. V. 7. N1. P. 11.Müller S.A., Tarantino I., Cora, et al.,a M., et al. A rapid and accurate new bedside test to assess maximal liver function: a case report. // Patient Saf Surg. 2013. V. 7. N1. P. 11.Nagasue N., Yukaya H., Ogawa Y., et al. Human liver regeneration after major hepatic resection. A study of normal liver and livers with chronic hepatitis and cirrhosis. // Ann Surg. 1987. V.206. N1. P. 30-39.Nagasue N., Yukaya H., Ogawa Y., et al. Human liver regeneration after major hepatic resection. A study of normal liver and livers with chronic hepatitis and cirrhosis. // Ann Surg. 1987. V.206. N1. P. 30-39.Perri F., Pastore M., Annese V., Andriulli A. The aminopyrine breath test. // Ital J Gastroenterol 1994. V.26. P. 306-317.Perri F., Pastore M., Annese V., Andriulli A. The aminopyrine breath test. // Ital J Gastroenterol 1994. V.26. P. 306-317.Ren Z., Xu Y., Zhu S. Indocyanine green retention test avoiding liver failure after hepatectomy for hepatolithiasis. // Hepatogastroenterology. 2012. V.59 N. 115. P.782-784. doi: 10.5754/hge11453.Ren Z., Xu Y., Zhu S. Indocyanine green retention test avoiding liver failure after hepatectomy for hepatolithiasis. // Hepatogastroenterology. 2012. V.59 N. 115. P.782-784. doi: 10.5754/hge11453.Sakaguchi T., Suzuki A., Unno N., et al. Bile leak test by indocyanine green fluorescence images after hepatectomy. // Am J Surg. 2010. V.200. N1. e19-23. doi: 10.1016/j.amjsurg.2009.10.015.Sakaguchi T., Suzuki A., Unno N., et al. Bile leak test by indocyanine green fluorescence images after hepatectomy. // Am J Surg. 2010. V.200. N1. e19-23. doi: 10.1016/j.amjsurg.2009.10.015.Shoup M., Gonen M., D'Angelica M., et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. // J Gastrointest Surg. 2003. V.7: P. 325–330.Shoup M., Gonen M., D'Angelica M., et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. // J Gastrointest Surg. 2003. V.7: P. 325–330.Reddy S.K., Barbas A.S., Turley R.S. A standard definition of major hepatectomy: resection of four or more liver segments. // HPB (Oxford). 2011. V.13. N7. P. 494–502.Reddy S.K., Barbas A.S., Turley R.S. A standard definition of major hepatectomy: resection of four or more liver segments. // HPB (Oxford). 2011. V.13. N7. P. 494–502.Wissler E.H.. Identifying a long standing error in single-bolus determination of the hepatic extraction ratio for indocyanine green. // Eur J Appl Physiol. 2011. V. 111. N.4. P.641-646. doi: 10.1007/s00421-010-1678-1. Epub 2010 Oct 16.Wissler E.H.. Identifying a long standing error in single-bolus determination of the hepatic extraction ratio for indocyanine green. // Eur J Appl Physiol. 2011. V. 111. N.4. P.641-646. doi: 10.1007/s00421-010-1678-1. Epub 2010 Oct 16.Wong J.S., Wong G.L., Chan A.W., et al. Liver stiffness measurement by transient elastography as a predictor on posthepatectomy outcomes // Ann Surg. 2013. V. 257 N5. P. 922-928. doi: 10.1097/SLA.0b013e318269d2ec.Wong J.S., Wong G.L., Chan A.W., et al. Liver stiffness measurement by transient elastography as a predictor on posthepatectomy outcomes // Ann Surg. 2013. V. 257 N5. P. 922-928. doi: 10.1097/SLA.0b013e318269d2ec.

The authors declare that there are no conflicts of interest present.