脂肪肝供肝活体肝移植的术前评估

Preoperative evaluation for fatty liver before living donor liver transplantation

背景:活体肝移植供者的脂肪肝情况与移植效果有明显的关系,如何尽量应用无创检查来准确评估脂肪肝供肝尤为重要。目的:比较体质量指数、B超及CT检查综合评价脂肪肝供肝进行肝移植的可能性和安全性。方法:回顾性分析38例活体肝移植供者的临床资料。记录身高体质量指数,术前腹部B超及CT评估供肝脂肪变情况,并与术中供肝活检的病理报告进行对比分析。结果与结论:供肝活检病理结果显示:轻度脂肪肝8例,中度脂肪肝3例。以术前体质量指数≥25kg/m2为轻度脂肪肝诊断标准,存在脂肪肝12例,与病理结果对照特异性为41.7%,敏感性45.4%。如这一标准用于评价中度脂肪肝,其中诊断中度脂肪肝的敏感度为100%,诊断中度脂肪肝的特异性为60%;术前CT诊断脂肪肝9例,特异性为44.4%,敏感性36.4%;术前超声诊断脂肪肝5例,特异性为60%,敏感性为27.7%。结果提示活体肝移植术前体质量指数,B超及CT评估脂肪肝供肝与供肝活检病理诊断结果比较均有较大差异,术前超声诊断特异性相对较高,术前体质量指数诊断敏感性相对较高。需要3者结合使用进行综合评估,必要时可行肝穿病理检查。

BACKGROUND： The condition of fatty liver has closely relationship with transplantation results in living donor liver transplantation. How to evaluate fatty liver with noninvasive method has great importance. OBJECTIVE： To evaluate the possibility and safety of body mass index （BMI）, B ultrasound and CT examination in evaluating fatty liver graft before living donor liver transplantation. METHODS： The clinical data including 38 cases with living donor liver transplantation were retrospective analyzed. BMI, preoperative assessment of abdominal B ultrasound and CT were recorded and compared with intraoperative liver biopsy pathology reports. RESULTS AND CONCLUSION： The biopsy pathology showed that, there were 8 cases with mild fatty liver, and 3 cases with moderate fatty liver. According to the diagnostic criteria, namely, BMI ≥ 25 kg/m2 as mild fatty liver, there were 12 cases with fatty liver. Compared with pathological results, the specificity of BMI was 41.7% and sensitivity was 45.4%, of which had 100% sensitivity and 60% specificity in diagnosing moderate fatty liver. Preoperative CT diagnosis showed 9 cases had fatty liver, and the specificity was 44.4% and sensitivity 36.4%. Preoperative ultrasound diagnosis showed 5 cases had fatty liver, with 60% specificity, and 27.7% sensitivity. There were great differences among BMI, B ultrasound, CT and donor liver biopsy in evaluating fatty liver graft before living liver transplantation. Preoperative ultrasound diagnosis had relatively high specificity, and preoperative BMI diagnosis had relatively high specificity. Accordingly, it is needed to conduct comprehensive assessment with three methods, and transhepatic pathological examination could be performed if necessary.