标准残肝体积联合肝纤维化测定在原发性肝癌切除术安全性评估中的价值

[目的]探讨标准残肝体积(SRLV)大小及肝纤维化程度与原发性肝癌切除术后发生肝功能代偿不全间的关系.[方法]对因肝癌行肝切除术的104例病例进行研究.残肝体积=全肝体积-切除肝脏体积;SRLV=残肝体积/体表面积;根据声脉冲辐射力成像(acoustic radiation force impulse,ARFI)评分将所有病例分为A组(中、重度肝纤维化组)和B组(正常或轻度肝纤维化组).通过受试者工作特征曲线(ROC)分析预防发生肝功能代偿不全的SRLV安全临界值.并将术后发生肝功能中度代偿不全患者的术前ARFI评分与术后SRLV进行直线回归分析.[结果]A组病例术后发生肝功能轻度代偿不全、中度代偿不全及重度代偿不全分别为53例、22例、4例.在A组病例中,肝功能中、重度代偿不全发生率为32.9％,(26/79),肝功能轻度代偿不全患者和中、重度代偿不全患者的SRLV[(605.69±1 18.98)ml/m2 vs (470.81±62.59)ml/m2]比较具有显著差异(P＜0.05).ROC曲线分析提示发生肝功能中、重度代偿不全的SRLV的临界值为503ml/m2.B组病例数少,不作统计学分析.将术后发生肝功能中度代偿不全患者的术前ARFI评分及术后SRLV进行直线回归分析,显示呈正相关(R=0.719,P＜0.01),其回归方程为:SRLV(ml/m2)=149.6×A RFI评分(m/s)+194.1.[结论]联合SRLV及肝纤维化程度测定对原发性肝癌术前安全切肝量评估有重要指导价值,对伴中、重度肝纤维化患者安全SRLV临界值为503ml/m2.

Standard Residual Liver Volume Combined Liver Fibrosis Determination in Safety Assessment for Resection of Primary Liver Cancer

Abstract：［Purpose］ To evaluate of standard residual liver volume(SRLV) combined with liver fibrosis determination in safety assessment for resection of primary liver cancer(PLC）. ［Methods］ One hundred and four consecutive patients with PLC who underwent hepatectomy were included in the study. Contrast-enhanced CT was used to measure the total liver volume and the acoustic radiation force impulse(ARFI) imaging was applied to estimate the degree of liver fibrosis pre-operatively. The volume of resected liver during the operation was estimated with drainage. SRLV was defined as the difference between the total liver volume and the resected liver volume divided by the body surface area of patients. All patients were classified into 2 groups according to the ARFI imaging. Group A was moderate or severe liver fibrosis，and group B was mild fibrosis or normal. The receiver operating characteristic（ROC） curves were used to establish the safety threshold value of SRLV to prevent decompensation of liver function. The relationship between SRLV and ARFI was analyzed by linear regression. ［Results］ The number of mild，moderate and severe liver function decompensation in groups A and B were 53，22，4 and 24，1，0，respectively. In group A，the incidence of moderate and severe liver function decompensation was 32.9%(26/79). Statistical analysis showed that the difference of SRLV ［（605.69±118.98）ml/m2 vs (470.81±62.59)ml/m2］ in patients with mild liver function decompensation and those with moderate and severe liver function decompensation was significant(P＜0.05)．The ROC curve showed that the safety threshold value of SRLV was 503ml/m2. In group B，the incidence of moderate and sever hepatic insufficiency 4.0%. The amount of the patients who suffered from moderate and severe post-operative liver function decompensation was not enough for statistical analysis. The liner relation(R=0.719，P＜0.01) was found by compared SRLV and ARFI of the patients with moderate post-operative liver function decompensation，and the regression equation was：SRLV(ml/m2)=149.6×ARFI(m/s)+194.1. ［Conclusion］ SRLV and liver fibrosis determination are effective parameters to estimate the safety line of resected liver volume in patient undergoing hepatectomy. For patients with moderate or severe liver fibrosis，the safety threshold value of SRLV is 503ml/m2.