标准残肝体积在肝硬化肝脏功能储备评估的应用  

The application of standard remnant liver volume to assessment of cirrhotic liver function reserve

作　　者：王桂林[1] 梅铭惠[1] 席江伟[1] 

机构地区：[1]桂林医学院附属医院,541001

出　　处：《中华肝胆外科杂志》2013年第1期15-18,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨合并肝硬化肝细胞癌（HCC）行肝切除术后标准残肝体积（SRLV）与肝功能代偿不全的关系.方法 67例行肝切除的HCC患者,测定下列参数：全肝体积（TLV）、切除肝体积、体表面积（BSA）、残肝体积（RLV）和SRLV.对比分析TLV、RLV、SRLV以及年龄、手术时间、术中出血量等与术后发生肝功能失代偿的关系,并确定预防肝功能失代偿的SRLV安全临界值.结果 根据术后肝功能情况将患者分为两组：术后肝功能轻度失代偿（A组）52例,中、重度肝功能失代偿（B组）15例（中度12例,重度3例,因后者例数过少,故两者合并进行统计分析）.分析显示,A、B两组间TLV、手术时间、术中出血量以及年龄无明显差异（P＞0.05）；而RLV、SRLV差异有统计学意义（P＜0.05）.其中A组SRLV均值为（562±89）ml/m2、B组为（410±87）ml/m2 （P＜0.01）.ROC曲线分析计算SRLV的安全临界值为438ml/m2.随机选取60例行肝切除术的HCC患者,进一步分析显示SRLV≤438 ml/m2患者与SRLV＞ 438 ml/m2患者术后肝功能中、重度失代偿率分别为92.3％和8.5％（P＜0.01）.结论 SRLV是预测合并肝硬化HCC术后肝储备功能的良好指标,其安全临界值为438 ml/m2.低于该值术后发生肝功能衰竭的风险较大.Objective To investigate the effect of standard remnant liver volume （SRLV） on liver insufficiency after hepatectomy in cirrhotic patients with hepatocellular carcinoma （HCC）.Methods Sixty-seven HCC patients with liver cirrhosis were involved in this study.The following parameters were obtained in all cases：total liver volume （TLV）,resected liver volume by surgery,body surface area （BSA）,remnant liver volume （RLV）and SRLV.Compared analysis of relationship between liver insufficient and the parameters as well as the age of patients,duration of operation and blood lose etc.was carried out,in order to establish the security threshold of SRLV.Results According to the postoperative liver function,the patients were divided into 2 groups：Group A,52cases with mild liver dysfunction; Group B,15cases among them 12 with moderate and 3 with severe liver insufficiency.Statistical analysis showed that the difference of TLV,duration of operation,intra-operative blood lose and age between Group A and B were insignificant（P〉0.05）.However,that of RLV and SRLV were significant（P〈0.05）.The average SRLV in Group A was 562±89 ml/m2 and 410±87 ml/m2 in Group B （P〈〈0.01）.The security threshold of SRLV was 438 ml/m2 calculated by receiver operating characteristic （ROC）in our patients.Then randomly selected sixty HCC patients,the incidences of moderate and severe liver insufficiency postoperative in the SRLV≤438 ml/m2 and SRLV〉438 ml/m2 patients were 92.3%and8.5% （P〈0.01）.Conclusions It is suggested from our present study that SRLV is a good predictor for post-operative liver function reserve in patients with cirrhotic HCC.Its security threshold is 438 ml/m2,and the risk of occurring hepatic failure will be high postoperatively when patient,s SRLV is less than this value.

关 键 词：标准残肝体积 肝切除术 肝功能不全 

分 类 号：R735.7[医药卫生—肿瘤]