【摘要】：目的:評估比較殘肝分數(shù)(%RLV)、殘肝體積/標準肝體積(RLV/SLV)、殘肝體積/體重比率(RLV/BW)及標準殘肝體積(SRLV)預測半肝切除術后發(fā)生肝功能衰竭(PHLF)的效能。方法:對181例乙肝病毒相關性肝細胞癌(HCC)病人術前采用Myrian-Liver手術規(guī)劃系統(tǒng)測模擬半肝切除并測定總功能性肝體積、腫瘤體積、殘肝體積、切除的肝體積。術中按照標準半肝切除,并排水法測定切除肝臟與腫瘤的總體積。按照50-50標準和國際肝臟外科小組(ISGLS)肝衰竭標準分別分組,分析術后發(fā)生PHLF的風險因素。ROC曲線分析比較%RLV、RLV/SLV、RLV/BW及SRLV預測PHLF的效能。根據(jù)預測PHLF的優(yōu)勢指標的截點值分組,比較兩組間并發(fā)癥發(fā)生率。結果:根據(jù)多因素分析結果,50-50標準分組顯示肝硬化(HR:0.002,95%CI:0-0.244,P=0.012)、RLV/SLV(HR:1.16×10205,95%CI:6.007×1028-8.543×10428,P=0.023)、RLV/BW(HR:2.58×1030,95%CI:9.546×107-6.971×1052,P=0.008)及SRLV(HR:0,95%CI:0-0.010,P=0.022)是術后發(fā)生PHLF的危險因素(P0.05)。根據(jù)ISGLS肝功能衰竭標準分組,多因素分析結果顯示術中出血量(HR:1.001,95%CI:1.000-1.002,P=0.004)及SRLV(HR:0.985,95%CI:0.971-0.999,P=0.033)是發(fā)生PHLF的危險因素(P0.05)。ROC曲線比較分析,50-50標準分組中,RLV/SLV、SRLV分別比較%RLV、RLV/BW具都有統(tǒng)計學意義(P0.05)。RLV/SLV與SRLV間比較無統(tǒng)計學差異(P0.05)。ROC曲線下面積(AUC)最大為SRLV和RLV/SLV(均為0.903)。SRLV發(fā)生PHLF的截點值為340ml/m~2,RLV/SLV截點值48%,靈敏度均為100%,特異度均為72.3%。ISGLS標準分組中,ROC曲線比較分析顯示SRLV與RLV/SLV、RLV/BW比較有統(tǒng)計學差異(P0.05),%RLV與RLV/SLV、RLV/BW、SRLV比較均無統(tǒng)計學意義(P0.05)。AUC最大者為SRLV(0.776),截點值340ml/m~2,靈敏度64%,特異度88.7%,P0.01)。SRLV340ml/m~2組病人術后無并發(fā)癥38例(32.8%),輕度并發(fā)癥65例(56%),重度并發(fā)癥13例(11.2%);SRLV≤340 ml/m~2組術后無并發(fā)癥1例(1.5%),輕度并發(fā)癥40例(61.5%),重度并發(fā)癥23例(35.4%),死亡1例(1.5%),差異有統(tǒng)計學意義(P0.01)。結論:%RLV、RLV/SLV、RLV/BW及SRLV均為評估殘肝體積的有效指標。對比研究,SRLV較%RLV、RLV/SLV、RLV/BW在評估術后發(fā)生PHLF具備更高敏感性、特異性,更穩(wěn)定的特點。當SRLV≤340ml/m~2時,乙肝病人半肝切除術后發(fā)生PHLF的風險增加,且增加術后重度并發(fā)癥發(fā)生的風險。
[Abstract]:Objective: to evaluate the efficacy of residual liver fraction (RLV), residual liver volume / standard liver volume (RLV/SLV), residual liver volume / body weight ratio (RLV/BW) and standard residual liver volume (SRLV) in predicting hepatic failure (PHLF) after hemihepatectomy. Methods: the total functional liver volume, tumor volume, residual liver volume and liver volume were measured by Myrian-Liver operation planning system in 181 patients with hepatitis B virus associated hepatocellular carcinoma (HCC) before operation. The total volume of liver and tumor was measured by standard hemihepatectomy and drainage method. According to the 50-50 standard and the (ISGLS) liver failure standard of the international group of liver surgery, the risk factors of PHLF after operation were analyzed. The ROC curve was used to analyze and compare the RLVR / SLV / BW and SRLV in predicting PHLF. The incidence of complications was compared between the two groups according to the cut-off points of the predominance index of PHLF. Results: according to the multivariate analysis results, the RLVP / SLV (HR:1.16 脳 10205CI6.007 脳 1028-8.543 脳 10428P0.023) and SRLV (HR:2.58 脳 103095CI9.546 脳 107-6.971 脳 1052P0.008) and SRLV (HR095) were the risk factors for the occurrence of PHLF after operation (P 0.05). According to ISGLS criteria for liver failure, Multivariate analysis showed that intraoperative bleeding volume (HR: 1.001 / 95CI: 1.000-1.002P0.004) and SRLV (HR0.985C95CI0.971-0.999P0.033) were the risk factors for the occurrence of PHLF (P0.05). The maximum value of (AUC) is SRLV and RLV/SLV (both 0.903). The cut-off point of PHLF is 340 ml / r / v, the sensitivity is 100 and the specificity is 100 in 72.3%.ISGLS standard group. The comparison between SRLV and RLVSLV / RLV / BW shows that there is no statistical difference between RLV / RLVR / RLV / RLV / RLVR / W / BW (P0.05). The largest value of AUC was SRLV (0.776), with a cut-off value of 340 ml / m ~ (2), a sensitivity of 64 and a specificity of 88.7ml / m ~ (0.01). There were 38 cases (32.8%) in the SRLV340ml / mmg group, 65 cases (56%) in the mild complication group, 13 cases (11.2%) in the LV 鈮，

本文編號：2175273