活体肝移植术前评估肝静脉引流域的临床价值

Clinical value of hepatic vein drainage territory evaluation before LDLT with right lobe graft

目的探讨肝静脉属支的直径与引流域的相关性及活体肝移植术前评估肝静脉引流域的临床价值。方法对68例供者术前行多层螺旋CT增强检查，并利用GEA dvantage Windows4．2工作站和IQQA9肝脏CT影像解读分析系统对图像进行重建与分析，标记肝静脉各属支，测定静脉直径与相应引流域，并对二者进行相关性分析。分别计算左、右半肝的功能肝体积，并依据术中血管重建情况计算有效肝体积及所对应的肝重量与体重比。结果共测定了220支肝右静脉或肝中静脉的属支，其直径与引流域体积之间的相关系数为0．752（P〈0．01），二者呈一定的正相关性，但相同直径血管的引流域体积差异较大。将血管直径和引流域体积分别以5mm与50cm^3进行分级和统计频数，二者差异有统计学意义（x^2=61．97，P％0．01）。肝右静脉引流域体积为（510．80±168．33）cm^3，右半肝功能肝体积为（577．26±156．72）cm^3。肝左静脉引流域体积为（292．70±76．61）cm^3，加上Ⅳ段属支的引流域体积为（551．26±111．82）cm^3。25例不带肝中静脉的右半肝的有效肝体积为（405．52～1038．43）cm^3，未保留肝中静脉的43例供者残肝的有效肝体积为（175．35～575．35）cm^3。结论相同直径血管的引流域差异较大，也并非直径越大，引流域就越大；活体肝移植术前评估供肝静脉引流域对于手术方案的制定具有重要的指导意义。

Objective To investigate the relationship between diameter and drainage territory of tributaries of the hepatic vein and the clinical value of hepatic venous drainage territory evaluation before LDLT. Methods MSCT covering abdomen was performed on 68 donors. The images were transported and reconstructed in GE Advantage Windows 4. 2 workplace and IQQA-liver CT images readout and analytical system. The tributaries of hepatic vein were marked, and the diameter and drainage territory were measured. Functional hepatic volume （FHV）, and effective hepatic volume （EfHV） of donors and recipients according to the hepatic venous reconstruction results during the operation were calculated. The corresponding graft-to-recipient body weight ratio of recipients was calculated. Results In the tributaries of 220 hepatic veins studied, the coefficient correlation of diameter and drainage territory was 0. 752 （P≤0. 01）, but there was significant difference in the drainage territory of the veins with same diameter. By using Chi-square analysis,venous diameter and drainage territory are classified and statistical frequency by 5 mm and 50 cm3 respectively, and there was statistically significant difference between them （X^2 = 61.97, P（0. 01）. The mean value of drainage territory of RHV （RHW） was 510. 80 ± 168. 33 cm3, and that of RFHV （drainage territory with reconstructed IRHV added） was 577. 26 ± 156. 72 cm3 respectively. The mean value of drainage territory of LHV （LHW） was 292. 70 ± 76. 61 cm3, and that of LFHV （drainage territory with IV segment tributaries of MHV added） was 551.26 ±111.82 cm3 respectively. In 25 grafts without MHV, the mean value of drainage territory of EfHV was 405.52±1038. 43 cm^3. In 43 donors donating grafts with MHV, the mean value of drainage territory of EfHV was 175.35-575.35 cm^3. Conclusion There is significant difference in drainage territory of same diameter veins. Bigger diameter doesn＇t always mean bigger drainage territory. Hepatic vein drainage territory evaluation before LDLT hasimportant clinical significance to formulate surgery scheme.