肝硬化活体肝脾体积变化的临床研究

Clinical study on changes in liver and spleen volume in vivo during cirrhosis

目的对肝硬化的活体肝脾体积变化进行前瞻性研究。方法利用ＮＡＩ－２００医用图象处理系统测定８１例肝炎后肝硬化、１７例血吸虫性肝硬化和３２例对照组的活体肝脾体积。结果（１）肝炎后组的肝体积为（４１６．６４±９０．６３）ｃｍ３／ｍ２，脾体积为（６２３．４９±２８１．１７）ｃｍ３／ｍ２；（２）血吸虫组的脾体积为（１２３９．０６±８７９．６４）ｃｍ３／ｍ２；（３）肝炎后组中术后有严重并发症者肝体积为（３４６．２５±９０．８３）ｃｍ３／ｍ２，明显小于顺利康复者；（４）肝炎后组中断流术者术后肝体积稍增加，而断流加分流术者术后肝体积平均减少８１．６０ｃｍ３／ｍ２。结论（１）肝炎后肝硬化的肝体积缩小，脾体积增大；（２）血吸虫性肝硬化的肝体积无变化，脾体积明显增大；（３）肝炎后组的肝体积最低，手术风险判断界值为４００ｃｍ３／ｍ２；（４）肝炎后组中分流加断流术后肝体积明显缩小，而断流术后肝体积变化不大。

bjective To study prospectively the changes in liver and spleen volume in patients with cirrhosis in vivo. Method Liver and spleen volume was measured in 81 patients with posthepatitic cirrhosis,17 with cirrhosis due to schistosomia and 32 normal subjects using NAI-200 medical image processing system. Results (1)In posthepatitic cirrhosis,the liver volume is (416.64±90.63)cm 3/m 2 and the spleen volume is (623.49±281.17)cm 3/m 2;(2)In cirrhosis due to schistosomia,the spleen volume is (1 239.06±879.64)cm 3/m 2;(3)In posthepatitic cirrhosis,the liver volume (346.25 cm 3/m 2±90.83 cm 3/m 2) in patients with serious complications is smaller than that of others ( P <0.001);(4)In posthepatitic cirrhosis,the liver volume has no change after devascularization only,but it decreased in an average by 81.60 cm 3/m 2 ( P < 0.01 ) after shunt plus devascularization. Conclusions (1)The liver volume of posthe- patitic cirrhosis is significantly smaller than that of the control,and the spleen volume of them is significantly larger than that of the control;(2)The liver volume of schistosomial cirrhosis due to schistosomia is not different from that of the control,but the spleen volume of them is the largest in groups studied ;(3)The critical value of liver volume for operation in posthepatitic cirrhosis is 400 cm 3/m 2;(4)The liver volume considerably reduced in patients with posthepatitic cirrhosis after shunt plus devascularization,but did not change after devascularization only.