应用单光子发射型计算机断层显像评价剩余肝功能的动物实验研究  

Three-dimensional assessment of the remnant hepatic function following surgery using single photon emission computed tomography in an animal model

作　　者：毛一雷[1] 张涛[1] 桑新亭[1] 李方[2] 巴建涛[2] 卢欣[1] 杨志英[1] 钟守先[1] 黄洁夫[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院肝脏外科,100730 [2]中国医学科学院中国协和医科大学北京协和医院核医学科,100730

出　　处：《中华外科杂志》2007年第9期609-612,共4页Chinese Journal of Surgery

基　　金：美国中华医学基金会资助项目(CMB06-837)

摘　　要：目的评价肝功能显像结合单光子发射型计算机断层显像(SPECT)技术对术后肝功能的预测价值。方法 20只新西兰白兔,随机平均分为肝纤维化肝癌组和正常组。两组均行肝脏右外叶切除术,术前1 d 行^(99m)Tc-二基乙酰苯胺亚氨二醋酸(^(99m)Tc-EHIDA)肝脏显像,计算代表整体肝功能的5 min 心区清除指数(HCI_5)、5 min 心肝相关指数(HLI_5)、15 min 肝脏排泄率(Ex_(15)),结合SPECT 技术计算代表剩余肝功能的 HCI_(5p)、HLI_(5P)和 Ex_(15P),;术后4 d 重复^(99m)Tc-EHIDA 肝脏显像。术前1 d 和术后4 d 检测肝功能,包括丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、总胆红素(TBil)、总蛋白(TP)、白蛋白(ALB)、胆碱脂酶(CHE)和白蛋白与球蛋白比值(A/G)。结果整体肝功能指标中,肝纤维化肝癌组 Ex_(15)低于正常组(P<0.05),肝纤维化肝癌组 HCI_5和 HLI_5较正常组有升高趋势(P>0.05);Ex_(15)与 ALB 成正相关、与 TBil 和 GGT 成负相关(P<0.05),HCI_5与 CHE 成正相关(P<0.05),HLI_5与 A/G 成负相关(P<0.05)。剩余肝功能指标中,HLI_(5P)与术后 A/G 成负相关(P<0.05),Ex_(15P)与 TBil 和 GGT 成负相关(P<0.05)。结论应用肝脏显像结合SPECT 技术可以在动物模型上建立三维立体肝功能评估方法,在获得的参数中,Ex_(15)可以定量评价整体肝功能,Ex_(15P)和 HLI_(5P)可以预测术后剩余肝功能。Objective The predictive value of postoperative hepatic function evaluated by liver functional imaging combined with single photon emission computed tomography （SPECT） technique was appraised in the present study. Methods Twenty New Zealand white rabbits were divided randomly into two groups, including the Hepatic Fibrosis with Carcinoma Group （ FC-Group, n = 10） and the Control Group （C-Group, n = 10）. All the rabbits underwent the resection of outer-right lobe of the liver. The whole hepatic function indexes, such as HCI5, HLI5 and Ex15, and the hepatic function remnant indexes, including HCI5P, HLI5P and Ex15P, were calculated by ^99mTc-EHIDA liver imaging. Results Ex,5 of FC- Group was lower than that of C-Group （ P 〈 0. 05 ）. HCI5 and HLI5 of FC-Group had the trends to increase compared with the C-Group. Ex15 was positively correlated with ALB, and negatively correlated with TBil and GGT （P 〈 0. 05 ）. HCI5 had a positive correlation with CHE （ P 〈 0. 05 ）, while HLI5 had a negative correlation with A/G （ P 〈 0.05 ）. HLI5P had the negative correlation with postoperative A/G （ P 〈 0. 05 ）, and Ex5P had the negative correlation with postoperative TBil and GGT （ P 〈 0. 05 ）. Conclusions This study has established a method of 3-D liver function evaluation system on an animal model. Among the indexes, Ex15 can exactly represent the whole liver function while Ex15P and HLI5P can predict the liver function after the liver resection. The results may help the future clinical use of this technique to evaluate the risk of operation.

关 键 词：外科手术 肝硬化 肝功能试验 ^99mTc-二乙基乙酰苯胺亚氨二醋酸 单光子发射型计算机断层显像 

分 类 号：R657.3[医药卫生—外科学]