成人活体右半肝移植术后供者残肝再生的动态研究

A study on donor remnant liver regeneration after right lobe adult living donor liver transplantation

目的 利用多层螺旋CT（MSCT）评价成人活体右半肝移植（living donor liver transplantation,LDLT）术后不同时间供者残肝的再生情况及不同临床因素对残肝再生的影响.方法 68例LDLT术后供者纳入本研究,利用IQQA-Liver工作站进行残肝体积测量,计算并比较LDLT术后不同时间段供者肝再生率（liver regeneration ratio,LRR）,利用逐步回归分析得出术后不同时间段LRR与其相关因素的回归方程.结果 术后不同时间残肝LRR差异有统计学意义（F=3.323,P=0.009）,其中术后7d与1、3个月LRR之间差异有统计学意义（分别t=-2.065,-2.214,均P＜0.05）,其余各时间段之间差异均无统计学意义（分别t=-0.825、-1.952、-1.621、-1.806、-1.586、-0.277、-0.476和-0.254,均P＞0.05）.移植物是否带肝中静脉、不同性别组LRR差异均无统计学意义（分别t=0.600、-0.622、1.464、0.926、-1.228、0.624、-0.688,0.131,均P＞0.05）;供者年龄与术后不同时间段LRR之间均无相关性（均P＞0.05）;残肝体积与供者术后不同时间段LRR之间均呈负相关（均P＜0.05）;得到术后不同时间段供者LRR与其相关因素的回归方程.结论 MSCT是评价LDLT术后供者残肝再生的有效方法.LDLT术后早期残肝再生明显,术后不同时间影响残肝再生的因素也不相同.

Objective To evaluate donor remnant liver regeneration and influencing factors at different stages after right lobe adult living donor liver transplantation （LDLT） using multi-slice spiral computed tomography （MSCT）.Methods 68 living donors were included in this study,We did CT volumetric measurement of the liver by using IQQA-Liver workstation.Liver regenerative ratio （LRR） at different stages of donors after LDLT were calculated and compared,correlation coefficient and stepwise regression analysis were calculated.Results The difference between LRRs at different stages after LDLT were significant （F =3.323,P =0.009）,there were significant difference between LRR of 7-day and 1-month,3-month （respectively t =-2.065,-2.214,all P ＜ 0.05）.The inclusion of middle hepatic vein and donor gender had no influence on LRR （respectively t =0.600,-0.622,1.464,0.926,-1.228,0.624,-0.688,0.131,all P ＞ 0.05）.There were negative correlation between the remnant liver volume and LRRs （P ＜ 0.05）.Conclusions MSCT is a valid modality to evaluate remnant liver regeneration after LDLT.Most evident remnant liver regeneration occurs in early stage after adult LDLT.