标准化残肝比例预测ALPPS术后肝功能不全的临床价值

[摘 要] 目的 探讨标准化残肝比例（SRLVR）预测联合肝脏离断和门静脉结扎二步肝切除术（ALPPS）后发生肝功能不全的临床价值。方法 采用回顾性横断面研究方法，收集2013年1月至2016年12月在右江民族医学院附属医院行ALPPS的29例原发性肝癌患者的临床资料，依据是否发生肝功能不全将29例患者分为肝功能不全组和无肝功能不全组。测定下列参数：全肝体积（TLV）、残肝体积（RLV）、残肝比例（RLVR）、体表面积（BSA）、标准化全肝体积（SLV）、标准化残肝比例（SRLVR），测定ALPPS I期术后标准化残肝比例的安全临界值。结果 29例I期术后患者有25例（86.2%）获得了二期手术，一期术后有6例发生肝功能不全。两组患者的年龄、全肝体积、残肝体积、标准肝体积、残余肝比例相比，差异无统计学意义（P > 0.05）；肝功能不全组的标准化残肝比例为（32.27±1.99）%，无肝功能不全组的标准化残肝比例为（35.68±2.51）%，两组相比差异有统计学意义（P < 0.05）。ROC曲线分析计算出SRLVR的安全临界值为36.24%。结论 标准化残肝比例是预测ALPPS术后发生肝功能不全的有效指标，若SRLVR < 36.24%，则ALPPS I期术后发生肝功能不全的风险极高。

The clinical value of SRLVR in predicting liver dysfunction after ALPPS

Abstract objective To explore the clinical value of standardized remnant liver volumn ratio (SRLVR) in predicting the risk of liver dysfunction after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods The clinical data of 29 patients with hepatocellular carcinoma who underwent ALPPS in the Affiliated Hospital of Youjiang Medical University for Nationalities from Jan. 2013 to Dec. 2016 were analyzed retrospectively. Patients were divided into liver dysfunction group and no liver dysfunction group. The following indices were determined: total liver volume (TLV), remnant liver volume (RLV), remnant liver volume ratio (RLVR), body surface area (BSA), standard liver volume (SLV) and standard remnant liver volume ratio (SRLVR). The safety threshold of SRLVR after stage I ALPPS was measured. Results Among the 29 patients after stage I procedure, 25 patients were qualified for stage II procedure and 6 patients were suffered from liver dysfunction. Statistical analysis showed that the difference of age, TLV, RLV, RLVR, BSA, and SLV between the two groups were insignificant (P>0.05). However, there was statistically significant difference of mean SRLVR [(32.27±1.99)% vs (35.68±2.51)%, P<0.05] between liver dysfunction group and no liver dysfunction group. The safety threshold of SRLVR was determined as 36.24% according to receiver operatingcharacteristic (ROC) curve in this study. Conclusion SRLVR can effectively predict liver dysfunction after ALPPS. The safety threshold of SRLVR was 36.24%, and the risk of liver dysfunction after stage I ALPPS is extremely high if SRLVR is below this value.