16层螺旋CT测量肝脏体积在肝癌切除术中的应用研究

Volumetric Study with 16 Slices Spiral CT in Hepatectomy for Hepatocellular Carcinoma

目的研究16层螺旋CT在肝癌切除术前预测切除肝体积及残肝体积的准确性,结合肝功能进一步探讨残肝体积率在肝癌切除术中的应用价值。资料与方法对50例行肝癌根治性切除术的患者术前利用16层螺旋CT预测切除肝体积及残肝体积,进一步计算残肝体积率。其中24例患者术后用排水法测量实际肝切除体积。记录手术前、后肝功能Child-Pugh分级并进行比较,对所得数据进行t检验及相关分析。结果术后排水法测量实际肝切除体积与术前CT预测切除肝体积比较差异无统计学意义,CT术前预测肝切除体积准确性平均为(92.82±3.93)%。残肝体积率与术后肝功能损害呈负相关。术前肝功能Child-Pugh分级为A级的肝癌患者,残肝体积率为25%是一个可供参考的安全线,而术前Child-Pugh分级为B级的肝癌患者,则以50%为一个可以参考的安全线。结论16层螺旋CT在肝癌切除术前预测切除肝体积及残肝体积方面具有较高的准确性。残肝体积率的大小是评价术后肝功能的重要指标,但在评价时应该结合肝硬化等引起的肝功能变化情况。

Objective To estimate accuracy of the resected and the remained liver volume with 16 slices Spiral CT before the hepatectomy for hepatocellular carcinoma, and estimate the value of the volumetric study in the operation combining the Liver function. Materials and MethodsThe resected and remained liver volumes were estimated with 16 slices spiral CT before the operation in 50 patients, and calculated the ratio of the remained liver volume. In 24 patients, the volumes of the resected specimens were measured by means of water displacement. The preoperative＇s and postoperative＇ s Child Pugh grade of liver function were recorded and compared. Statistics analysis was used with SPSS 13.0. Results Paired t test between the resected specimens measured by means of water displacement and the resected estimated with 16 slices CT in 24 patients had no statistically significance （ P 〉 0.05 ）, the accuracy of the resected liver volume study with CT was（92.82± 3.93 ） %. The ratio of the remained liver volume and liver function damage had negative correlation. For the patients whose preoperative＇ s Child Pugh grade were A, it was rather safety that the ratio of the remained liver volumes were 25% , however for the patients whose preoperative＇ s Child Pugh grade were B, 50% of the remained liver volumes were more safety. Conclusion Volumetric study of the resected and the remained liver volume with 16 slices spiral CT before the hepatectomy for hepatocellular carcinoma has rather higher accuracy. The ratio of the remained liver volumes is an important index for evaluating postoperative＇s liver function, meanwhile evaluation should combine the information of liver function changing clue to hepatic cirrhosis.