残肝体积/体重比率预测肝癌合并肝硬化患者术后肝功能衰竭的研究

目的 探讨肝细胞性肝癌（HCC）合并肝硬化患者残肝体积/体重比率（RLV-BWR）的安全临界值及其评估术后肝功能衰竭（PHLF）的效能。方法 分析181例行半肝切除的HCC患者临床资料，术前采用Myrian-Liver手术规划系统测定肝脏总体积、肿瘤体积、残肝体积，切除的肝体积。术中排水法测定切除标本体积。按照“50-50标准”分成肝衰竭组与无肝衰竭组，分析发生PHLF的相关因素，统计分析肝硬化亚组RLV-BWR的临界值及其预测PHLF的效能，回顾性分析患者肝硬化背景CT分级。结果 术后共发生PHLF22例，PHLF相关死亡1例。多因素分析显示术前胆红素水平及RLV-BWR是发生PHLF的危险因素。按照术后肝硬化病理进行亚组分析，肝硬化组102例，18例术后发生PHLF，PHLF相关死亡1例。HCC合并肝硬化行半肝切除发生PHLF的RLV-BWR临界值为0.94%（ROC=0.853， P<0.01，敏感度94.4%，特异性72.3%）。半肝切除肝硬化患者CT评级为Ⅰ~Ⅲ级。结论 对RLV-BWR≤0.94%的HCC合并肝硬化患者行半肝切除术，术后发生PHLF风险增高。

Clinical Investigation of Remnant Liver Volume-to-Body Weight Ratio in Predicting Post-hepatectomy Liver Failure in Patients with Hepatocellular Carcinoma in Cirrhotic Liver

Objective To explore a new cut-off of remnant liver volume-to-body weight ratio (RLV-BWR) and investigate the relationship between RLV-BWR and post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) of cirrhotic liver. Methods We analyzed the clinical data of 181 patients who underwent hemihepatectomy. Total liver volume, tumor volume, remnant liver volume and resected liver volume were measured by Myrian-Liver surgical planning system before surgery. Intraoperative resected liver volume(include resected normal liver and tumor volume) were collected by drainage method. Patients were divided into PHLF group and non-PHLF group according to the “50-50”criteria. Then the risk factors of PHLF were analyzed. The cut-off of RLV-BWR and efficiency to predict PHLF were analyzed in the subgroup of cirrhotic liver. The grading of liver cirrhosis was analysed by helical CT, retrospectively. Results After operation, 22 patients developed PHLF and one patient died of PHLF. Logistic regression analysis showed that preoperative total bilirubin level and RLV-BWR were identified as independent predictors of PHLF. According the postoperative pathological data, 102 patients with cirrhotic liver were selected; 18 patients developed PHLF and one patient died of PHLF in the subgroup. ROC curve analysis showed that the cut-off of RLV-BWR was 0.94%(the areas under the curve was 0.853, P<0.01, sensitivity and specialty rates were 94.4% and 72.3%) in patients with HCC in cirrhotic liver. By analyzing helical CT, 84 cases were grade I or II and 18 cases were grade Ⅲ. Conclusion The risk of PHLF would increase in the HCC in cirrhotic liver patients with RLV-BWR ≤0.94% after hemihepatectomy.