用余肝体积预测半肝切除耐受性的安全标准  

Future liver volume for predicting safety after hemihepatectomy in cirrhotic patients

作　　者：孙惠川[1] 汤敏[2] 钦伦秀[1] 王鲁[1] 叶青海[1] 任宁[1] 樊嘉[1] 曾蒙苏[2] 汤钊猷[1] 

机构地区：[1]复旦大学肝癌研究所、附属中山医院肝脏外科,上海市200032 [2]复旦大学附属中山医院放射科

出　　处：《中华肝胆外科杂志》2006年第6期366-369,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探索用余肝体积作为半肝切除的安全标准。方法拟行半肝切除的肝癌病人术前以 CT 测定余肝体积,以病人体表面积计算标准化的肝脏体积。评价病人术后的安全性及其影响因素。结果 2003年12月至2005年3月对拟行半肝切除的病人测定余肝体积25例。以标化余肝体积>250ml 作为耐受半肝切除的标准。实际行半肝切除20例,其中右半肝切除15例,左半肝切除5例。接受右半肝切除的病例 SFLV 和 SFLVR 的中位值分别为298.6ml 和42.2%;在左半肝切除病例组,SFLV 和 SFLXR 的中位值分别为650ml 和91.8%。术后出现并发症9例,其中8例为少量一中等量的腹水,无手术死亡。以腹水定义为术后肝功能不全,结果术中是否输血是术后肝功能不全的惟一影响因素。结论标准化余肝体积>250ml,或标准化余肝体积比例>35%可作为 Child A 的乙型肝炎病人耐受半肝切除的一个指标。Objective To determine the value of future liver volume for prediction of safety after hemihepatectomy in cirrhotic patients with HBV infection. Methods The future liver volume was calculated by computer tomography and standardized by body surface area in 25 patients treated in our hospital from December 2003 to March 2005. The relation of postoperative liver dysfunction to standardized future liver volume （SFLV） or SFLV ratio as well as other influencing factors was analyzed. Results Twenty out of the 25 patients received hemihepatectomy. Of the 20 patients, 15 underwent right hemihepatectomy and 5 extended left hemihepatectomy. The median SFLV and SFLV ratio were 298. 6 ml and 42. 2% after the right hemihepatectomy and 650 ml and 91.8% after the left one, respectively. Postoperative complications occurred in 9 patients, and 8 of them had mild to moderate amount of ascites. No operative death was noted in this series. The postoperative liver dysfunction, which was defined as mild to moderate amount of ascites, was related to intraoperative blood transfusion but neither SFLV nor SFLV ratio. Conclusions Hemihepatectomy can be safely performed in the patients with HBV infection of Child A when they had a SFLV over 250 ml or a SFLV ratio over 35%.

关 键 词：肝肿瘤 肝切除术 肝脏体积测定 

分 类 号：R735.7[医药卫生—肿瘤]