RU2409317C1 - Method to forecast liver impairment development in post-operational period in patients after hemihepatectomy - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely, to ultrasonic diagnostics, and is intended to predict development of liver impairment in patients after hemihepatectomy. Ultrasonic Doppler sonography of portal system vessels is carried out. Time of acceleration is identified in splenic artery before operation and 2 days after, and if time of acceleration increases 1.5-2.1 times, development of liver impairment is forecasted in post-operational period. ^ EFFECT: method is noninvasive, makes it possible to forecast development of liver impairment in patients after hemihepatectomy. ^ 2 ex

Description

The invention relates to medicine and can be used to predict the development of liver failure in patients undergoing hemihepatectomy.

The main method for treating liver tumors is resection of a part of the liver. The volume of resection is determined by the location and nature of the lesion. However, the loss of a significant part of the hepatic parenchyma is often accompanied by liver failure in the postoperative period with a death rate of 9-18%. Hepatic failure develops acutely, from the first day of the postoperative period. It is not possible to predict the course of the postoperative period with existing techniques.

There are various examination methods for predicting the development of liver failure in the postoperative period, such as a biochemical blood test, liver ultrasound in seroscale mode, a liver biopsy under ultrasound monitoring (Khizroev Kh.M. Results of surgical treatment of patients with extensive focal liver lesions. Abstract, Moscow , 2008, p.13).

A known method for the diagnosis of liver failure in diseases of the hepatopancreatobiliary system in patients with external drainage of the biliary tract in the postoperative period, which consists in determining the level of cholesterol in bile on the third day after surgery and in the dynamics at its concentration below 16 mg% determine liver failure (Patent RU 2087912, publ. 08/20/1997).

A known method for diagnosing the functional state of the left lobe of the liver with hemihepatectomies on the right (patent RU 2332175, publ. August 27, 2008) is to study the biochemical composition of the blood.

However, a blood test is not very informative in the early stages of liver failure and does not allow for a timely response to changes in the patient's condition and prescribe appropriate treatment.

The generally accepted ultrasound criteria (signs) of liver failure are changes in the vessels of the portal system: expansion of the portal and splenic veins, ascites, splenomegaly, development of portocaval anastomoses, including recanalized umbilical veins (Khazanov A.I. Functional diagnosis of liver diseases, M., Medicine 1988, 302 pp.). But after performing liver resections, not all generally accepted criteria (signs) are suitable for assessing hemodynamics in the portal system.

Blood flow through the splenic artery is rarely studied in liver failure, especially in the group of postoperative patients with extensive liver resections, although such indicators as peak systolic velocity and, especially, acceleration time (VA), which is a time interval in milliseconds from the onset of systole to peak systolic velocity, allow with a high degree of reliability to diagnose an increase in pressure in the portal vein system.

The problem to which the invention is directed is the development of a non-invasive method for predicting the development of liver failure in the postoperative period in patients undergoing hemihepatectomy.

The technical result is the ability to predict the development of liver failure after surgery.

The method consists in conducting ultrasound dopplerography of the vessels of the portal system, determining the acceleration time in the splenic artery before and 2 days after the operation, and with a significant increase in the acceleration time, namely 1.5-2.1 times, the development of liver failure in the postoperative period is predicted .

The claimed method is as follows.

Research is being conducted on an expert-grade scanner, the Voluson 730 Pro, equipped with electronic multi-frequency convex sensors. Ultrasound examination includes seroscale scanning of the abdominal organs, echocardiography, ultrasound dopplerography of the portal system vessels, hepatic and renal veins, including color Doppler mapping and energy Doppler.

It was found that among all the dopplerographic parameters, the most informative for predicting the development of liver failure is the time of acceleration in the splenic artery.

The proposed method was examined in three groups of patients. The first included 10 people - almost healthy individuals.

The acceleration time of the splenic artery in them was 0.025 ± 0.004 s.

The second group included 12 patients who underwent extensive liver resection (in the volume of right-sided or left-sided hemihepatectomy). The acceleration time was 0.032 ± 0.007 s before surgery.

The third group included 7 patients, the acceleration time before surgery was 0.092 ± 0.026 s.

Two days after surgery, the acceleration time in patients of group 2 was 0.125 ± 0.015 s, in patients of group 3 - 0.175 ± 0.073 s. In patients of the 2nd group, the acceleration time after surgery compared to the preoperative period increased by 3.6–4.4 times, in patients of the 3rd group, the acceleration time after surgery compared to the preoperative period increased by 1.5–2.1 times. Patients of group 3 in the postoperative period noted liver failure according to the clinic - laboratory studies.

One month after the operation, all operated patients were re-examined, the acceleration time in patients of group 2 was 0.093 ± 0.006, in patients of group 3 - 0.108 ± 0.056 s.

Specific examples of the application of the proposed method.

Example 1. Patient 3., 64 years old, was admitted to the surgical department on 01/19/09 with a diagnosis of R-rectum T4 Nx M1 (liver, lungs). Condition after resection of the rectosigmoid colon, metastatic lesion of the right lobe of the liver, 4 courses of PCT. After further examination, including laboratory diagnostics, instrumental methods of research, the patient is recommended surgical treatment in the amount of right-sided extended hemihepatectomy. Before the operation, on January 21, 2009, an ultrasound and Doppler examination was performed, and the acceleration time of the splenic artery (BACA) was determined - 0.038 s. Conclusion - MTS lesion of the right lobe of the liver. Diffuse changes in the liver and pancreas.

The operation - right-sided extended hemihepatectomy was performed on January 22, 2009.

During the examination in the intensive care unit on 24.1.2009, on the second day after the operation, BACA was 0.11 s, compared with the preoperative examination BACA increased by 2.89 times.

Conclusion - Condition after PHGE. In the postoperative period, according to clinical and laboratory studies of liver failure was not observed. Conducted a month later, on February 25, 2009, the ultrasound control determined the Vasa 0.09 s.

Example 2. Patient K., 61 years old, was admitted on February 9, 2009 to the surgical department with a diagnosis of C-r of the rectum T4 Nx M1 (liver). Condition after resection of the rectosigmoid colon, metastatic lesion of the right lobe of the liver, 3 courses of PCT. After further examination, including laboratory diagnostics, instrumental methods of investigation, the patient is recommended surgical treatment in the amount of right-sided extended hemihepatectomy. Before the operation, an ultrasound and Doppler examination was performed on 10.2.2009, BACA was 0.11 s.

Conclusion - focal (secondary) damage to the right lobe of the liver. Chronic stoneless cholecystitis. Diffuse changes in the pancreas. Polyp of the gallbladder. Operation: right-sided extended hemihepatectomy performed 02/11/2009. As a result of the examination in the intensive care unit on February 13, 2009, BACA was 0.19 s, compared with the preoperative examination, BACA increased 1.73 times.

Conclusion - the state after PHGE. In the postoperative period, a clinic of liver failure, confirmed by laboratory tests, developed on day 2.

Normalization of liver enzymes for 8-9 days. Doppler ultrasound monitoring of Vasa on day 4 0.18 s, on day 8 0.14 s. Conducted a month later, on March 16, 2009, the control of the ultrasound scan showed Vasa 0.11 s.

The acceleration time of the flow in the splenic artery is an important dopplerographic criterion for predicting the development of liver failure, which allows not only to establish the fact of increased pressure in the portal vein system in the operated patients, but also allows in some cases to predict the course of this syndrome.

Claims (1)

A method for predicting the development of liver failure in the postoperative period in patients undergoing hemihepatectomy, which consists in conducting ultrasound dopplerography of the portal system vessels, determining the acceleration time in the splenic artery before and 2 days after surgery and with an increase in the acceleration time of 1.5-2 , 1 time predict the development of liver failure in the postoperative period.