标准残肝体积联合瞬时弹性成像技术预测半肝切除的安全性研究  

Study on the prediction of the safety of hemihepatectomy by the standard remnant liver volume combined with transient elastography

作　　者：吴金柱[1] 蔡卫华[1] 徐磊[1] 陈琳[1] 肖锋[1] 许甜 王建新[1] 朱任飞[1] 季汉珍[1] 张鹏[1] Wu Jinzhu;Cai Weihua;Xu Lei;Chen Lin;Xiao Feng;Xu Tian;Wang Jianxin;Zhu Renfei;Ji Hanzhen;Zhang Peng(Department Hepatobiliary Surgery,The Third People's Hospital of Nantong City,Jiangsu 226006,China)

机构地区：[1]南通大学附属南通第三人民医院肝胆外科,江苏南通226006

出　　处：《中华普外科手术学杂志（电子版）》2020年第6期585-589,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：江苏省南通市科技局重点项目(MS12019021);江苏省南通市卫健委面上项目(MA2019008)。

摘　　要：目的探讨肝细胞癌(HCC)患者应用标准残肝体积(SRLV)及肝脏瞬时弹性成像技术(TE)评估半肝手术患者肝储备功能的可行性及安全性。方法回顾性分析2016年1月至2020年1月27例行半肝切除并病理证实为HCC患者的资料,术前CT测定肝脏总体积、瘤体体积、残肝体积,术中排水法测定切除的半肝标本的体积,计算SRLV;采用IBM SPSS 25.0完成分析,计量资料以(±s)表示,采用t检验或方差分析;计数资料的组间对比采用χ^2分析;采用ROC曲线分析不同因素ROC曲线下面积,检验水准P<0.05。结果半肝切除患者病理分期肝纤维化S2~S4期SRLV临界值均为0.329 L/m2,半肝切除术后发生肝功能不全患者13例,其中肝纤维化S2~S4期SRLV临界值均亦为0.329 L/m2;Child-Pugh分级预测术后肝功能代偿良好准确率为52.2%,而新评价模型预测术后肝功能代偿良好准确率为100.0%(P<0.05);Child-Pugh分级预测术后肝功能代偿轻度不良准确率为25.0%,而新评价模型预测术后肝功能代偿轻度不良准确率为88.2%(P<0.05)。结论SRLV联合是评估HCC行半肝切除安全指标;Child-Pugh分级联合肝瞬时弹性值的新肝储备评估模型对半肝手术患者储备功能的评估有较好的临床指导意义。Objective To explore the feasibility and safety of standard remnant liver volume(SRLV)and the transient elastography(TE)in the evaluation of liver reserve function of patients undergoing hemihepatectomy for hepatocellular carcinoma(HCC).Methods The clinical data of 27 patients undergoing hepatectomy with a pathological diagnosis of HCC from January 2016 to January 2020 were analyzed retrospectively;the total liver volume,tumor volume and remnant liver volume were detected by CT before operation;the volume of resected half liver was measured by using drainage method and SRLV was calculated during operation.IBM SPSS 25.0 was used for data analysis.Measurement data were expressed as(±s)and were analyzed by using t test or one-way analysis of variance.The comparison of count data between groups were performed by usingχ^2 analysis;ROC curve was used for analyzing the areas under the ROC curves of different factors.A P value<0.05 was considered as statistically significant difference.Results The threshold value of SRLV in all S2~S4 liver fibrosis patients undergoing hepatectomy was 0.329L/m2;hepatic insufficiency occurred in 13 patients after hemihepatectomy,of whom the safety threshold value of SRLV in S2~S4 liver fibrosis patients was 0.329L/m2 too;the accuracy rate of Child-Pugh score in predicting good postoperative liver function compensation was 52.2%,while the accuracy rate of the new evaluation model in predicting good postoperative liver function compensation was 100%(P<0.05);the accuracy rate of Child-Pugh score in predicting mildly poor postoperative liver function compensation was 25%,while the accuracy rate of the new evaluation model in predicting mildly poor postoperative liver function compensation was 88.24%(P<0.05).Conclusion SRLV combined with transient elastography is a safe index to evaluate the safety of hemihepatectomy for HCC,and the new liver reserve evaluation model of Child-Pugh score combined with instantaneous hepatic elasticity could achieve a better clinical guiding significance for the

关 键 词：癌 肝细胞 肝硬化 肝切除术 弹性成像技术 

分 类 号：R73[医药卫生—肿瘤]